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

Abstract

Since it was first reported in China, coronavirus disease 2019 (COVID-19) has spread rapidly around the world, and the number of cases has increased exponentially. Initial reports suggested that patients with cancer have an estimated twofold increased risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) compared with the general population. More importantly, it is expected that COVID-19 will be particularly life threatening in patients with hematological malignancies because of their immune dysfunction. Recent studies have reported an overall COVID-19–related mortality of 29% to 42% 3-8 in patients with hematological disease, depending on the type of malignancy, in contrast to the 2% to 7% observed in the general population. Regrettably, there remains a lack of studies about COVID-19 in patients receiving cellular therapies, including chimeric antigen receptor (CAR) T cells. CAR T cells are genetically modified autologous T cells, which have shown great promise in the treatment of advanced malignant hematological disorders, including non-Hodgkin lymphoma, acute lymphoblastic leukemia, and multiple myeloma. CAR T-cell recipients have significant B-cell aplasia requiring immunoglobulin G replacement therapy and may also develop delayed cytopenias, leaving them unable to mount any humoral response to viral infections. Shah et al 10 demonstrated that the seroconversion rate in a small cohort of patients treated with hemopoietic stem cell transplantation (HSCT) and CAR T-cell therapy did not exceed 66%.