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Invasive Fungal Disease is Rare in Multiple Myeloma Patients Treated with BCMA CAR-T Therapy

Summary

Researchers studied patients with multiple myeloma who received a new type of cancer treatment called BCMA CAR-T cell therapy. While this powerful therapy can sometimes increase infection risk, the study found that serious fungal infections occurred in only a small percentage of patients (1.7%). However, when these fungal infections did occur, they were often severe and potentially life-threatening, particularly in patients who experienced significant side effects from the therapy.

Background

B-cell maturation antigen (BCMA) chimeric antigen receptor T-cell (CAR-T) therapy has transformed treatment of relapsed/refractory multiple myeloma. While this innovative immunotherapy may introduce increased risks for infections, little is known about the characteristics and incidence of invasive fungal disease in these patients.

Objective

To evaluate the incidence and characteristics of invasive fungal disease in multiple myeloma patients treated with first BCMA CAR-T therapy across two institutions.

Results

Among 234 patients with median age 66 years, cytokine release syndrome was observed in 84.6% of patients. Four patients (1.7%) developed proven/probable invasive fungal disease: 1 with Candida albicans peritonitis and 3 with invasive aspergillosis, occurring 6-104 days post-infusion. All four cases had CRS/ICANS and received corticosteroids, with mixed outcomes and 2 deaths within 30 days.

Conclusion

This is the largest study demonstrating a low incidence of invasive fungal disease in BCMA CAR-T recipients despite lack of routine antifungal prophylaxis. However, these infections may be severe and affect the most vulnerable patients, with 50% mortality in affected patients with active infection.
  • Published in:Open Forum Infectious Diseases,
  • Study Type:Retrospective Cohort Study,
  • Source: 10.1093/ofid/ofae631.1199, PMC11779259
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