Viral Dynamics of SARS-CoV-2 in Critically Ill Allogeneic Hematopoietic Stem Cell Transplant Recipients and Immunocompetent Patients with COVID-19

Hematopoietic stem cell transplant (HSCT) recipients and patients receiving chimeric antigen receptor T-cell therapy represent a delicate subgroup within the ICU. Amid the ongoing coronavirus disease (COVID-19) pandemic, the clinical course of the disease in these patients who are at high risk and have elevated mortality rates is still poorly understood. Here, we provide comprehensive data on viral dynamics and outcomes in 6 consecutive patients with a history of HSCT or chimeric antigen receptor T-cell therapy (Tx) requiring ICU treatment for COVID-19 compared with 18 patients with COVID-19 without a history of malignant disease as control patients (individual patient characteristics of patients with Tx are presented in Table 1). BAL samples and plasma samples were assessed. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA was detected and quantified by using real-time RT-PCR, as previously described (1, 2). Antibody titers were determined with the Elecsys Anti–SARS-CoV-2 Ig assay (N-protein) (Elecsys Corp.). Viral isolation was performed using native bronchoalveolar samples as described previously (3). After 48–72 hours, infected Vero cells (CCL81; American Type Culture Collection) were monitored for cytopathic effect, and viral replication was confirmed via RT-PCR (1). For statistical analysis, chi-square analysis, the Fisher exact and Mann-Whitney U tests (SPSS 24.0 [IBM Corp.]), and KaplanMaier analysis were used (GraphPad Prism 8.4.1 [GraphPad Software]).