Infections in haematology patients treated with CAR-T therapies: A systematic review and meta-analysis

A registered (PROSPERO - CRD42022346462) systematic review and meta-analysis was conducted of all-grade infections amongst adult patients receiving CAR-T therapy for haematological malignancy. Meta-analysis of pooled incidence, using random effects model, was conducted. Cochran’s Q test examined heterogeneity. 2678 patients across 33 studies were included in the primary outcome. Forty-percent of patients (95% CI: 0.33 – 0.48) experienced an infection of any grade. Twenty-five percent of infection events (95% CI: 0.16 – 0.34) were severe. Late infections were as common as early infections (IRR = 0.86, 95% CI: 0.38 – 1.98). All-grade infections, bacterial and viral infections were highest in myeloma patients at 57%, 37% and 28% respectively. Patients with NHL more commonly experienced late infections. Pooled rate of invasive candidiasis/yeast infections was 2% in studies utilizing anti-yeast prophylaxis. This review identified a high rate of all-grade infections, moderate rate of severe infections, and myeloma as a high-risk haematological group. • 17% of patients experienced a serious infection (Grade ≥ 3) after CAR-T therapy. • Bacterial infections were more common than viral or fungal infections after CAR-T. • All-grade infections were highest in patients with multiple myeloma receiving CAR-T therapy. • Late infections were as common as early infections in patients with Non-Hodgkin lymphoma.