ArticleTransplantation and cellular therapy2026
Infections Within 100 Days of Idecabtagene Vicleucel and Impact on Survival for Relapsed/Refractory Multiple Myeloma: A CIBMTR Analysis.
Article in Transplantation and cellular therapy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Infections are common after chimeric antigen receptor (CAR) T-cell therapy and contribute to morbidity and mortality. While well characterized with CD19 CAR T-cells, data related to infections with B-cell maturation antigen (BCMA) CAR T-cell therapy are limited. This study aims to characterize the burden, patterns, risk factors, and clinical impact of infections on outcomes in patients with relapsed/refractory multiple myeloma (RRMM) treated with idecabtagene vicleucel (ide-cel). In this real-world analysis, we evaluated 807 patients with RRMM who received ide-cel after ≥4 prior lines of therapy between March 2021 and December 2023, using the Center for International Blood and Marrow Transplant Registry database. The infection density within 100 d post-ide-cel was 0.49 for any infection, and 0.23, 0.22, and 0.012 for bacterial, viral, and fungal infections, respectively. Bacterial infections predominated during the first 30 d post-infusion, whereas viral infections were more prevalent between day +30 and d +100. After a median follow-up among survivors of 11.6 months, 364 patients relapsed and 222 died, translating into a 1-yr progression-free survival of 46.5% and overall survival (OS) of 67.3%. Disease progression was the leading cause of death, followed by infections. Infection-related mortality was 1.1% at d +100. On multivariable Cox regression, baseline infection history prior to ide-cel, poor performance status (KPS<80), grade≥2 cytokine release syndrome, and grade≥3 neurotoxicity were independent predictors of infection. Recurrent infections (≥2 events) within 100 d and relapse within 100 d after ide-cel were associated with inferior OS. Infections are common and can result in inferior outcomes after ide-cel, underscoring the importance of risk stratification, surveillance, and stringent infection prevention strategies to optimize outcomes.
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