10.21.21

SARS-CoV-2 Infection in HCT and CAR-T Recipients

Mushtaq MU, Shahzad M, Chaudhary SG, et al. Impact of SARS-CoV-2 in Hematopoietic Stem Cell Transplantation and Chimeric Antigen Receptor T Cell Therapy Recipients. Transplantation and Cellular Therapy. 2021; 27 (9): 796.e1 (doi: 10.1016/j.jtct.2021.07.005).

Recipients of allogeneic hematopoietic stem cell transplantation (allo-HCT), those with acute GVHD receiving immunosuppressive therapy and chimeric antigen receptor T cell (CAR-T) therapy are at increased risk of having moderate-severe COVID-19 pneumonia and die from SARS-CoV-2 infection, according to new research.. The study included 32 adult allo-HCT recipients, 23 autologous HCT recipients, and 3 CAR-T therapy recipients infected with SARS-CoV-2. The average interval between HCT/CAR-T therapy and SARS-CoV-2 infection was 17.7 months, and 22% of patients were in the first 100 days post-therapy. Plasma cell, myeloid, and lymphoid malignancies were the most frequent hematologic disorders observed, and 62% received myeloablative conditioning. COVID-19 severity was mild in 50% of patients, moderate in 22%, and severe in 28%. Pneumonia or abnormal chest imaging was seen in 50% of the patients, while hypoxia was seen in 28%, 19% were admitted to the intensive care unit, and 10% needed mechanical ventilation. Therapy included remdesivir, convalescent plasma, dexamethasone, monoclonal antibodies, and tocilizumab. Viral shedding lasted an average 7.7 weeks. At a median 6.1 months follow-up, mortality rate was 16% for all patients and 28% in HCT recipients. Survivors with moderate-severe COVID-19 spent a median 4.2 weeks recovering. The data highlight the need for continued preventive measures and aggressive treatment for HCT and CAR-T therapy patients who develop SARS-CoV-2 infection.

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