Infectious Complications in Patients Admitted to the ICU After CAR T-Cell Therapy

Monday, March 23, 2026

2:30 PM - 3:30 PM Central Time

Location: Connections Central - RST 09

CM

Colleen McEvoy, MD (she/her/hers)

Washington University, Missouri

Disclosure(s): Janssen Pharmaceuticals: Advisory Board (Terminated); Merck: Advisory Board (Terminated); United Therapeutics: Advisory Board (Terminated)
Stephen Pastores, MD, MACP, FCCP

Memorial Sloan Kettering Cancer Center, NY

Disclosure information not submitted.
PR

Prabalini Rajendram, MD

Program Director, Critical Care Medicine Fellowship
Memorial Sloan Kettering Cancer Center

Disclosure information not submitted.
EM

Elena Mead, MD

Attending Physician
Memorial Sloan Kettering Cancer Center

Disclosure information not submitted.
LF

Lei Feng, MS

Biostatistician
MD Anderson

Disclosure information not submitted.
AD

Ananda Dharshan, MD, FACP

Assistant Professor of Oncology and Critical Care
Roswell Park Cancer Institute

Disclosure information not submitted.
MH

Megan Herr, MD

Associate Professor of Oncology
Roswell Park Cancer Institute

Disclosure information not submitted.
RS

Robert Stephens, MD

Associate Professor of Medicine
University of Maryland School of Medicine

Disclosure information not submitted.
MB

Melissa Beasley, N/A

Clinical Research Coordinator
Washington University in St. Louis

Disclosure information not submitted.
NK

Natalie Kostelecky, BSN, RN, CCRP

Clinical Research Nurse
Memorial Sloan Kettering Cancer Center

Disclosure information not submitted.
MH

Matthew Hensley, MD, MPH

Assistant Professor of Medicine
University of Pittsburgh

Disclosure information not submitted.
AB

Anne Rain Brown, PharmD, BCCCP, FCCM

Critical Care PharmD
University of Texas MD Anderson Center

Disclosure information not submitted.
SA

Sairah Ahmed, MD

Associate Professor of Medicine
MD Anderson

Disclosure information not submitted.
HM

Heather May, BCCCP, PharmD, FCCM

Mayo Clinic, Minnesota

Disclosure information not submitted.
AG

Alice Gallo De Moraes, MD, FACP

Associate Professor of Medicine
Mayo Clinic

Disclosure information not submitted.
SM

Simon Mucha, MD, FACP

Director of Medical Oncology ICU
Cleveland Clinic Foundation

Disclosure information not submitted.
AT

Arsal Tharwani, MD

PCCM fellow
Cleveland Clinic

Disclosure information not submitted.
Cristina Gutierrez, MD

Texas

Disclosure information not submitted.

Introduction: Infectious complications are a significant cause of morbidity and mortality after CAR T-cell therapy. We assessed the risk factors and outcomes of patients who developed infections during ICU admission within 30 days of CAR T-cell infusion.

Methods: Retrospective cohort of CAR T-cell recipients requiring ICU admission at 8 US centers (1/2018-9/2023), excluding patients with a primary diagnosis of sepsis. Data collected included demographics, malignancy type, CAR product, SOFA score, CRS and ICANS toxicity grade, immunosuppressive therapy received and infection type. Summary statistics include median (IQR) for continuous variables; numbers and percentages for categorical variables. Chi-square and Wilcoxon rank sum tests were used to evaluate differences between patients with and without infections.

Results: 382 CAR T-cell recipients were admitted to the ICU; 86 (22.5%) developed infections (i.e., positive cultures). Fifty-five patients (64%) had bacterial infections, 25 (29%) viral and 11 (13%) fungal; 9 (10%) patients had >1 type of infection. Age, malignancy, and CAR product administered were similar in patients with and without infection. Patients with infectious complications were more likely to have Grade ≥3 CRS or ICANS (41% vs. 25%, p=0.006; 76% vs. 62%, p=0.02; respectively) or immune effector cell-related hemophagocytic lymphohistiocytosis (18% vs. 3.6%; p=0.0004). SOFA score was 6 and 5 in patients with and without infections, respectively (p=0.0007) The number of patients who received steroids and tocilizumab was similar, but patients with infections were more likely to have received anakinra (44% vs. 30%, p=0.01), higher steroid dose (median (IQR) 2026 mg (853-4656) vs.1227 mg (560-3253); p=0.02) or other immunosuppressants for refractory toxicities (16% vs. 4%; p=0.0001). Hospital mortality was higher in patients with infections compared to those without infections (41% vs. 15%; p< 0.0001).

Conclusions: 1 in 5 CAR T-cell recipients admitted to the ICU developed infections and had higher mortality rates compared to those without infections. These data may reflect an added risk of stacking multiple immunosuppressive drugs for treating high-grade CAR T-cell toxicities. Improved strategies are needed to prevent and manage infections for those at high risk to improve patient outcomes.