Gentilini Marianna, Casadei Beatrice, Pellegrini Cinzia, Argnani Lisa, Gugliotta Gabriele, Carella Matteo, Stefoni Vittorio, Fabbri Nicole, Gabrielli Giulia, Salvatore Flavia, Desiderio Alessandro, Mazzoni Camilla, Maglio Pierluca, Bagnato Gianmarco, Broccoli Alessandro, Bonifazi Francesca, Zinzani Pier Luigi
IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Via Massarenti, 9, Bologna, 40138, Italy.
Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
Ann Hematol. 2025 Jun 4. doi: 10.1007/s00277-025-06425-8.
Although the COVID-19 pandemic has officially ended, outbreaks still occur, especially in immunocompromised patients, including those undergoing chimeric antigen receptor T-cell (CAR T-cell) therapy, who have weakened immune systems due to prior treatments or CAR T-related effects such as severe and prolonged neutropenia, lymphopenia and hypogammaglobulinemia. This retrospective study analyzed relapsed/refractory (R/R) large B-cell lymphoma (LBCL) patients receiving CAR T-cell therapy, assessing the impact of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection on overall survival (OS), progression-free survival (PFS), and delays in leukapheresis and CAR T-cell infusion. Among 89 infused patients, 37 (41.6%) developed COVID-19. Compared to the COVID + cohort, COVID- patients had worse prognostic scores and higher LDH and ferritin levels before infusion. SARS-CoV-2 infection delayed leukapheresis (14-35 days) and CAR T-cell infusion (20-65 days). The best overall response rate (BRR) in the CAR T-cell population was 77.5% (69/89 patients), with a complete response (CR) rate of 67%. The BRR was 100% in COVID + patients vs. 61.5% in COVID-. Median PFS was 5.47 months in the COVID- cohort and not reached in the COVID + cohort (p = 0.007). Median OS was 19 months in COVID- patients and not reached in COVID+ (p < 0.0001). No significant survival differences were found between COVID + and COVID - patients. Improved outcomes likely resulted from widespread vaccination, prophylaxis, early antiviral treatments, and the emergence of less virulent SARS-CoV-2 variants, reducing disease severity and mortality, allowing for better management of these patients.
尽管新冠疫情已正式结束，但疫情仍有发生，尤其是在免疫功能低下的患者中，包括接受嵌合抗原受体T细胞（CAR T细胞）治疗的患者，这些患者由于先前的治疗或CAR T相关效应，如严重且持续时间长的中性粒细胞减少、淋巴细胞减少和低丙种球蛋白血症，导致免疫系统减弱。这项回顾性研究分析了接受CAR T细胞治疗的复发/难治性（R/R）大B细胞淋巴瘤（LBCL）患者，评估了严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染对总生存期（OS）、无进展生存期（PFS）以及白细胞分离术和CAR T细胞输注延迟的影响。在89例接受输注的患者中，37例（41.6%）发生了新冠感染。与新冠阳性队列相比，新冠阴性患者在输注前的预后评分更差，乳酸脱氢酶（LDH）和铁蛋白水平更高。SARS-CoV-2感染使白细胞分离术延迟（14 - 35天），CAR T细胞输注延迟（20 - 65天）。CAR T细胞群体中的最佳总体缓解率（BRR）为77.5%（69/89例患者），完全缓解（CR）率为67%。新冠阳性患者的BRR为100%，而新冠阴性患者为61.5%。新冠阴性队列的中位PFS为5.47个月，新冠阳性队列未达到（p = 0.007）。新冠阴性患者的中位OS为19个月，新冠阳性患者未达到（p < 0.0001）。新冠阳性和新冠阴性患者之间未发现显著的生存差异。预后改善可能得益于广泛接种疫苗、预防措施、早期抗病毒治疗以及毒性较低的SARS-CoV-2变体的出现，降低了疾病的严重程度和死亡率，从而使这些患者得到更好的管理。
