Chimeric Antigen Receptor T-Cell Postinfusion Fever: Infection Profile, Clinical Parameters, and Biomarkers Trends to Assist Antibiotic Stewardship.

Background: This study aimed to describe documented infections associated with postinfusion fever after CAR T-cell therapy and to evaluate daily changes in vital signs, laboratory results, and the National Early Warning Score (NEWS) in patients with and without confirmed bacterial infections following fever onset, with the objective of assisting in antibiotic stewardship.
Methods: This was a retrospective, observational study including all consecutive adult patients who received CAR T-cell therapy. Documented infection in the first fever episode after infusion, and clinical and analytic trend comparison of patients with bacterial documented infections and those without documented infections, are described.
Results: Among 152 patients treated with CAR T-cell therapy, 87 (57.2%) had fever within 30 days of infusion, with a median time from infusion to fever of 3 (interquartile range, 2-5) days. Of these 87 patients, 82 (94.3%) received broad-spectrum antibiotics. Infection was documented in 9 (10.3%) patients and only 4 (4.6%) had bacterial infections. Clinical signs and biomarkers were similar in patients with bacterial documented infection and in those without documented infection at fever onset. Fever, tachycardia, and high C-reactive protein levels remained high during the first 3 days after CAR T-cell infusion, even when no infection was documented.
Conclusions: Fever is a common symptom following CAR T-cell infusion and is largely treated with broad-spectrum antibiotics. However, confirmed bacterial documented infections after the first fever post-CAR T-cell infusion are very unusual. Because clinical parameters and biomarkers are not useful for identifying infectious fever, other methods should be assessed to ensure the proper use of antibiotics.
Competing Interests: Potential conflicts of interest. C. G.-V. has received honoraria for talks on behalf of Gilead Sciences, MSD, Pfizer, Janssen, Novartis, Basilea, GSK, Shionogi, AbbVie, and Advanz Pharma, and grant support from Gilead Sciences, Pfizer, GSK, MSD, and Pharmamar. A. S. has received honoraria for talks on behalf of Merck Sharp and Dohme, Pfizer, Novartis, Angelini, Menarini, and Gilead Sciences as well as grant support from Pfizer and Gilead Sciences. J. M. has received honoraria for talks on behalf of Merck Sharp and Dohme, Pfizer, Novartis, and Angelini. O. P. has received honoraria for talks on behalf of BMS and Qiagen and consulting for Sanofi. C. F. d. L. declares receiving grants through his institution from BMS, Janssen, and Amgen; honoraria from Amgen, Janssen, BMS, GSK, and Sanofi; support for attending meetings or travel from Janssen, BMS, GSK, and Amgen; and participation in data and safety monitoring boards or advisory boards with Janssen, BMS, Amgen, Pfizer, and Sanofi. All other authors report no potential conflicts of interest.
(© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)