Infectious complications following bispecific antibody or CAR T therapy in adult patients with hematologic malignancies: a retrospective database analysis
5 affiliations
- 1Department of Medicine, Houston Methodist Research Institute, Houston, TX USA
- 2Faculty of Medicine, Cairo University, Cairo, Egypt
- 3School of Rural, Surveying and Geoinformatics Engineering, National Technical University of Athens, Athens, Greece
- 4School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
- 5Department of Medicine, Weill Cornell Medical College, New York, USA
Abstract
T-cell redirection therapies, including bispecific antibodies (BsAbs) and chimeric antigen receptor (CAR) T therapy, have transformed the treatment of relapsed or refractory hematologic malignancies. However, comparative data on infectious complications between these treatments remain limited. We performed a propensity score-matched analysis of adults with hematologic malignancies treated with BsAbs or CAR T using the TriNetX global research network. To mitigate confounding, we utilized 1:1 propensity score matching (caliper 0.1) to balance cohorts on demographics, malignancy type, comorbidities, and prior treatments. The primary outcome was 1-year infection hazard in BsAbs vs. CAR T. We included 2 192 matched patients (1 096/group; mean age 65.8 (11.4) years for BsAbs, 65.4 (10.2) years for CAR T). Multiple myeloma was the most common malignancy (~62%). At 1 year, infection hazard was not statistically different between cohorts (BsAbs: 57% vs. CAR T: 55.9%; HR: 1.07; 95% CI: [0.96–1.20]). Early phase infection hazard (days 1–30) was lower with BsAbs but not statistically significant (HR: 0.87; 95% CI: [0.74–1.02]). However, BsAbs therapy was associated with higher infection hazard during intermediate (days 31–180; HR: 1.27; 95% CI: [1.10–1.46]) and late phases (days 181–365; HR: 1.20; 95% CI: [1.01–1.41]). In the late phase, BsAbs carried higher hazard for fungal (HR: 2.14; 95% CI: [1.26–3.64]) and viral pathogens (HR: 1.32; 95% CI: [1.02–1.73]). Respiratory tract infections were the most frequent complication and were higher with BsAbs across all time windows (1-year: 35.4% vs. 30.4%; HR: 1.32; 95% CI: [1.14–1.53]). In conclusion, among patients captured within TriNetX, the overall observed 1-year infection rate did not differ significantly between BsAbs and CAR T therapy. However, BsAbs therapy was associated with higher coded rates of late-onset infections after extensive adjustment, although residual confounding from disease severity and treatment duration remains possible. Further studies must better define this infection burden and optimize prevention strategies.
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BibTeX
@article{michael2026infectious,
title = {{Infectious complications following bispecific antibody or CAR T therapy in adult patients with hematologic malignancies: a retrospective database analysis}},
author = {Mark Michael and Fady Mishriky and Konstantinos Ouranos and Nadine Hassan and Evangelia K. Mylona and Fadi Shehadeh and Tilemachos Koutouratsas and Diana Avila and Siddharth Das and Jenny Petkova and Eleftherios Mylonakis},
journal = {Blood Cancer Journal},
year = {2026},
month = aug,
doi = {10.1038/s41408-026-01599-4},
url = {https://doi.org/10.1038/s41408-026-01599-4},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Infectious complications following bispecific antibody or CAR T therapy in adult patients with hematologic malignancies: a retrospective database analysis
AU - Mark Michael
AU - Fady Mishriky
AU - Konstantinos Ouranos
AU - Nadine Hassan
AU - Evangelia K. Mylona
AU - Fadi Shehadeh
AU - Tilemachos Koutouratsas
AU - Diana Avila
AU - Siddharth Das
AU - Jenny Petkova
AU - Eleftherios Mylonakis
PY - 2026
DA - 2026/08/13
JO - Blood Cancer Journal
DO - 10.1038/s41408-026-01599-4
UR - https://doi.org/10.1038/s41408-026-01599-4
AB - T-cell redirection therapies, including bispecific antibodies (BsAbs) and chimeric antigen receptor (CAR) T therapy, have transformed the treatment of relapsed or refractory hematologic malignancies. However, comparative data on infectious complications between these treatments remain limited. We performed a propensity score-matched analysis of adults with hematologic malignancies treated with BsAbs or CAR T using the TriNetX global research network. To mitigate confounding, we utilized 1:1 propensity score matching (caliper 0.1) to balance cohorts on demographics, malignancy type, comorbidities, and prior treatments. The primary outcome was 1-year infection hazard in BsAbs vs. CAR T. We included 2 192 matched patients (1 096/group; mean age 65.8 (11.4) years for BsAbs, 65.4 (10.2) years for CAR T). Multiple myeloma was the most common malignancy (~62%). At 1 year, infection hazard was not statistically different between cohorts (BsAbs: 57% vs. CAR T: 55.9%; HR: 1.07; 95% CI: [0.96–1.20]). Early phase infection hazard (days 1–30) was lower with BsAbs but not statistically significant (HR: 0.87; 95% CI: [0.74–1.02]). However, BsAbs therapy was associated with higher infection hazard during intermediate (days 31–180; HR: 1.27; 95% CI: [1.10–1.46]) and late phases (days 181–365; HR: 1.20; 95% CI: [1.01–1.41]). In the late phase, BsAbs carried higher hazard for fungal (HR: 2.14; 95% CI: [1.26–3.64]) and viral pathogens (HR: 1.32; 95% CI: [1.02–1.73]). Respiratory tract infections were the most frequent complication and were higher with BsAbs across all time windows (1-year: 35.4% vs. 30.4%; HR: 1.32; 95% CI: [1.14–1.53]). In conclusion, among patients captured within TriNetX, the overall observed 1-year infection rate did not differ significantly between BsAbs and CAR T therapy. However, BsAbs therapy was associated with higher coded rates of late-onset infections after extensive adjustment, although residual confounding from disease severity and treatment duration remains possible. Further studies must better define this infection burden and optimize prevention strategies.
SN - 2044-5385
ER -