COVID-19 and CAR T cells: a report on current challenges and future directions from the EPICOVIDEHA survey by EHA-IDWP

Abstract

Patients receiving chimeric antigen receptor T cells (CAR-T cells) therapy may be particularly susceptible to coronavirus disease 2019 (COVID-19) because of several factors including the immunosuppression associated to the underlying disease and delayed cytopenias. Regrettably, data on outcomes of CAR-T recipients with COVID-19 are extremely scarce. The aim of this study was to investigate the characteristics and outcomes of COVID-19 in patients treated with CAR-T therapy. The European Hematology Association - Scientific Working Group Infection in Hematology endorsed a survey to collect and analyze data from patients developing COVID-19 after CAR-T therapy. Overall, 459 patients treated with CAR-T cells were reported from 18 European centers. The prevalence of COVID-19 cases was 4.8%. Median time from CAR-T therapy and COVID-19 diagnosis was 169 days. Severe infection occurred in 66.7% of patients and 43.3% of the subjects required admission to ICU. The COVID-19 mortality was 33%. In multivariable analysis, the disease status at the time of COVID-19 trended marginally towards adverse outcome (P=0.075). In conclusion, we documented a high fatality rate for CAR-T patients with COVID-19, supporting the need to design successful interventions to mitigate the risk of infection in this vulnerable group of patients.

Serologic response and safety of COVID-19 vaccination in HSCT or CAR T-cell recipients: a systematic review and meta-analysis

“…Patients with hematologic diseases receiving HSCT or CAR T-cell therapy are at an increased risk of morbidity and mortality associated with COVID-19 [ 18 , 50 ]. Whether and when these patients should receive COVID-19 vaccines has become a critical issue.…”

Infectious complications, immune reconstitution, and infection prophylaxis after CD19 chimeric antigen receptor T-cell therapy

“…Viral shedding time of SARS-CoV-2 virus in patients undergoing transplantation and CAR-T cells could be up to 2 months [39]. Data from the European Hematology Association (EHA) reported an incidence of COVID-19 of 4.8% with the median time from CAR T-cell therapy to infection of 169 days [40]. Severe infection was observed in 67% and the COVID-19related mortality was around 50% highlighting that overall outcome of COVID-19 infection after CAR T-cell therapy was poor [41].…”

COVID-19 in Patients with Hematologic Malignancies: Outcomes and Options for Treatments

“…Reports from the Center for International Blood and Marrow Transplant Research (CIBMTR) and the European Society for Blood and Marrow Transplantation (EBMT) show an overall survival in patients undergoing allogeneic stem-cell transplant (allo-SCT) at 68% and 78%, respectively, and in those undergoing autologous stem-cell transplant at 67% and 72%, respectively [ 45 , 46 ]. Concerningly, the mortality rate in those receiving CAR-T cells has been recently reported to be substantial [ 16 , 47 ]. In a large European cohort of CAR-T cells patients with COVID-19 infection, 66.7% of patients had severe disease, 43.3% required ICU admission, and the COVID-19-related mortality was 33% [ 47 ].…”

“…Concerningly, the mortality rate in those receiving CAR-T cells has been recently reported to be substantial [ 16 , 47 ]. In a large European cohort of CAR-T cells patients with COVID-19 infection, 66.7% of patients had severe disease, 43.3% required ICU admission, and the COVID-19-related mortality was 33% [ 47 ]. Altogether, these data suggest that despite the immunosuppression associated with cellular therapies, the mortality in this group of patients is likely driven by the underlying disease state.…”