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

Shah, Gunjan L; DeWolf, Susan; Lee, Yeon Joo; Tamari, Roni; Dahi, Parastoo B; Lavery, Jessica A; Ruiz, Josel D; Devlin, Sean M; Cho, Christina; Peled, Jonathan U; Politikos, Ioannis; Scordo, Michael; Babady, N Esther; Jain, Tania; Vardhana, Santosha; Daniyan, Anthony F; Sauter, Craig S; Barker, Juliet N; Giralt, Sergio A; Goss, Cheryl; Maslak, Peter; Hohl, Tobias M; Kamboj, Mini; Ramanathan, Lakshmi; van den Brink, Marcel Rm; Papadopoulos, Esperanza B; Papanicolaou, Genovefa A; Perales, Miguel-Angel

BACKGROUND Understanding 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 therapy (CAR-T) at Memorial Sloan Kettering Cancer Center, we aimed to identify clinical variables associated with COVID-19 severity and assess lymphocyte populations. METHODS We retrospectively investigated patients diagnosed between March 15th and May 7th, 2020. In a subset of patients, lymphocyte immunophenotyping, quantitative real-time PCR from nasopharyngeal swabs, and SARS-CoV-2 antibody status were available. RESULTS We identified 77 SARS-CoV-2 + cellular therapy recipients (Allo = 35, Auto = 37, CAR-T = 5; median time from cellular therapy 782 days (IQR 354,1611). Overall survival at 30 days was 78%. Clinical variables significantly associated with the composite endpoint of non-rebreather or higher oxygen requirement and death (n events = 25/77) included number of co-morbidities (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 subjects. Immune profiling revealed reductions and rapid recovery in lymphocyte populations across lymphocyte subsets. Antibody responses were seen in a subset of patients. CONCLUSION In this series of Allo, Auto, and CAR-T recipients, we report overall favorable clinical outcomes for COVID-19 patients without active malignancy and provide preliminary insights into the lymphocyte populations that are key for the anti-viral response and immune reconstitution. FUNDING NIH P01 CA23766, NIH/NCI P30 CA008748.