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COVID-19 and hematopoietic stem cell transplantation and immune effector cell therapy: a US cancer center experience
Katie Maurer1, Anna Saucier1, Haesook T Kim2
1Division of Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
Abstract:
The novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), identified in late 2019 as the causative agent of COVID-19, was declared a pandemic by the World Health Organization on 11 March 2020. Widespread community transmission in the United States triggered a nationwide shutdown, raising major challenges for administration of hematopoietic stem cell transplant (HSCT) and chimeric antigen receptor (CAR)-T cell therapies, leading many centers to delay or cancel operations. We sought to assess the impact of the COVID-19 pandemic on operations and clinical outcomes for HSCT and CAR-T cellular therapies at the Dana-Farber Cancer Institute by reviewing administration and outcomes in 127 cell therapy patients treated during the initial COVID-19 surge: 62 adult allogeneic HSCT (allo-HSCT), 38 autologous HSCT (auto-HSCT), and 27 CAR-T patients. Outcomes were compared with 66 allo-HSCT, 43 auto-HSCT, and 33 CAR-T patients treated prior to the pandemic. A second control cohort was evaluated for HSCT groups to reflect seasonal variation in infections. Although there were changes in donor selection and screening as well as cryopreservation patterns of donor products, no differences were observed across groups in 100-day overall survival, progression-free survival, rates of non-COVID-19 infections, including hospital length of stay, neutrophil engraftment, graft failure, acute graft-versus-host disease in allo-HSCT patients, or cytokine release syndrome and neurotoxicity in CAR-T patients. No HSCT patients contracted COVID-19 between days 0 and 100. One CAR-T patient contracted COVID-19 at day +51 and died of the disease. Altogether, our data indicate that cellular therapies can be safely administered throughout the ongoing COVID-19 pandemic with appropriate safeguards.
Insights
Hematopoietic stem cell transplant (HSCT) and CAR-T cell therapies can be safely administered during the COVID-19 pandemic. Despite operational changes, key clinical outcomes remained consistent, with minimal COVID-19 transmission in patients.
Area of Science:
- Oncology
- Immunology
- Infectious Diseases
Background:
- The COVID-19 pandemic presented significant challenges to the administration of life-saving cell therapies.
- Centers faced decisions to delay or cancel hematopoietic stem cell transplant (HSCT) and chimeric antigen receptor (CAR)-T cell therapies due to widespread transmission.
- Assessing the impact on operations and patient outcomes was crucial for continued treatment during the pandemic.
Purpose of the Study:
- To evaluate the impact of the COVID-19 pandemic on the operations and clinical outcomes of HSCT and CAR-T cell therapies.
- To compare patient outcomes during the pandemic surge with pre-pandemic cohorts.
- To determine the safety and feasibility of administering these therapies amidst the pandemic.
Main Methods:
- Retrospective review of 127 cell therapy patients (62 allo-HSCT, 38 auto-HSCT, 27 CAR-T) treated during the COVID-19 surge.
- Comparison of outcomes with pre-pandemic control cohorts (66 allo-HSCT, 43 auto-HSCT, 33 CAR-T).
- Analysis included 100-day survival, progression-free survival, infection rates, engraftment, graft-versus-host disease, and cytokine release syndrome/neurotoxicity.
Main Results:
- No significant differences were observed in 100-day overall survival, progression-free survival, or non-COVID-19 infection rates between pandemic and pre-pandemic cohorts.
- Key clinical endpoints such as engraftment, graft failure, acute graft-versus-host disease, and cytokine release syndrome/neurotoxicity remained comparable.
- No HSCT patients contracted COVID-19 within 100 days post-transplant; one CAR-T patient contracted and died from COVID-19.
Conclusions:
- Cellular therapies, including HSCT and CAR-T, can be safely administered during the COVID-19 pandemic with appropriate safety measures.
- Operational adjustments did not negatively impact critical clinical outcomes for these patient populations.
- The study provides evidence supporting the continuation of essential cell therapies throughout the pandemic.
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