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Cellular Therapy During COVID-19: Lessons Learned and Preparing for Subsequent Waves.

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COVID-19 treatment delays impacted cellular therapy, with 66% of patients eventually receiving hematopoietic cell transplantation (HCT) or CAR-T therapy. Delays led to disease progression and deaths, especially in high-risk leukemia patients.

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Area of Science:

  • Oncology
  • Hematology
  • Immunotherapy

Background:

  • Healthcare resource constraints, exacerbated by COVID-19, necessitate evidence-based triage for cellular therapy distribution.
  • Hematopoietic cell transplantation (HCT) and Chimeric Antigen Receptor T-cell (CAR-T) therapy are critical treatments with complex logistical demands.

Purpose of the Study:

  • To evaluate the impact of COVID-19-related treatment delays on patients undergoing HCT or CAR-T therapy.
  • To assess patient outcomes, reasons for non-proceeding, and disease status changes during therapy delays.

Main Methods:

  • Real-time data collection from March 19 to May 11, 2020, for 85 delayed cellular therapy patients.
  • Analysis of patient demographics, therapy type (autologous HCT, allogeneic HCT, CAR-T), reasons for delay, and clinical outcomes.
  • Evaluation of disease status, including measurable residual disease (MRD) in acute leukemia patients.

Main Results:

  • 66% (56/85) of delayed patients ultimately received their planned cellular therapy.
  • Common reasons for not proceeding included disease control (plasma cell dyscrasias) and disease progression (acute leukemia).
  • Five patients died during the delay; disease progression occurred in 42% of allogeneic HCT and 3/7 CAR-T patients, notably those with MRD.

Conclusions:

  • Treatment delays for cellular therapy, particularly for high-risk acute leukemia patients with MRD, can lead to adverse outcomes and should be minimized.
  • The findings underscore the need for robust triage plans to mitigate the impact of healthcare resource limitations on critical cancer treatments.
  • Maintaining access to HCT and CAR-T therapy is crucial, especially for patients with poor prognostic indicators like MRD.