Favorable outcomes of COVID-19 in recipients of hematopoietic cell transplantation
Favorable outcomes of COVID-19 in recipients of hematopoietic cell transplantation
复制标题
DOI：
10.1172/jci141777
复制
发表时间：
2020-12-01
影响因子：
15.9
通讯作者：
Perales, Miguel-Angel
中科院分区：
文献类型：
--
作者：
Shah, Gunjan L.;DeWolf, Susan;Perales, Miguel-Angel
背景了解SARS-CoV-2细胞治疗接受者的结果和免疫学特征对于在COVID-19时代实施这些可能挽救生命的治疗至关重要。在这项在纪念斯隆-凯特琳癌症中心接受同种异体（Alto）和自体（Auto）造血细胞移植和CD 19定向嵌合抗原受体T细胞（CART）治疗的受者的研究中，我们旨在确定与COVID-19严重程度相关的临床变量并评估淋巴细胞群。我们回顾性调查了2020年3月15日至2020年5月7日期间诊断的患者。在一个患者亚组中，淋巴细胞免疫表型，鼻咽拭子定量实时PCR和SARS-CoV-2抗体状态是可用的。我们确定了77名接受细胞治疗的SARS-CoV-2患者（Allo，35; Auto，37; CAR T，5;细胞治疗的中位时间，782天; IQR，354-1611天）。30天的总生存率为78度/0。与非再呼吸器或更高需氧量和死亡（n事件= 25/77）复合终点显著相关的临床变量包括合并症（HR 5.41，P = 0.004）、浸润（HR 3.08，P= 0.032）和中性粒细胞减少（HR 1.15，P= 0.04）的数量。在Allo受体中未发现移植物抗宿主病恶化。免疫分析显示淋巴细胞亚群中淋巴细胞群减少和快速恢复。在一部分患者中观察到抗体应答。在这一系列Allo、Auto和CART接受者中，我们报告了无活动性恶性肿瘤的COVID-19患者的总体有利临床结局，并提供了对抗病毒反应和免疫重建关键的淋巴细胞群的初步见解。
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 (Alto) and autologous (Auto) hematopoietic cell transplant and CD19-directed chimeric antigen receptor T cell (CART) therapy 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 15, 2020, and May 7, 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 patients with SARS-CoV-2 who were recipients of cellular therapy (Allo, 35; Auto, 37; CAR T, 5; median time from cellular therapy, 782 days; IQR, 354-1611 days). Overall survival at 30 days was 78 degrees/0. Clinical variables significantly associated with the composite endpoint of nonrebreather or higher oxygen requirement and death (n events = 25 of 77) included number of comorbidities (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 recipients. 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 CART recipients, we report overall favorable clinical outcomes for patients with COVID-19 without active malignancy and provide preliminary insights into the lymphocyte populations that are key for the antiviral response and immune reconstitution.