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Despite their selective mechanism of action, infectious complications are clinically significant and have been flagged as a disproportionate safety signal in post-marketing surveillance. This review characterizes the infection risk profiles of all fifteen FDA-approved ADCs through systematic extraction of prescribing information and pivotal trial safety data, and examines the pathophysiological mechanisms, antigen-specific clinical patterns, and evidence-based prophylaxis strategies applicable to this class.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Recent findings<\/jats:title>\n                    <jats:p>Calicheamicin-based agents carry the highest infection burden, with grade\u2009\u2265\u20093 infection rates exceeding 30\u201347% and near-universal severe neutropenia. CD30- and CD79b-targeting vedotin conjugates are associated with opportunistic infections\u2014including progressive multifocal leukoencephalopathy and Pneumocystis jirovecii pneumonia\u2014through mechanisms beyond myelosuppression, particularly T-cell immune surveillance disruption and bystander-effect lymphotoxicity. Solid tumor ADCs demonstrate lower overall infection rates with distinct organ-specific patterns: genitourinary infections predominate with Nectin-4\u2013 and Tissue Factor\u2013directed agents, whereas pulmonary events characterize HER2- and c-Met\u2013targeted conjugates. Linker cleavability, drug-to-antibody ratio, and payload metabolism are identified as key pharmacological determinants of myelosuppressive and infectious risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>Infectious complications of ADC therapy are clinically significant but heterogeneous, with risk profiles primarily determined by target antigen, immunologic context, and concurrent treatment. These findings support the growing adoption of a combined prevention strategy incorporating disease-based risk stratification and drug-directed infection prophylaxis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11912-026-01804-4","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T05:28:28Z","timestamp":1783661308000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Infectious Complications of Antibody\u2013Drug Conjugates: A Review of Safety Data from FDA-Approved Agents"],"prefix":"10.1007","volume":"28","author":[{"given":"Georgios","family":"Schinas","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pantazis-Michael","family":"Voutsinas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitra","family":"Stefanou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christos","family":"Stafylidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aikaterini","family":"Gkoufa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios C.","family":"Ziogas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiotis T.","family":"Diamantopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Gogas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amalia","family":"Anastasopoulou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,10]]},"reference":[{"key":"1804_CR1","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1038\/s41571-021-00470-8","volume":"18","author":"JZ Drago","year":"2021","unstructured":"Drago JZ, Modi S, Chandarlapaty S. 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