{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T18:11:19Z","timestamp":1788459079897,"version":"build-2803163510"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,3,21]],"date-time":"2025-03-21T00:00:00Z","timestamp":1742515200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Chimeric antigen receptor T cell (CAR-T) therapy for relapsed\/refractory (r\/r) B cell acute lymphoblastic leukemia (B-ALL) and B cell non-Hodgkin lymphoma (B-NHL) patients has shown promising effects, but side effects such as viral infections have been observed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 45 patients with r\/r B-ALL and r\/r B-NHL were included in this retrospective study. Patient demographics were recorded, with the primary endpoint being viral infection within 3 months post CAR-T treatment. Univariate and multivariate logistic regression analyses and least absolute shrinkage and selection operator (LASSO) regression analysis were used to analyze independent factors. The patients were divided into a training cohort of 28 and a validation cohort of 17 to construct a prediction model based on determined independent factors. The model\u2019s discrimination and calibration were assessed using the receiver operating characteristic curve (ROC), calibration plot, and decision curve analysis (DCA curve).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The univariate and multivariate logistic regression analyses of the 43 patients showed that low baseline lymphocyte ratio was an independent risk factor and using granulocyte colony-stimulating factor (G-CSF) early was a protective factor for viral infection after CAR-T therapy in patients with B-ALL and B-NHL. Based on that, the area under the ROC curve (AUC) of the training cohort and validation cohort was 0.935 (95% CI 0.837-1.000) and 0.869 (95%CI 0.696-1.000), respectively, showing excellent predictive value.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We established a nomogram to predict the factors\u2019 influence on viral infection after CAR-T therapy and found that the ratio of baseline lymphocytes and using G-CSF early or lately were able to predict viral infection after CAR-T therapy in r\/r B-ALL and B-NHL.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2025.1549809","type":"journal-article","created":{"date-parts":[[2025,3,21]],"date-time":"2025-03-21T13:59:47Z","timestamp":1742565587000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["A viral infection prediction model for patients with r\/r B-cell malignancies after CAR-T therapy: a retrospective analysis"],"prefix":"10.3389","volume":"15","author":[{"given":"Shujing","family":"Guo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jile","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bing","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaomei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yifan","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianmei","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinping","family":"Cao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohan","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xia","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingfeng","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,3,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1709866","article-title":"Tisagenlecleucel in children and young adults with B-cell lymphoblastic leukemia","volume":"378","author":"Maude","year":"2018","journal-title":"N Engl J Med"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1707447","article-title":"Axicabtagene ciloleucel CAR T-cell therapy in refractory large B-cell lymphoma","volume":"377","author":"Neelapu","year":"2017","journal-title":"N Engl J Med"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1709919","article-title":"Long-term follow-up of CD19 CAR therapy in acute lymphoblastic leukemia","volume":"378","author":"Park","year":"2018","journal-title":"N Engl J Med"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2021.0054","article-title":"NCCN guidelines\u00ae Insights: B-cell lymphomas, version 5.2021","volume":"19","author":"Zelenetz","year":"2021","journal-title":"J Natl Compr Canc Netw"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2018.12.068","article-title":"Clinical utilization of chimeric antigen receptor T cells in B cell acute lymphoblastic leukemia: an expert opinion from the European society for blood and marrow transplantation and the American society for blood and marrow transplantation","volume":"25","author":"Kansagra","year":"2019","journal-title":"Biol Blood Marrow Transplant"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2018.12.758","article-title":"ASTCT consensus grading for cytokine release syndrome and neurologic toxicity associated with immune effector cells","volume":"25","author":"Lee","year":"2019","journal-title":"Biol Blood Marrow Transplant"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2019004000","article-title":"How I prevent infections in patients receiving CD19-targeted chimeric antigen receptor T cells for B-cell Malignancies","volume":"136","author":"Hill","year":"2020","journal-title":"Blood"},{"key":"B8","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1016\/j.bbmt.2019.08.003","article-title":"Late events after treatment with CD19-targeted chimeric antigen receptor modified T cells","volume":"26","author":"Cordeiro","year":"2020","journal-title":"Biol Blood Marrow Transplant"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofae082","article-title":"Modeling invasive aspergillosis risk for the application of prophylaxis strategies","volume":"11","author":"Young","year":"2024","journal-title":"Open Forum Infect Dis"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1186\/s13045-019-0838-y","article-title":"Axicabtagene ciloleucel CD19 CAR-T cell