Abstract
BACKGROUNDUnderstanding outcomes and immunologic characteristics of cellular therapy recipients with SARS-CoV-2 is critical to performing these potentially life-saving therapies in the COVID-19 era. In this study of recipients of allogeneic (Allo) and autologous (Auto) hematopoietic cell transplant and CD19-directed chimeric antigen receptor T cell (CAR T) therapy at Memorial Sloan Kettering Cancer Center, we aimed to identify clinical variables associated with COVID-19 severity and assess lymphocyte populations.METHODSWe retrospectively investigated patients diagnosed between March 15, 2020, and May 7, 2020. In a subset of patients, lymphocyte immunophenotyping, quantitative real-time PCR from nasopharyngeal swabs, and SARS-CoV-2 antibody status were available.RESULTSWe identified 77 patients with SARS-CoV-2 who were recipients of cellular therapy (Allo, 35; Auto, 37; CAR T, 5; median time from cellular therapy, 782 days; IQR, 354-1611 days). Overall survival at 30 days was 78%. Clinical variables significantly associated with the composite endpoint of nonrebreather or higher oxygen requirement and death (n events = 25 of 77) included number of comorbidities (HR 5.41, P = 0.004), infiltrates (HR 3.08, P = 0.032), and neutropenia (HR 1.15, P = 0.04). Worsening graft-versus-host disease was not identified among Allo recipients. Immune profiling revealed reductions and rapid recovery in lymphocyte populations across lymphocyte subsets. Antibody responses were seen in a subset of patients.CONCLUSIONIn this series of Allo, Auto, and CAR T recipients, we report overall favorable clinical outcomes for patients with COVID-19 without active malignancy and provide preliminary insights into the lymphocyte populations that are key for the antiviral response and immune reconstitution.FUNDINGNIH grant P01 CA23766 and NIH/National Cancer Institute grant P30 CA008748.
Keywords: COVID-19; Stem cell transplantation; T cells; Transplantation.
【저자키워드】 COVID-19, T cells, transplantation, Stem cell transplantation, 【초록키워드】 SARS-CoV-2, therapy, severity, Antibody Response, Lymphocyte subsets, outcome, immune, Population, Clinical outcome, lymphocyte, T cell, Characteristics, SARS-CoV-2 antibody, nasopharyngeal swabs, clinical, Patient, death, Allogeneic, disease, Critical, patients, chimeric antigen receptor, neutropenia, cellular, antiviral response, transplantation, stem cell, composite endpoint, reduction, recipients, median time, overall survival, center, active malignancy, recipient, quantitative real-time PCR, Oxygen requirement, variable, Cell, autologous, event, CAR, identify, significantly, investigated, diagnosed, subset, clinical variable, IQR, Memorial, number of comorbidity, patients with COVID-19, patients with SARS-CoV-2, with COVID-19, 【제목키워드】 outcome, cell transplantation, recipient,