Impact of COVID-19 infection on CAR-T therapy outcomes.

Abstract

e23329 Background: CAR T-cell therapy has revolutionized the treatment of hematologic malignancies, offering a highly effective immunotherapy option. However, CAR T-cell recipients are immunocompromised, which may increase their susceptibility to severe outcomes from COVID-19. Understanding the impact of COVID-19 in this population is crucial for optimizing clinical management. This study aimed to evaluate the differences in clinical outcomes between CAR T-cell patients with and without COVID-19. Methods: We conducted a retrospective cohort study using a real-world global database to identify all patients who received CAR T-cell therapy over the past 10 years. Patients were stratified into two cohorts based on COVID-19 status and propensity score matched (1:1) for age, race, and comorbidities. Outcomes, including mortality, cardiovascular events, acute kidney injury, secondary malignancies, and hospital readmission rates, were assessed over a 30-day follow-up period. Risk ratios (RR) with 95% confidence intervals (CIs) were calculated to compare outcomes between cohorts. Results: Our study included a total of 3,141 patients, divided into 2,545 CP and 596 CN CAR T-cell therapy recipients. After PSM, 594 patients from each group were compared. The mean age of the CP group was 35.5 ± 20.5 years, significantly younger than the CN group at 49.5 ± 9.3 years (p = 0.065). BMI was nearly identical between the groups (27.9 ± 6.5 vs. 27.9 ± 6.1, p = 0.991). Both cohorts had similar rates of essential hypertension (43.8%), diabetes mellitus (17.0%), and malnutrition (~18%). In terms of outcomes, mortality was higher in the CP group (RR = 1.5, 95% CI: -0.008 to 0.02) compared to the CN group, though this was not statistically significant (p = 0.31). Readmission rates were comparable between the groups (RR = 0.90, 95% CI: -0.02 to 0.02, p = 0.75). Significant findings included higher rates of cardiac arrest (1.7% vs. 0%, p = 0.001), new heart failure (RR = 2.17, 95% CI: 1.10-4.25, p = 0.021), and acute kidney injury (RR = 1.45, 95% CI: 0.95-2.23, p = 0.084) in CP patients. These results emphasize the increased burden of complications in CP CAR T-cell recipients, underscoring the need for close monitoring and tailored management in this high-risk population. Conclusions: COVID-positive patients experienced higher rates of cardiac arrest, new heart failure, acute kidney injury, and mortality compared to COVID-negative patients, despite similar baseline characteristics. These findings underscore the need for vigilant monitoring, preventive strategies, and tailored care to mitigate the risks of COVID-19 in this vulnerable population.