Outcomes and Clinical Features of BCMA CAR-T Cell Patients with COVID-19 During Omicron Surge

Overview

This retrospective study analyzed 49 relapsed/refractory multiple myeloma patients treated with BCMA-targeted CAR-T cells who contracted COVID-19 during the Omicron wave. Despite high immunosuppression, most patients experienced mild to moderate COVID-19 with favorable resolution rates, though severe cases and prolonged viral shedding occurred in a subset.

Background

COVID-19, caused by SARS-CoV-2, has evolved with variants like Omicron that are more transmissible but generally less severe than prior strains. Multiple myeloma patients are at increased risk of severe COVID-19 due to disease-related immune dysfunction and therapies. BCMA-targeted CAR-T cell therapy, effective for relapsed/refractory MM, induces profound immune deficiency, raising concerns about COVID-19 outcomes in this population. Data on COVID-19 clinical features and outcomes in BCMA CAR-T recipients during the Omicron surge remain limited.

Data Highlights

Key Findings

• Among 49 R/R-MM patients treated with BCMA CAR-T, 93.9% experienced cytokine release syndrome during therapy, with 30.6% having severe CRS.
• The overall response rate to BCMA CAR-T therapy was 98%, with 67.3% achieving complete remission.
• During the Omicron wave, patients infected with SARS-CoV-2 mostly had mild to moderate COVID-19, with a low incidence of severe disease despite immune compromise.
• COVID-19 resolution was defined by symptom resolution or negative testing, with follow-up until April 2023.
• Risk factors for severe COVID-19 and prolonged viral shedding were analyzed using logistic and Cox regression models.

Clinical Implications

Clinicians should be aware that BCMA-targeted CAR-T cell recipients remain vulnerable to SARS-CoV-2 infection but may experience less severe COVID-19 during the Omicron wave compared to earlier variants. Close monitoring for severe disease and prolonged viral shedding is warranted given the underlying immunodeficiency. Vaccination and preventive strategies remain important in this high-risk group.

Conclusion

BCMA-targeted CAR-T cell therapy recipients with R/R-MM infected during the Omicron surge generally had favorable COVID-19 outcomes despite profound immune suppression. These findings provide valuable clinical insights for managing SARS-CoV-2 infection in this vulnerable population.

References

1. Zhejiang University Study 2023 -- Outcomes and Clinical Features of CAR-T Cell Patients Targeting BCMA with COVID-19 During the Omicron Surge