Cellular therapy during COVID-19: Lessons learned and preparing for subsequent waves

Abstract Background An evidence-based triage plan for cellular therapy distribution is critical in the face of emerging constraints on healthcare resources. We evaluated the impact of treatment delays related to COVID-19 on patients scheduled to undergo hematopoietic cell transplantation (HCT) or chimeric antigen receptor T-cell (CAR-T) therapy at our center. Objective To evaluate the impact of treatment delays related to COVID-19 on patients who were planned to undergo HCT or chimeric antigen receptor T-cell (CAR-T) therapy at our center. Study Design Data was collected in real time between March 19 – May 11, 2020 on patients delayed to cellular therapy. We evaluated the proportion of delayed patients who ultimately received cellular therapy; reasons for not proceeding to cellular therapy; and changes in disease and health status during delay. Findings 85 patients were delayed, including 42 patients planned to undergo autologous HCT, 36 patients planned to undergo allogeneic HCT, and 7 patients planned to undergo CAR-T therapy. 56 patients (66%) have since received planned therapy. Five patients died during delay. The most common reason for not proceeding to autologous HCT was good disease control among patients with plasma cell dyscrasias (75%). The most common reason for not proceeding to allogeneic HCT was progression of disease (42%). All patients with acute leukemia who progressed had measurable residual disease (MRD) at the time of delay, while no patient without MRD at the time of delay progressed. Six patients (86%) ultimately received CAR-T therapy, including three patients who progressed during the delay. Conclusion For patients with high risk disease such as acute leukemia and particularly those with MRD at time of planned HCT, treatment delay resulted in devastating outcomes and should be avoided if at all possible.