Impact of COVID‐19 monoclonal antibodies on outcomes of COVID‐19 infection in hematopoietic stem cell transplant and chimeric antigen receptor therapy recipients

Abstract

BackgroundHematopoietic stem cell transplant (HSCT) and chimeric antigen receptor T‐cell therapy (CAR‐T) recipients are at higher risk of serious complications of COVID‐19 infection than the general population. Though there is evidence that monoclonal antibodies (MCA) against COVID‐19 reduce the risk of death and hospitalization in the general population, data regarding their efficacy in HSCT and CAR‐T recipients remains scarce.MethodsWe conducted a retrospective review of HSCT and CAR‐T recipients to compare 30‐day outcomes between patients who did and did not receive MCA after their first episode of COVID‐19 between May 1, 2020 and December 31, 2022. Outcomes were defined as the most severe complication experienced out of the following: 30‐day emergency department visit, hospitalization, intensive care unit admission, and death after COVID‐19 infection.ResultsWe identified 166 patients comprised of 53.6% allogeneic HSCT, 35.5% autologous HSCT, and 10.8% CAR‐T recipients; 107 had received a COVID‐19 vaccine >2 weeks prior to testing positive, and 40 were treated with MCA. After adjusting for age, presence of symptoms at the initial positive test, and COVID‐19 vaccination status, patients who did not receive MCA were five times more likely to develop complications after COVID‐19 infection (adjusted odds ratio 5.0 [95% CI, 1.9–12.8], p = .001).ConclusionHSCT and CAR‐T recipients who received MCA following COVID‐19 infection were far less likely to develop COVID‐related complications than those who did not receive MCA, regardless of vaccination status. This underscores the potential benefit of developing novel MCA with efficacy against circulating COVID‐19 strains. image