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3353 Cytomegalovirus (CMV) Reactivation within in the First Year after Chimeric Antigen Receptor (CAR) T Cell Therapy: Experience from the First Two Years at a Major Cancer Center

Program: Oral and Poster Abstracts
Session: 705. Cellular Immunotherapies: Late Phase and Commercially Available Therapies: Poster II
Hematology Disease Topics & Pathways:
Research, Clinical Research, health outcomes research
Sunday, December 11, 2022, 6:00 PM-8:00 PM

Fareed Khawaja, MBBS1, Rishab Prakash, BS2*, Joseph Sassine, MD3*, Guy Handley, MD4*, Tracy VanWieren2*, Georgios Angelidakis2*, Swaminathan P. Iyer, MD5, Jeremy L. Ramdial, MD6, Sairah Ahmed, MD7, Yago Nieto, MD8, Amy Spallone2*, Ella J. Ariza-Heredia, MD9* and Roy Chemaly, MD, MPH10*

1Department of Infectious Diseases, MD Anderson Cancer Center, Houston, TX
2The University of Texas MD Anderson Cancer Center, Houston, TX
3Oklahoma University College of Medicine, Oklahoma City, OK
4University of South Florida Morsani College of Medicine, Tampa, FL
5Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
6Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
7Department of Lymphoma/Myeloma and Stem Cell Transplantation, The University of Texas M D Anderson Cancer Center, Houston, TX
8Department of Stem Cell Transplantation and Cellular Therapy, UT M.D. Anderson Cancer Ctr., Houston, TX
9MD Anderson Cancer Center, Houston, TX
10Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, TX

Background: Chimeric antigen receptor (CAR) T cell therapy has changed the landscape for the treatment of lymphoma patients with refractory or relapsed disease. Infections due to CAR T have been described during the immediate post-treatment phase, but this is often limited to bacterial infections. Cytomegalovirus (CMV) is rarely described as a complication after CAR T cell therapy, and little is known about the risk factors for reactivation. Our study aimed to identify risk factors for clinically significant CMV infection (CS-CMVi) in CAR T cell recipients one year after therapy.

Methods: Between January 2018 and February 2021, we reviewed 230 patients who received CAR T cell infusions at our center and collected data on demographics, oncological history, characteristics of the CAR T cell therapy, and infectious complications after treatment. Additionally, we collected data on CS-CMVi within one year after CAR T cell therapy. CS-CMVi was defined as CMV requiring treatment due to elevated viral load or development of end-organ disease. Univariate analysis compared patients with and without viral infections; Fischer exact test and Wilcoxon rank sum were used for categorical and continuous variables, respectively.


Amongst 230 patients, the majority of patients were male (69%), white (65%), had an Eastern Cooperative Oncology Group (ECOG) performance score of 0-1 (82%), underwent CAR T cell therapy for diffuse large B cell lymphoma (DLBCL) (70%) and received axicabtagene ciloleucel (Yescarta) (89%) (Table 1). We identified 24 (10%) of patients who developed CS-CMVi. Patients with CS-CMVi were more likely to be female, have a lower absolute neutrophil and monocyte count 30 days after CAR T therapy, developed grade 2 or higher cytokine release syndrome (CRS) or immune effector cell-associated neurotoxicity syndrome (ICANS), required treatment for CRS/ICANS, and had a higher cumulative steroid dose during the first 30 days after CAR T cell infusion (Table 1 and 2). Patients with CS-CMVi had a higher overall mortality rate after 1 year post CAR T when compared to non-infected patients. Patients with CS-CMVi were identified 17 days (range of 0-343) after CAR T cell therapy (Table 3). CAR T cell patients with CS-CMVi had a high rate of end-organ infection with 33% of patients diagnosed with CMV pneumonitis and a 60-day overall mortality rate of 55% after developing CS-CMVi (Table 3).


CS-CMVi is an under-recognized complication after CAR T cell therapy. Therefore, strategies to prevent the development of end-organ disease and prophylaxis would benefit CAR T cell recipients at high risk for CMV reactivation.

Disclosures: Iyer: Salarius Pharmaceuticals, Inc.: Consultancy. Ahmed: Merck: Research Funding; Chimagen: Consultancy, Research Funding; Servier: Membership on an entity's Board of Directors or advisory committees; Tessa Therapeutics: Consultancy, Research Funding; Myeloid Therapeutics: Consultancy; Xencor: Research Funding; Seagen: Research Funding. Nieto: Secura Bio: Research Funding; Affimed: Other: Scientific advisory Board, Research Funding; Astra Zeneca: Research Funding. Ariza-Heredia: Oxford Immunotec: Research Funding; Merck: Research Funding. Chemaly: Genentech: Other: Personnel fees, Research Funding; Chimerix: Research Funding; Janssen: Other: Personnel fees, Research Funding; Karius: Research Funding; Oxford Immunotec: Other: Personal fees, Research Funding; Takeda/Shire: Other: Personnel fees, Research Funding; Viracor: Research Funding; Qiagen: Other: Personnel fees; Partner Therapeutics: Other: Personnel fees; Pulmotec: Other: Personnel fees; Shinogi: Other: Personnel fees; Adagio: Other: Personnel fees; Ansun Biopharma: Other: Personnel fees, Research Funding; AiCuris: Consultancy, Research Funding; Merck: Consultancy, Other, Research Funding.

*signifies non-member of ASH