Patients with previous CD19-directed chimeric antigen receptor (CAR) T-cell therapy have a prolonged vulnerability to viral infections. Coronavirus disease 2019 (COVID-19) has a great impact and has previously been shown to cause high mortality in this population. Until now, real-world data on the impact of vaccination and treatment on patients with COVID-19 after CD19-directed CAR T-cell therapy are lacking. Therefore, this multicenter, retrospective study was conducted with data from the EPICOVIDEHA survey. Sixty-four patients were identified. The overall mortality caused by COVID-19 was 31%. Patients infected with the Omicron variant had a significantly lower risk of death due to COVID-19 compared with patients infected with previous variants (7% vs 58% [P = .012]). Twenty-six patients were vaccinated at the time of the COVID-19 diagnosis. Two vaccinations showed a marked but unsignificant reduction in the risk of COVID-19–caused mortality (33.3% vs 14.2% [P = .379]). In addition, the course of the disease appears milder with less frequent intensive care unit admissions (39% vs 14% [P = .054]) and a shorter duration of hospitalization (7 vs 27.5 days [P = .022]). Of the available treatment options, only monoclonal antibodies seemed to be effective at reducing mortality from 32% to 0% (P = .036). We conclude that survival rates of CAR T-cell recipients with COVID-19 improved over time and that the combination of prior vaccination and monoclonal antibody treatment significantly reduces their risk of death. This trial was registered at www.clinicaltrials.gov as #NCT04733729.
Van Doesum, J. A., Salmanton-Garcia, J., Marchesi, F., Blasi, R. D., Falces-Romero, I., Cabirta, A., Farina, F., Besson, C., Weinbergerova, B., Van Praet, J., Schonlein, M., Lopez-Garcia, A., Lamure, S., Guidetti, A., De Ramon-Sanchez, C., Batinic, J., Gavriilaki, E., Tragiannidis, A., Tisi, M. C., Plantefeve, G., Petzer, V., Ormazabal-Velez, I., Almeida, J. M. D., Marchetti, M., Maertens, J., Machado, M., Kulasekararaj, A., Hernandez-Rivas, J. -., Silva, M. G. D., Fernandez, N., Espigado, I., Drgona, L., Dragonetti, G., Metafuni, E., Calbacho, M., Blennow, O., Wolf, D., Van Anrooij, B., Rodrigues, R. N., Nordlander, A., Martin-Gonzalez, J. -., Lievin, R., Jimenez, M., Grafe, S. K., Garcia-Sanz, R., Cordoba, R., Rahimli, L., Van Meerten, T., Cornely, O. A., Pagano, L., Impact of SARS-CoV-2 vaccination and monoclonal antibodies on outcome post–CD19-directed CAR T-cell therapy: an EPICOVIDEHA survey, <<BLOOD ADVANCES>>, 2023; 7 (11): 2645-2655. [doi:10.1182/bloodadvances.2022009578] [https://hdl.handle.net/10807/260262]
Impact of SARS-CoV-2 vaccination and monoclonal antibodies on outcome post–CD19-directed CAR T-cell therapy: an EPICOVIDEHA survey
Dragonetti, Giulia;Metafuni, Elisabetta;Pagano, Livio
2023
Abstract
Patients with previous CD19-directed chimeric antigen receptor (CAR) T-cell therapy have a prolonged vulnerability to viral infections. Coronavirus disease 2019 (COVID-19) has a great impact and has previously been shown to cause high mortality in this population. Until now, real-world data on the impact of vaccination and treatment on patients with COVID-19 after CD19-directed CAR T-cell therapy are lacking. Therefore, this multicenter, retrospective study was conducted with data from the EPICOVIDEHA survey. Sixty-four patients were identified. The overall mortality caused by COVID-19 was 31%. Patients infected with the Omicron variant had a significantly lower risk of death due to COVID-19 compared with patients infected with previous variants (7% vs 58% [P = .012]). Twenty-six patients were vaccinated at the time of the COVID-19 diagnosis. Two vaccinations showed a marked but unsignificant reduction in the risk of COVID-19–caused mortality (33.3% vs 14.2% [P = .379]). In addition, the course of the disease appears milder with less frequent intensive care unit admissions (39% vs 14% [P = .054]) and a shorter duration of hospitalization (7 vs 27.5 days [P = .022]). Of the available treatment options, only monoclonal antibodies seemed to be effective at reducing mortality from 32% to 0% (P = .036). We conclude that survival rates of CAR T-cell recipients with COVID-19 improved over time and that the combination of prior vaccination and monoclonal antibody treatment significantly reduces their risk of death. This trial was registered at www.clinicaltrials.gov as #NCT04733729.
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