therapy results in high rates of systemic and neurologic remissions in ten patients with refractory large B cell lymphoma including two with HIV and viral hepatitis","volume":"13","author":"Abbasi","year":"2020","journal-title":"J Hematol Oncol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1097\/QCO.0000000000000500","article-title":"Hepatitis B virus and hepatitis C virus infection in immunocompromised patients","volume":"31","author":"Hwang","year":"2018","journal-title":"Curr Opin Infect Dis"},{"key":"B12","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1182\/blood-2017-11-812982","article-title":"CD19 CAR-T therapy and sepsis: dancing with the devil","volume":"131","author":"Budde","year":"2018","journal-title":"Blood"},{"key":"B13","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1186\/s12951-021-00806-7","article-title":"Virus-like particles: preparation, immunogenicity and their roles as nanovaccines and drug nanocarriers","volume":"19","author":"Nooraei","year":"2021","journal-title":"J Nanobiotechnol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2018.00320","article-title":"Host immune response to influenza A virus infection","volume":"9","author":"Chen","year":"2018","journal-title":"Front Immunol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2019000717","article-title":"Durable preservation of antiviral antibodies after CD19-directed chimeric antigen receptor T-cell immunotherapy","volume":"3","author":"Hill","year":"2019","journal-title":"Blood Adv"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2016-06-721662","article-title":"The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia","volume":"127","author":"Arber","year":"2016","journal-title":"Blood"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1038\/s41571-023-00754-1","article-title":"Long-term outcomes following CAR T cell therapy: what we know so far","volume":"20","author":"Cappell","year":"2023","journal-title":"Nat Rev Clin Oncol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1056\/NEJMoa1804980","article-title":"Tisagenlecleucel in adult relapsed or refractory diffuse large B-cell lymphoma","volume":"380","author":"Schuster","year":"2019","journal-title":"N Engl J Med"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1038\/s41409-019-0487-3","article-title":"Early and late hematologic toxicity following CD19 CAR-T cells","volume":"54","author":"Fried","year":"2019","journal-title":"Bone Marrow Transplant"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2017-07-793760","article-title":"Infectious complications of CD19-targeted chimeric antigen receptor-modified T-cell immunotherapy","volume":"131","author":"Hill","year":"2018","journal-title":"Blood"},{"key":"B21","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1038\/s41408-020-00346-7","article-title":"Infection during the first year in patients treated with CD19 CAR T cells for diffuse large B cell lymphoma","volume":"10","author":"Wudhikarn","year":"2020","journal-title":"Blood Cancer J"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciy152","article-title":"Cytokine release syndrome grade as a predictive marker for infections in patients with relapsed or refractory B-cell acute lymphoblastic leukemia treated with chimeric antigen receptor T cells","volume":"67","author":"Park","year":"2018","journal-title":"Clin Infect Dis"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2019-0233","article-title":"The European medicines agency review of kymriah (Tisagenlecleucel) for the treatment of acute lymphoblastic leukemia and diffuse large B-cell lymphoma","volume":"25","author":"Ali","year":"2020","journal-title":"Oncologist"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1080\/14787210.2021.1855143","article-title":"CAR-T cell therapy and infection: a review","volume":"19","author":"Bupha-Intr","year":"2021","journal-title":"Expert Rev Anti Infect Ther"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.AC119.007558","article-title":"Granulocyte-macrophage colony-stimulating factor inactivation in CAR T-cells prevents monocyte-dependent release of key cytokine release syndrome mediators","volume":"294","author":"Sachdeva","year":"2019","journal-title":"J Biol Chem"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1158\/2159-8290.CD-17-1319","article-title":"Clinical and biological correlates of neurotoxicity associated with CAR T-cell therapy in patients with B-cell acute lymphoblastic leukemia","volume":"8","author":"Santomasso","year":"2018","journal-title":"Cancer Discovery"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1038\/s41375-022-01572-7","article-title":"GM-CSF disruption in CART cells modulates T cell activation and enhances CART cell anti-tumor activity","volume":"36","author":"Cox","year":"2022","journal-title":"Leukemia"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.816619","article-title":"Consequences of viral infection and cytokine production during pregnancy on brain development in offspring","volume":"13","author":"Elgueta","year":"2022","journal-title":"Front Immunol"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.3390\/v10100521","article-title":"Interplay between cellular metabolism and cytokine responses during viral infection","volume":"10","author":"Zhang","year":"2018","journal-title":"Viruses"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2025.1549809\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,21]],"date-time":"2025-03-21T13:59:49Z","timestamp":1742565589000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2025.1549809\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,21]]},"references-count":29,"alternative-id":["10.3389\/fonc.2025.1549809"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2025.1549809","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,21]]},"article-number":"1549809"}}