Background Hematopoietic cell transplant (HCT) or chimeric antigen receptor T cell (CAR-T) therapy recipients have high morbidity from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. There are limited data on outcomes from SARS-CoV-2 infection shortly before cellular therapy and uncertainty whether to delay therapy. Methods We conducted a retrospective cohort study of patients with SARS-CoV-2 infection within 90 days prior to HCT or CAR-T therapy between January 2020 and November 2022. We characterized the kinetics of SARS-CoV-2 detection, clinical outcomes following cellular therapy, and impact on delays in cellular therapy. Results We identified 37 patients (n=15 allogeneic HCT, n=11 autologous HCT, n=11 CAR-T therapy) with SARS-CoV-2 infections within 90 days of cellular therapy. Most infections (73%) occurred between March and November 2022, when Omicron strains were prevalent. Most patients had asymptomatic (27%) or mild (68%) coronavirus disease 2019 (COVID-19). SARS-CoV-2 positivity lasted a median of 20.0 days [IQR, 12.5-26.25]. The median time from first positive SARS-CoV-2 test to cellular therapy was 45 days [IQR, 37.75-70]; one patient tested positive on the day of infusion. After cellular therapy, no patients had recrudescent SARS-CoV-2 infection or COVID-19-related complications. Cellular therapy delays related to SARS-CoV-2 infection occurred in 70% of patients for a median of 37 days. Delays were more common after allogeneic (73%) and autologous (91%) HCT compared to CAR-T cell therapy (45%). Conclusions Patients with asymptomatic or mild COVID-19 may not require prolonged delays in cellular therapy in the context of contemporary circulating variants and availability of antiviral therapies.

中文翻译：

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造血细胞移植和嵌合抗原受体 T 细胞治疗受者接受细胞治疗前 SARS-CoV-2 感染的结果

背景 造血细胞移植 (HCT) 或嵌合抗原受体 T 细胞 (CAR-T) 治疗接受者因严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 感染而发病率较高。关于细胞治疗前不久的 SARS-CoV-2 感染结果的数据有限，并且不确定是否推迟治疗。方法 我们对 2020 年 1 月至 2022 年 11 月期间 HCT 或 CAR-T 治疗前 90 天内感染 SARS-CoV-2 的患者进行了回顾性队列研究。治疗，以及对细胞治疗延迟的影响。结果 我们在细胞治疗后 90 天内确定了 37 名患有 SARS-CoV-2 感染的患者（n = 15 名同种异体 HCT，n = 11 名自体 HCT，n = 11 名 CAR-T 治疗）。大多数感染 (73%) 发生在 2022 年 3 月至 11 月期间，当时 Omicron 菌株流行。大多数患者患有无症状 (27%) 或轻度 (68%) 2019 年冠状病毒病 (COVID-19)。SARS-CoV-2 阳性持续时间中位数为 20.0 天 [IQR，12.5-26.25]。从首次 SARS-CoV-2 检测呈阳性到细胞治疗的中位时间为 45 天 [IQR，37.75-70]；一名患者在输注当天检测呈阳性。细胞治疗后，没有患者出现复发性 SARS-CoV-2 感染或 COVID-19 相关并发症。70% 的患者因 SARS-CoV-2 感染而导致细胞治疗延迟，中位延迟时间为 37 天。与 CAR-T 细胞治疗 (45%) 相比，同种异体 (73%) 和自体 (91%) HCT 后的延迟更为常见。结论 在当前循环变异和抗病毒治疗可用的情况下，无症状或轻度 COVID-19 患者可能不需要长时间延迟细胞治疗。