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The following is a summary of “Association of CD19+-Targeted Chimeric Antigen Receptor (CAR) T-cell Therapy with Hypogammaglobulinemia, Infection, and Mortality,” published in the November 2024 issue of Allergy and Clinical Immunology by Sutherland et al. 

CD19-targeted chimeric antigen receptor T-cell therapy (CAR-T therapy) effectively treats hematologic malignancies. However, it can lead to B-cell aplasia and hypogammaglobulinemia, with limited data on their clinical significance. 

Researchers conducted a retrospective study to analyze hypogammaglobulinemia and associated risks after CD19-targeted CAR-T therapy. 

They evaluated 579 patients receiving CD19-directed CAR-T therapy, assessing demographics, hypogammaglobulinemia (immunoglobulin G [IgG] ≤600 mg/dL), and risk factors for infections, hospitalizations, and mortality. 

The results showed patients had a mean age of 64 years, with 64% male. Hypogammaglobulinemia increased from 60% pre-CAR-T to 91% post-CAR-T therapy, with mean IgG levels dropping from 587 to 362 mg/dL (P<0.0001).  Serious infections were developed in 37% of post-CAR-T. Pre-CAR-T hypogammaglobulinemia was associated with worsening levels and increased infection risk (IRR=2.7; 95% CI=1.5-5.2; P=0.002). Mortality risk factors included mild hypogammaglobulinemia, infections within 100 days post-CAR-T, and hospitalizations, while immunoglobulin replacement reduced mortality risk. 

Investigators concluded that ~90% developed hypogammaglobulinemia post-CAR-T, with pre-existing cases linked to higher infection and mortality risks, highlighting the need for enhanced monitoring. 

Source: jacionline.org/article/S0091-6749(24)01165-5/abstract