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Infectious complications after anti-BCMA CAR-T cell therapy in patients with multiple myeloma: a systematic literature review
Journal article   Open access   Peer reviewed

Infectious complications after anti-BCMA CAR-T cell therapy in patients with multiple myeloma: a systematic literature review

Arthur Franco Cotia, Andre Luis Franco Cotia, Beatriz Bonini Zancope, Newton de Freitas Centuriao, Mariana Kim Hsieh, Erika Viana-Cardenas, Patricia Deffune Celeghini, Pietra Sovero, Isabele Pardo, Vinicius S. Marra, …
Antimicrobial stewardship & healthcare epidemiology : ASHE, Vol.6(1), e263
09/09/2026
DOI: 10.1017/ash.2026.10830
Appears in  UI Libraries Support Open Access
url
https://doi.org/10.1017/ash.2026.10830View
Published (Version of record) Open Access

Abstract

Background: Chimeric antigen receptor T-cell (CAR-T) therapy has transformed the treatment of relapsed/refractory multiple myeloma but is associated with significant infectious complications due to prolonged immunosuppression, cytopenias, and immune dysfunction.Objective: To systematically evaluate the incidence, timing, microbiologic patterns, and risk factors of infectious complications in patients with multiple myeloma undergoing anti-BCMA CAR-T cell therapy.Study design: Systematic review following PRISMA guidelines. We searched PubMed, EMBASE, Scopus, CINAHL, Cochrane Library, and Google Scholar through February 2025. Eligible studies included cohorts, phase II and III trials, and case-control studies reporting infections after CAR-T therapy. Data were extracted independently and quality assessed with the Downs and Black scale. Owing to heterogeneity, results were synthesized descriptively. Etiology and temporal patterns were analyzed at the event level.Results: Nineteen studies published between 2021 and 2025, including 1,495 patients with multiple myeloma treated with CAR T-cell therapy, were included. Infection incidence ranged from approximately 33% to over 70%. Bacterial infections predominated, particularly during the first 30 days after infusion, whereas viral infections increased during later follow-up. Fungal infections were less frequent. Rates of severe infection varied widely (5% to 60%), and infection-related mortality ranged from 0% to over 5%. Key risk factors included prolonged cytopenias, low CD4+ T-cell, and hypogammaglobulinemia.Conclusions: Infectious complications following CAR-T cell therapy in multiple myeloma are frequent, with distinct early and late microbiologic profiles. Standardized infection definitions, harmonized surveillance, and risk-stratified prevention strategies are essential to reduce infection-related morbidity while preserving the benefits of this therapy.
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