Supportive Care: Infection Disease Prophylaxis and Advice for Community Doctors
Panelists discuss the essential role of supportive care following chimeric antigen receptor (CAR) T-cell therapy in multiple myeloma, emphasizing infection prevention through prophylaxis, immunoglobulin replacement, and vaccination strategies, along with the importance of coordinated long-term management between CAR T centers and community oncologists to ensure sustained survivorship care.
EP: 1.Late-Line R/R: Treatment Landscape
EP: 2.Outcomes and Factors for Consideration When Choosing Between CAR T Therapies
EP: 3.Comparing CAR T Safety, Efficacy in Relapsed/Refractory Multiple Myeloma
EP: 4.Role of Talquetamab as Bridging Therapy for CAR T-Cell Therapy
EP: 5.Optimal Sequencing Strategies for CAR T and Bispecifics in R/R MM
EP: 6.Role of CAR T in Earlier Lines for R/R MM
EP: 7.Non-ICANS and Delayed Neurotoxicity With CAR T: Risk Factors and Ways to Prevent
EP: 8.Real-World Data of SOC Cilta-Cel in R/R MM and Cilta-Cel in Patients With High-Risk Features
EP: 9.Identifying and Treating Patients With Adverse Prognostic Factors
EP: 10.Supportive Care: Infection Disease Prophylaxis and Advice for Community Doctors
EP: 11.Best Practices for Referring Patients for CAR T Therapy
Supportive care is a critical component of managing patients after CAR T-cell therapy, especially given the elevated risk of infections in the first year post treatment. Prophylactic strategies are essential to mitigate nonrelapse mortality, which is often driven by infection rather than disease progression. Standard practice includes antiviral (eg, acyclovir) and Pneumocystis prophylaxis (eg, trimethoprim/sulfamethoxazole [Bactrim]) for at least 6 months, often extended based on immune reconstitution markers like CD4 counts. Immunoglobulin replacement with intravenous immunoglobulin is frequently initiated as a primary preventive measure, targeting immunoglobulin G levels above 400 mg/dL, with adjustments made for patients experiencing recurrent or severe infections.
Vaccination strategies are evolving in response to increasing survivorship. Many centers now reinitiate childhood vaccinations approximately 6 months after CAR T-cell infusion, mirroring autologous transplant protocols. However, with increasing awareness of waning immunity, some institutions are checking vaccine titers and recommending revaccination for a broader set of antigens, including measles, mumps, and rubella, if titers are low and the patient’s immune function has recovered. Respiratory infection prevention, especially during winter months, and antifungal prophylaxis in patients receiving steroids or with prolonged neutropenia, are also key parts of posttreatment care.
Close collaboration between tertiary CAR T centers and community oncologists is essential. Although patients may receive CAR T therapy in specialized centers, long-term infection risk management often shifts to community providers. Clear communication about the need for individualized prophylaxis, immune monitoring, and vaccination schedules ensures that care is not disrupted after patients transition back. With more patients surviving longer following CAR T-cell therapy, these supportive measures are becoming foundational to survivorship care in relapsed/refractory myeloma.
