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

Summary

Researchers studied 234 multiple myeloma patients who received a cutting-edge cancer treatment called BCMA CAR-T therapy. While this therapy can cause serious side effects related to immune system activation, the study found that dangerous fungal infections were surprisingly rare, occurring in only 1.7% of patients. However, when fungal infections did occur in these patients, they tended to be severe and life-threatening, highlighting the need for careful monitoring of high-risk patients.

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 therapy may introduce increased risks for infections, little is known about the characteristics and incidence of invasive fungal disease (IFD) in this patient population.

Objective

To evaluate the incidence and characteristics of invasive fungal disease in multiple myeloma patients treated with first BCMA CAR-T therapy and assess the relationship between immune effector cell toxicities and IFD development.

Results

Among 234 patients (median age 66 years, 56% male), only 4 patients (1.7%) developed proven/probable IFD, including 1 case of Candida albicans peritonitis and 3 cases of invasive aspergillosis. The most common immune effector cell toxicity was cytokine release syndrome (CRS) observed in 84.6% of patients. All four IFD cases had CRS/ICANS, received corticosteroids, with outcomes including 2 deaths within 30 days.

Conclusion

This is the largest study to provide details on IFD incidence in BCMA CAR-T recipients, demonstrating a low incidence despite lack of routine antifungal prophylaxis. However, infections may be severe and appear to affect the most vulnerable with immune effector cell toxicities, with 50% of affected patients dying with active infection. Larger studies are needed to define underlying risk factors.
  • Published in:Open Forum Infectious Diseases,
  • Study Type:Retrospective Cohort Study,
  • Source: 10.1093/ofid/ofae631.1199, PMID: PMC11779259
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