Infections in CAR- T

 

 

Prophylaxis Post CAR-T infections

Prophylaxis     Preferred Drugs       Alternate          Start     End

1.       Antibacterial (with Pseudomonas coverage)           

a.       Preferred: Fluoroquinolones (Levofloxacin 500mg PO daily)

b.       Alternate: Cefpodoxime 200mg PO BID      

c.       Start with: Onset of neutropenia (ANC < 500/mm3)           

d.       Stop when: Recovery of neutropenia (ANC > 500/mm3)

2.       Antiviral (for HSV/VZV prevention)   

a.       Preferred Acyclovir 400-800mg PO BID       

b.       Alternate: Valacyclovir 500mg PO daily, Famciclovir 250mg PO BID              

c.       Start with lymphodepletion  Continue until CD4 counts > 200 or at least 6 months

3.       Antifungals     

a.       Preferred Fluconazole 200mg PO daily (standard risk).  Posaconazole 300mg PO daily          

b.       Alternate: Micafungin 50 IV q24H (if LFT abnormality)       

c.       Start with Onset of neutropenia (ANC < 500/mm3)            

d.       Stop when: Recovery of neutropenia (ANC > 500/mm3)

4.       Antifungals in high risk * (high risk= mold coverage for patients with prior fungal infection, and/or high dose corticosteroids)

a.       Voriconazole 200mg PO two times a day, Posaconazole 300mg PO daily

b.       Start of high dose steroids, other risk factors          

c.       Mold prophylaxis for 1 month after completion of Immune suppressive therapies

5.       Anti-PJP pneumonia

a.       Trimethoprim/Sulfamethoxazole 1 double-strength PO three times a week.

b.       Alternate: pentamidine 300 mg monthly inhaled. Dapsone 100 mg PO daily. Atovaquone 1500 mg PO daily     

c.       Start: Day 28 

d.       Stop: Continue at least 3 months, until CD4 > 200/uL

6.       Hepatitis B carriers/exposed ( HBs Ag positive or Anti-HBc Ab IgG positive)

a.       Entecavir                                       

b.       Start At least 6 months and surveillance of LFT and HBV DNA as indicated.