A recent study found that cytomegalovirus (CMV) reactivation is a significant complication among CMV-seropositive patients who undergo chimeric antigen receptor (CAR) T-cell therapy. The study included 95 adult patients treated between February 2018 and February 2023, revealing that 33% experienced CMV reactivation, and 11% developed clinically significant CMV. The median time to CMV reactivation was 19 days post-CAR T-cell infusion. Key risk factors for CMV reactivation included grade 3-4 cytokine release syndrome (CRS), the use of corticosteroids, anakinra, tocilizumab, or multiple immunosuppressants. The study highlighted a twofold increased risk of CMV reactivation among those receiving ≥2 immunosuppressants and significantly higher 1-year mortality rates among patients with CMV reactivation.

The study underscores the critical need for vigilant monitoring and potentially preemptive antiviral therapy for CMV-seropositive CAR T-cell therapy recipients, especially those requiring immunosuppressive treatments for managing CAR T-cell toxicities like CRS. The findings align with previous reports, indicating that CMV reactivation poses substantial risks. The results advocate for routine CMV monitoring and tailored preventive strategies to mitigate the increased mortality risk associated with CMV reactivation in this patient population.

Reference: Lin RY, Anderson AD, Natori Y, et al. Incidence and outcomes of cytomegalovirus reactivation after chimeric antigen receptor T-cell therapy. Blood Adv. 2024;8(14):3813-3822. doi: 10.1182/bloodadvances.2024012922.