Abid on Optimizing COVID-19 Vaccines in CAR T-Cell Therapy Recipients

Welcome to OncLive On Air^®! I’m your host today, Kristi Rosa.

OncLive On Air^® is a podcast from OncLive^®, which provides oncology professionals with the resources and information they need to provide the best patient care. In both digital and print formats, OncLive^® covers every angle of oncology practice, from new technology to treatment advances to important regulatory decisions.

In today’s episode, we had the pleasure of speaking with Muhammad Bilal Abid, MD, MRCP, an assistant professor of medicine in the Divisions of Hematology/Oncology & Infections Diseases at the Medical College of Wisconsin, about his recent review paper outlining what is known about the risk of infections with CAR T-cell therapy and determinants of SARS-CoV-2 responses.

CAR T-cell therapies have demonstrated unprecedented response rates in patients with relapsed or refractory hematologic malignancies. However, this modality also has been found to have distinctive short- and long-term toxicities and infection risks in those who receive it after several prior treatments, such as transplant.

Toxicities can include cytokine release syndrome and immune effector cell–associated neurotoxicity syndrome. Other adverse effects like long-term B-cell depletion, hypogammaglobulinemia, and cytopenia can predispose patients to severe infections and impact remission success.

Risk of such infections depend upon certain patient- and disease-related factors, including lymphodepletion chemotherapy regimen, the interval between cell collection and infusion, bridging therapy, CAR T-cell dose, signaling and costimulatory domains, and target antigen. Moreover, certain CAR T constructs may confer a higher risk or more frequent CRS than others, resulting in a higher incidence of infections.

Early observational findings suggested that patients with hematologic malignancies might not achieve an acceptable response to SARS-CoV-2 vaccination. In our exclusive interview, Abid discussed immune-compromising factors that are indigenous to CAR T recipients, the immunogenic potential of different vaccines, determinants of vaccine responses, and the potential need for booster vaccine dosing in this population.

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