Late infection prophylaxis in adult patients receiving CAR T-cell therapy
| Infection . | Recommendation . | Prophylaxis . | Duration . |
|---|---|---|---|
| Bacterial | • Not generally recommended • Consider in patients with prolonged neutropenia or long-term corticosteroid administration | • Fluoroquinolones (eg, levofloxacin) • Alternatives include extended-spectrum beta-lactam antibiotics (eg, amoxicillin/ clavulanic acid) or nonabsorbable antibiotics (eg, rifaximin) in patients with specific allergies | • Continue until resolution of neutropenia and discontinuation of corticosteroids |
| Fungal | • Not generally recommended • Consider in patients with prolonged neutropenia and/or long-term corticosteroid administration | • Fluconazole 200-400 mg orally daily • Posaconazole 300 mg orally daily can be considered in patients at higher risk (eg, prior mold infection; prior allogeneic stem transplant) | • Continue until resolution of neutropenia and discontinuation of corticosteroids |
| Herpes viruses | • Generally recommended for all patients | • Acyclovir 200-400 mg orally twice a day or valacyclovir 500 mg orally twice a day | • Continue a minimum of 6 months and until CD4 count >200 cells/mL |
| Pneumocystis jirovecii | • Generally recommended for all patients | • Double-strength trimethoprim-sulfamethoxazole orally 3 times weekly • Dapsone 100 mg orally daily for patients with a sulfa allergy or prolonged cytopenias • Atovaquone 1500 mg orally daily or monthly aerosolized pentamidine for patients with a G6PD-deficiency | • Continue a minimum of 6 months and until CD4 count >200 cells/mL |
| Infection . | Recommendation . | Prophylaxis . | Duration . |
|---|---|---|---|
| Bacterial | • Not generally recommended • Consider in patients with prolonged neutropenia or long-term corticosteroid administration | • Fluoroquinolones (eg, levofloxacin) • Alternatives include extended-spectrum beta-lactam antibiotics (eg, amoxicillin/ clavulanic acid) or nonabsorbable antibiotics (eg, rifaximin) in patients with specific allergies | • Continue until resolution of neutropenia and discontinuation of corticosteroids |
| Fungal | • Not generally recommended • Consider in patients with prolonged neutropenia and/or long-term corticosteroid administration | • Fluconazole 200-400 mg orally daily • Posaconazole 300 mg orally daily can be considered in patients at higher risk (eg, prior mold infection; prior allogeneic stem transplant) | • Continue until resolution of neutropenia and discontinuation of corticosteroids |
| Herpes viruses | • Generally recommended for all patients | • Acyclovir 200-400 mg orally twice a day or valacyclovir 500 mg orally twice a day | • Continue a minimum of 6 months and until CD4 count >200 cells/mL |
| Pneumocystis jirovecii | • Generally recommended for all patients | • Double-strength trimethoprim-sulfamethoxazole orally 3 times weekly • Dapsone 100 mg orally daily for patients with a sulfa allergy or prolonged cytopenias • Atovaquone 1500 mg orally daily or monthly aerosolized pentamidine for patients with a G6PD-deficiency | • Continue a minimum of 6 months and until CD4 count >200 cells/mL |