The burden of SARS-CoV-2 in patients receiving chimeric antigen receptor T cell immunotherapy: everything to lose.
Expert Rev Anti Infect Ther
; 20(9): 1155-1162, 2022 09.
Article
in English
| MEDLINE | ID: covidwho-1937582
ABSTRACT
INTRODUCTION:
Chimeric antigen receptor T (CAR-T) cell immunotherapy has revolutionized the prognosis of refractory or relapsed B-cell malignancies. CAR-T cell recipients have immunosuppression generated by B-cell aplasia, leading to a higher susceptibility to respiratory virus infections and poor response to vaccination. AREAS COVERED This review focuses on the challenge posed by B-cell targeted immunotherapies managing long-lasting B-cell impairment during the successive surges of a deadly viral pandemic. We restricted this report to data regarding vaccine efficacy in CAR-T cell recipients, outcomes after developing COVID-19 and specificities of treatment management. We searched in MEDLINE database to identify relevant studies until 31 March 2022. EXPERT OPINION Among available observational studies, the pooled mortality rate reached 40% in CAR-T cell recipients infected by SARS-CoV-2. Additionally, vaccine responses seem to be widely impaired in recipients (seroconversion 20%, T-cell response 50%). In this setting of B-cell depletion, passive immunotherapy is the backbone of treatment. Convalescent plasma therapy has proven to be a highly effective curative treatment with rare adverse events. Neutralizing monoclonal antibodies could be used as pre-exposure prophylaxis or early treatment but their neutralizing activity is constantly challenged by new variants. In order to reduce viral replication, direct-acting antiviral drugs should be considered.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Hepatitis C, Chronic
/
Receptors, Chimeric Antigen
/
COVID-19
Type of study:
Observational study
/
Prognostic study
/
Reviews
Topics:
Vaccines
/
Variants
Limits:
Humans
Language:
English
Journal:
Expert Rev Anti Infect Ther
Journal subject:
Communicable Diseases
Year:
2022
Document Type:
Article
Affiliation country:
14787210.2022.2101448
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