Infectious complications, immune reconstitution, and infection prophylaxis after CD19 chimeric antigen receptor T-cell therapy

Bone Marrow Transplant. 2022 Oct;57(10):1477-1488. doi: 10.1038/s41409-022-01756-w. Epub 2022 Jul 15.


CD19-targeted chimeric antigen receptor (CAR) T-cell becomes a breakthrough therapy providing excellent remission rates and durable disease control for patients with relapsed/refractory (R/R) hematologic malignancies. However, CAR T-cells have several potential side effects including cytokine release syndrome, neurotoxicities, cytopenia, and hypogammaglobulinemia. Infection has been increasingly recognized as a complication of CAR T-cell therapy. Several factors predispose CAR T-cell recipients to infection. Fortunately, although studies show a high incidence of infection post-CAR T-cells, most infections are manageable. In contrast to patients who undergo hematopoietic stem cell transplant, less is known about post-CAR T-cell immune reconstitution. Therefore, evidence regarding antimicrobial prophylaxis and vaccination strategies in these patients is more limited. As CAR T-cell therapy becomes the standard treatment for R/R B lymphoid malignancies, we should expect a larger impact of infections in these patients and the need for increased clinical attention. Studies exploring infection and immune reconstitution after CAR T-cell therapy are clinically relevant and will provide us with a better understanding of the dynamics of immune function after CAR T-cell therapy including insights into appropriate strategies for prophylaxis and treatment of infections in these patients. In this review, we describe infections in recipients of CAR T-cells, and discuss risk factors and potential mitigation strategies.

Publication types

  • Review
  • Research Support, N.I.H., Extramural

MeSH terms

  • Antigens, CD19
  • Cell- and Tissue-Based Therapy
  • Hematologic Neoplasms* / drug therapy
  • Humans
  • Immune Reconstitution*
  • Immunotherapy, Adoptive / adverse effects
  • Neoplasm Recurrence, Local / drug therapy
  • Receptors, Chimeric Antigen* / therapeutic use


  • Antigens, CD19
  • Receptors, Chimeric Antigen