Managing Infections after Transplant and CAR T-cell Therapy

Summary: People who undergo a stem cell transplant or CAR T-cell therapy have an increased risk of infection after treatment. This presentation discusses who’s at risk, when infections typically arise, steps taken by transplant teams to avoid and treat infections and steps patients can take to reduce their risk of developing a serious infection.
Presenter: Erik Dubberke MD, MSPH, Washington University School of Medicine
To read the transcript, go to:
bmtinfonet.org/video/managing...
Highlights:
The risk of developing a serious infection after a stem cell transplant or CAR T-cell therapy depends on the patient’s disease, prior treatment, past infections that are dormant in the body, the type of chemotherapy and/or radiation received prior to transplant or CAR T-cell therapy, the source of stem cells for transplant, and whether the patient is on medications that weaken the immune system.
People transplanted with donor cells (allogeneic transplant) are more prone to infections than those who were transplanted with their own stem cells (autologous transplant), particularly those who develop graft-versus-host disease (GVHD).
Typically, patients are revaccinated 6-12 months after transplant or CAR T-cell therapy to protect against infection. However, live vaccines for measles, mumps, rubella and chicken pox should be avoided until two years after transplant, or longer if a patient is being treated for graft-versus-host disease (GVJD)
May 2024, Part of the Virtual Celebrating a Second Chance at Life Survivorship Symposium 2024
Presentation is 40 minutes long with 19 minutes of Q & A.
Key Points:
(02:38): People whose immune system is not working properly are prone to developing opportunistic infections - bacterial, viral and fungal infections that people with normal immune systems typically don’t get.
(05:05): Prior to transplant or CAR T-cell therapy, patients should be screened for past infections such as cytomegalovirus (CMV), varicella zoster virus (the virus that causes chicken pox) HIV, hepatitis B and hepatitis C. These viruses may already be in the body and can become activated in patients whose immune system is weak after transplant.
(14:00): Damage to skin and mucus membranes in the mouth or gut increases the risk of infection.
(15:58): After transplant and CAR T-cell therapy, there are fairly predictable periods of infection risk based on the parts of our immune system that are being impacted by the transplant on CAR T-cell therapy.
(16:12): Until the stem cells engraft after transplant, ulcers in the mouth and intestines, and infections around the venous catheter are common.
(17:48): After engraftment, people transplanted with their own cells usually do not require ongoing medication to prevent infection. Those transplanted with donor cells, however, are still at risk of developing opportunistic infections such as cytomegalovirus (CMV), varicella zoster virus (VZV), and adenovirus, as well as infections caused by pneumocystis, toxoplasmosis and mold.
(19:46): Infections are fairly common during the 100 days after transplant, after which the risk declines, except for those with significant GVHD.
(26:55): Following four steps for food safety can help prevent infection: (1) Wash your hands before preparing food and thoroughly wash fresh fruits and vegetables, including the rinds, before eating. (2) Keep raw meat separated from vegetables. (3) Cook food to a safe temperature (use a thermometer to check). (4) Chill all leftovers.
(31:31): For the first year after transplant, avoiding new pets is advised. Do not touch reptiles, live poultry, livestock, game or exotic pets. Avoid changing cat litter, bird cases and fish tanks.
(33:04): Additional precautions include wearing gloves and thorough handwashing after digging in dirt; avoid construction and remodeling projects which can increase mold spores in the air; avoid crowds and people who may be infected; and if travelling, check the CDC website for infectious risks in various destinations and make an appointment to be seen in a travel clinic before traveling to developing countries.
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