Treatment with anti-spike monoclonal antibodies in allogeneic HCT and CAR T-cell recipients with mild to moderate COVID-19: The Mayo Clinic experience.

Authors

null

Razan Mohty

Mayo Clinic, Jacksonville, FL

Razan Mohty , Matthew Thoendel , Samuel Swei , Radhika Bansal , Jeanne Palmer , William J. Hogan , Paschalis Vergidis , Javier Munoz , Madiha Iqbal , Farah Yassine , Nabila Nora Bennani , Matthew Hathcock , Hemant S. Murthy , Januario E. Castro , Yi Lin , Raymund R. Razonable , Mohamed Kharfan-Dabaja

Organizations

Mayo Clinic, Jacksonville, FL, Mayo Clinic, Rochester, MN, Division of Hematology, Mayo Clinic, Rochester, MN, Mayo Clinic, Phoenix, AZ, Division of Hematology, Mayo Clinic, Gilbert, AZ, Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL

Research Funding

No funding received

Background: Prognosis of COVID-19 is poor in the setting of immunosuppression. Casirivimab/imdevimab (REGEN-COV), bamlanivimab, and sotrovimab are investigational monoclonal antibodies (MoAbs) authorized for treatment of mild/moderate COVID-19 for patients (pts) 12 years or older and who are at high-risk for progression to severe COVID-19. These neutralizing antibodies, against SARS-CoV-2 spike proteins, have been shown to decrease risk of progression to severe disease. Recipients of allogeneic stem cell transplants (allo-SCT) or chimeric antigen T cell therapy (CAR T cell) represent a high risk population. However, treatment outcomes with these MoAbs in these pts are not well described. Methods: This retrospective study included 33 consecutive adult pts who developed mild/moderate COVID-19 and received anti-spike SARS-CoV-2 MoAbs between December 2020 and November 2021. Allo-SCT (N=27) or CAR T cell (N=6) recipients were included, and outcomes were analyzed separately. Pts received REGEN-COV (N=19), bamlanivimab (N=11), or sotrovimab (N=1), missing (N=2). Results: In the allo-SCT cohort (N=27), median age at time of COVID-19 was 55 (23-76) years. Median time from allo-SCT to COVID-19 was 31 (22-64) months. Two pts received CAR T-cell therapy prior to allo-SCT. Diagnoses included leukemia or myeloid diseases (82%), lymphoma (11%), or myeloma (7%). Transplant characteristics are summarized (Table). Thirteen pts were vaccinated against SARS-CoV-2 prior to breakthrough COVID-19. Events considered included hospitalization due to COVID-19, disease progression, or death from any cause. The 6-month event-free and overall survivals were 81% and 91%, respectively. In the CAR T cell recipients cohort (N=6), 4 pts received axicabtagene ciloleucel for diffuse large B-cell or follicular lymphoma and 2 received brexucabtagene autoleucel for mantle cell lymphoma. The median follow-up was 8 (1-11) months. Two pts received autologous SCT prior to COVID-19. Median time from CAR T cell therapy to COVID-19 was 10 (3-24) months. Three pts were vaccinated prior to COVID-19. Only 1 pt was hospitalized due to severe COVID-19 requiring mechanical ventilation leading to death. Conclusions: These results show a potential benefit of MoAbs in high-risk pts, namely allo-SCT or CAR T cell recipients. Future studies should evaluate the role of prophylactic use MoAbs in these populations. A comparative analysis with a matched control cohort (who did not receive MoAbs) will be provided at the meeting.

Transplant characteristics (allo-SCT group).


N=27
Donor type

MRD/ MUD/ MMUD 9/10/ Haploidentical/ Syngeneic
6/15/2/3/1
Cell source
PBSC (27)
Conditioning regimen intensity

MAC/RIC
16/11
GVHD prophylaxis

Tac or CsA with MTX or MMF/ Sirolimus with MTX or MMF
22 / 3
PTCY/ATG
6 / 3
Patients on immunosuppressive therapy at time of COVID-19
13

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Abstract Details

Meeting

2022 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Hematologic Malignancies—Leukemia, Myelodysplastic Syndromes, and Allotransplant

Track

Hematologic Malignancies

Sub Track

Allogenic Stem Cell Transplantation

Citation

J Clin Oncol 40, 2022 (suppl 16; abstr e19049)

DOI

10.1200/JCO.2022.40.16_suppl.e19049

Abstract #

e19049

Abstract Disclosures

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