Favorable outcomes of COVID-19 in recipients of hematopoietic cell transplantation.

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.

• Authors: Gunjan L Shah, Susan DeWolf, Yeon Joo Lee, Roni Tamari, Parastoo B Dahi, Jessica A Lavery, Josel Ruiz, Sean M Devlin, Christina Cho, Jonathan U Peled, Ioannis Politikos, Michael Scordo, N Esther Babady, Tania Jain, Santosha Vardhana, Anthony Daniyan, Craig S Sauter, Juliet N Barker, Sergio A Giralt, Cheryl Goss, Peter Maslak, Tobias M Hohl, Mini Kamboj, Lakshmi Ramanathan, Marcel Rm van den Brink, Esperanza Papadopoulos, Genovefa Papanicolaou, Miguel-Angel Perales
• Journal: The Journal of clinical investigation (J Clin Invest) Vol. 130 Issue 12 Pg. 6656-6667 (12 01 2020) ISSN: 1558-8238 [Electronic] United States
• PMID: 32897885 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Research Support, N.I.H., Extramural)

Chemical References

• Antibodies, Viral

Topics

• Adoptive Transfer
• Adult
• Aged
• Allografts
• Antibodies, Viral (blood)
• Autografts
• COVID-19 (blood, mortality, therapy)
• Disease-Free Survival
• Female
• Follow-Up Studies
• Hematopoietic Stem Cell Transplantation
• Humans
• Male
• Middle Aged
• Retrospective Studies
• SARS-CoV-2
• Survival Rate