Best Practice Considerations for Infection Prevention and Management Post-CAR T

In this episode of ASTCT Talks, host Terri Lynn Shigle, PharmD(The University of Texas MD Anderson Cancer Center; Pharmacy SIG Immediate Past-Chair), sits down with Zainab Shahid, MD (Memorial Sloan Kettering Cancer Center; ID SIG Chair), and Gabriela Maron, MD (St. Jude Children’s ResearchHospital). As coauthors of the ASTCT Practice Guidelines, "American Society for Transplantation and Cellular Therapy Best Practice Considerations for the Prevention and Management of Infections After Chimeric Antigen Receptor T-Cell Therapy for Hematological Malignancies," recently published in Transplantation and Cellular Therapy, they discuss the implementation of critical strategies for safeguarding CAR T recipients.

The conversation explores the nuances of the manuscript,providing a practical perspective on translating these consensus recommendations into clinical operations.

• Assessing the Burden of Immunosuppression: Evaluating the cumulative risk factors that predispose CAR T recipients to infection, including heavy pretreatment and the effects of lymphodepletion.

• Prophylaxis Optimization: Critical considerations regarding the timing, selection, and duration of antimicrobial regimens in the post-CAR T setting.

• Managing Hypogammaglobulinemia: A pragmatic look at IVIG replacement strategies, balancing emerging clinical evidence with institutional protocols and global product shortages.
• Addressing Evidence Gaps: Insider insights into the expert panel’s deliberations on "grey areas," such as the management of CMV reactivation and optimal post-therapy vaccination schedules.
• The Pediatric-Adult Continuum: Ensuring that prevention and management strategies are robust and applicable across the full age spectrum of CAR-T recipients.

This episode provides essential context for cliniciansseeking to move beyond the published guidelines and operationalize these bestpractices with greater precision and confidence.

Thank you to Johnson & Johnson and Legend Biotech forsupporting this episode.