Fungal Infections Associated with CD19-Targeted Chimeric Antigen Receptor T Cell Therapy

Purpose of Review: This review focuses on the epidemiology of fungal infections after CD19-targeted chimeric antigen receptor (CAR) T cell therapy and associated risk factors for their development and describes infectious disease screenings and antifungal prophylactic strategies. Recent Findings: Epidemiologic studies characterizing fungal infections in patients with hematologic malignancies treated with CD19-targeted CAR T cell therapy are scarce. Fungal infections occur in approximately 2–13% of CAR T cell recipients, both early and late after infusion. Candida, Aspergillus, and Pneumocystis are the most common culprit pathogens. Invasive fungal infections seldom contribute to mortality. While various risk factors for the development of fungal infections have been proposed, all relate to dysregulation in innate and adaptive immunity. Exposure to areas where endemic fungi are known to be present in the environment may also be a risk factor. Infectious disease screenings and prophylactic strategies vary broadly across institutions. Summary: Although data are limited, fungal infections occur in a small proportion of patients after CD19-targeted CAR T cell therapy. Additional studies are needed to better describe fungal infection epidemiology, individualize infectious disease screenings, and inform antifungal prophylaxis in this population.