Burden and management of infectious diseases in patients treated by chimeric antigen-receptor T (CAR-T)-cell therapy for refractory or relapsing diffuse large B-cell lymphoma or multiple myeloma

Chimeric Antigen Receptor T-cell (CAR-T) therapy has revolutionized the treatment landscape for relapsed/refractory B-cell lymphomas (BCL) and multiple myeloma (MM). Despite its remarkable efficacy, a significant and often life-threatening complication is the elevated risk of severe infections and infection-related mortality, stemming from profound and prolonged immunosuppression. This paper reviews the diverse infection burden associated with CAR-T therapy, categorizing risks across distinct treatment phases (pre-CAR-T, early, prolonged, and late) and their management. It details the frequency and types of bacterial, viral, and fungal infections observed in clinical trials and real-world data. Furthermore, it outlines comprehensive strategies for managing infection risk, including pre-infusion screening, active and passive immunoprophylaxis, and pharmacological interventions tailored to each phase of therapy. The report emphasizes the critical need for a collaborative, multidisciplinary approach involving hematologists and infectious disease specialists to optimize patient outcomes given the complexity and current limitations in robust, CAR-T-specific infection management data.