Fig. 1: Viral infections, changes of immune system, and recommendations of viral management in patients receiving BCMA-targeting CAR T-cell therapy. | Blood Cancer Journal

Fig. 1: Viral infections, changes of immune system, and recommendations of viral management in patients receiving BCMA-targeting CAR T-cell therapy.

From: Viral infection/reactivation during long-term follow-up in multiple myeloma patients with anti-BCMA CAR therapy

Fig. 1

A All infection events detected from screening till the data cut-off date or last follow-up are shown; each symbol represents a virus type. The blue and purple bars represent the overall survival of patients receiving mouse- and fully human-originate anti-BCMA CAR, respectively. The viral DNA replication detected at screening was marked on the baseline, including one HBV, one CMV, and eight EBV cases. After anti-BCMA CAR T-cell infusion, 18 viral infection/reactivation events were recorded, including four EBV, six CMV, three HBV, four herpes zoster, and one COVID-19 case. Most events were recorded within the first 6 months post infusion. B The percentage of lymphocyte subpopulations, including T cells, B cells, and NK cells, was analyzed by flow cytometry. B cells and NK cells fell to the nadir at the first and the third months post infusion, respectively, while T cells peaked at 3 months post infusion. The bar at each point represents the standard error of the mean. C BCMA CAR transgene and immunoglobulin levels in patients were tested post infusion. BCMA CAR transgene reached the peak at the first months, which was parallel with the depletion of B cells. Decrease of immunoglobulin fell behind the B cells depletion and recovered from the sixth month. The bar at each point represents the standard error of the mean. D At the time of patient enrollment, screening tests of common viruses, such as HBV, HCV, HIV, CMV, and EBV, would be needed. Regular monitoring of viral nucleic acid after anti-BCMA CAR infusion is recommended. Long-time entecavir prophylaxis is necessary for patients with HBV infection, and acyclovir prophylaxis is recommended for all patients. Immunoglobulin replacement is preferred for patients with IgG ≤ 400 mg/dL or symptomatic infection. Antiviral treatment would be needed immediately after positive viral findings except for EBV. Abbreviations: CMV, cytomegalovirus; EBV, Epstein-Barr virus; HBV/HCV, hepatitis B/C virus; HIV, human immunodeficiency virus; IG, Immunoglobulin. *Only patients who are confirmed with HBV infection (including chronic and resolved infection) need regular monitoring of viral nucleic acid post infusion.

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