Risk of infection in patients with hematological malignancies receiving CAR T-cell therapy: systematic review and meta-analysis

Expert Rev Anti Infect Ther. 2022 Nov;20(11):1455-1476. doi: 10.1080/14787210.2022.2128762. Epub 2022 Sep 28.


Background: Chimeric antigen receptor (CAR) T-cell therapy has emerged as a promising treatment option for relapsed or refractory B-cell malignancies and multiple myeloma. Underlying and treatment-related variables may contribute to the development of infectious complications.

Research design and methods: We conducted a systematic review and meta-analysis on the incidence of overall and severe (grade ≥3) infection in patients with hematological malignancies receiving CAR T-cells. Secondary outcomes included the specific rates of bacterial, viral and invasive fungal infection (IFI), and infection-related mortality. PubMed, Embase and Web of Science databases were searched from inception to 27 May 2022. Sensitivity analysis were performed according to the type of malignancy and study design (randomized clinical trials [RCTs] or observational studies).

Results: Forty-five studies (34 RCTs) comprising 3,591 patients were included. The pooled incidence rates of overall and severe infection were 33.8% (I2 = 96.31%) and 16.2% (I2 = 74.41%). The respiratory tract was the most common site of infection. Most events were bacterial or viral, whereas the occurrence of IFI was rare. The pooled attributable mortality was 1.8% (I2 = 43.44%).

Conclusions: Infection is a frequent adverse event in patients receiving CAR T-cell therapy. Further research should address specific risk factors in this population.

Keywords: CAR T-cell therapy; adverse event; incidence; infection; meta-analysis; risk factor; systematic review.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antigens, CD19
  • Hematologic Neoplasms* / therapy
  • Humans
  • Immunotherapy, Adoptive / adverse effects
  • Neoplasms* / drug therapy
  • Receptors, Chimeric Antigen*


  • Receptors, Chimeric Antigen
  • Antigens, CD19