14
Management
Table 7. Infections
Workup/Evaluation:
• History and physical exam
• Full blood count
• Bacterial cultures and evaluation for other infection (fungal, viral)
Grading Management
All Grades • Antiviral and PJP prophylaxis per institutional
standards, for 6–12 months following CAR
T-cell infusion and/or until CD4 cell count is
>200 cells/ul.
• Antifungal agents should be considered for high-
risk patients.
• G-CSF should be considered in patients after
CRS with >7 days of neutropenia.
G1: Mild infection only • Offer supportive care.
• Empiric antimicrobials (antibiotics such as
levofloxacin or ciprofloxacin, antifungals such
as fluconazole or antivirals such as valacyclovir
or acyclovir) should be considered upon onset
of fever.
G2: Mild infection; oral
intervention indicated (e.g.,
antibiotic, antifungal, or
antiviral)
• Start course of oral antimicrobials.
G3: Severe infection; IV
antibiotic, antifungal, or antiviral
intervention indicated; invasive
intervention indicated
• Start IV antimicrobials.
G4: Life-threatening
consequences; urgent
intervention indicated
• Critical care support.
