Infection complications in febrile chimeric antigen receptor (CAR)‐T recipients during the peri‐CAR‐T cell treatment period examined using metagenomic next‐generation sequencing (mNGS)

Abbreviations ASCT autologous stem cell transplantation BK virus Human polyoma virus 1 CAR-T Chimeric antigen receptor-engineered T cell therapy cHL classical Hodgkin lymphoma CMV Human beta herpes virus 5 CRES CAR-T cell-related encephalopathy syndrome CRS cytokine release syndrome EBV Human gamma herpes virus 4 HBV Hepatitis B virus HCT hematopoietic stem cell transplant mNGS metagenomic next-generation sequencing r/r B-ALL refractory/relapsed B-cell acute lymphocytic leukemia S. maltophilia Stenotrophomonas maltophilia TB Mycobacterium tuberculosis Dear Editor, Chimeric antigen receptor-engineered (CAR)-T cell therapy has achieved unprecedented efficacy on refractory/relapsed B-cell malignancies [ 1]. Combining the findings of mNGS and conventional tests, 175 infection events were detected, including 41 bacterial infections, 10 fungal infections, and 124 viral infections (Figure 1G). Since different CRS stages often represent different immunological states, we compared the microbe distribution pattern between the mild and severe CRS groups. Nine out of the 10 fungal infections were detected by mNGS. mNGS detected additional bacterial infections in 18 patients, fungal infections in 8 patients, and viral infections in 54 patients that would have been missed if only conventional methods were used. [...]35.44% (28/79) patients would not be properly diagnosed if only conventional methods were applied. [...]we combined mNGS with conventional methods, detecting more infection events compared to a single method.