Muhammad Bilal Abid, MD, MRCP, assistant professor of medicine, Divisions of Hematology/Oncology and Infectious Diseases, Medical College of Wisconsin, discusses the impact of adaptive lymphodepletion in patients with relapsed/refractory B-cell non-Hodgkin’s lymphoma (NHL) who received CAR T-cell therapy.

This evaluation compared toxicity outcomes in adult patients with relapsed/refractory B-cell NHL between June 2018 and August 2020 who received 2 intensities of lymphodepletion chemotherapy. Patients either received the standard dose of lymphodepletion at 30 mg/m2 of fludarabine and 500 mg/m2 of cytarabine per day for each for 3 days prior to receiving axicabtagene ciloleucel (axi-cel; Yescarta), or a lower-dose of 30 mg/m2 of fludarabine for 3 days and 500 mg/m2 of cytarabine for 1 day.

Patients in the low-dose lymphodepletion cohort had a median duration of lymphopenia of 5 days, compared with a median duration of lymphopenia of 11 days in patients who received standard-dose lymphodepletion, Abid says. Moreover, 50% of patients in the low-dose cohort experienced episodes of neutropenic fever in the first 28 days, vs 85% in the standard-dose cohort, Abid explains.

Risk of neurotoxicity, such as cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome, were significantly less in the low-dose cohort, Abid adds. As a result, the use of corticosteroids and tocilizumab (Actemra) was less in the low-dose cohort, Abid concludes.

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Muhammad Bilal Abid, MD, MRCP, discusses the impact of adaptive lymphodepletion in patients with relapsed/refractory B-cell non-Hodgkin’s lymphoma who received CAR T-cell therapy.


Dr. Abid on Adaptive Lymphodepletion in CAR T-Cell Recipients in R/R B-Cell NHL

Muhammad Bilal Abid, MD, MRCP, assistant professor of medicine, Divisions of Hematology/Oncology and Infectious Diseases, Medical College of Wisconsin, discusses the efficacy of a third COVID-19 vaccine dose after hematopoietic cell transplantation in patients with hematologic malignances.

Seventy-five patients were put together to study the efficacy of a third COVID-19 vaccine dosage after receiving hematopoietic cell transplantation, CAR T-cell therapy, or bispecific T-cell engagers (BiTEs), Abid says. This population included 30 autologous recipients, 26 allogeneic recipients, 10 CAR T recipients, 9 BiTEs recipients, Abid explains. Moreover, all 75 of the patients had not seroconverted to any degree after receiving two doses of the initial primary vaccination and 59% developed protective antibodies after the third dose, Abid says.

When stratified by subgroups, the seroconversion rates were 63% among autologous transplantation recipients, 58% among allogeneic transplantation recipients, and 40% among CAR T-cell recipients, and 67% among BiTE recipients, Abid explains. While there was no significant differences in seroconversion rates based on the state of contemporary relevant clinical variables, corticosteroid usage stood out in terms of conversion rates, Abid emphasizes.

Moreover, there was a significant difference between the titers among those patients who were receiving a dose of corticosteroids at the time of the third vaccination dose vs those who were not, Abid continues. On a subgroup analysis, a significant difference was noted between seroconversion rates among patients with multiple myeloma and lymphoma in autologous transplant subgroups, as seroconversion patients with myeloma converted better than patients with lymphoma, Abid concludes.

Muhammad Bilal Abid, MD, MRCP, discusses the efficacy of a third COVID-19 vaccine dose after hematopoietic cell transplantation in patients with hematologic malignances.


Dr. Abid on the Efficacy of a Third COVID-19 Vaccine Dose After Hematopoietic Cell 

Muhammad Bilal Abid, MD, MRCP, assistant professor of medicine, Divisions of Hematology/Oncology and Infectious Diseases, Medical College of Wisconsin, discusses the potential impact of CAR T-cell therapy on the efficacy of COVID-19 vaccinations.

Patients who undergo CAR T-cell therapy should be revaccinated for COVID-19 following infusion, because the treatment may cause them to lose their response to the vaccine, according to Abid.

Additionally, it has been shown that if the patient received the COVID-19 vaccine within 6 months of receiving CAR T-cell infusion, response rates were not as favorable, Abid explains. Patients who received the vaccination more than 6 months after infusion have improved response rates, likely because they have better immune reconstitution, Abid concludes.

Muhammad Bilal Abid, MD, MRCP, discusses the potential impact of CAR T-cell therapy on the efficacy of COVID-19 vaccinations.

Dr. Abid on the Potential Impact of CAR T-Cell Therapy on COVID-19 Vaccination

Muhammad Bilal Abid, MD, MRCP, assistant professor of medicine in the Divisions of Hematology/Oncology and Infectious Diseases at the Medical College of Wisconsin, discusses challenges with CAR-T cell therapy during the coronavirus disease 2019 (COVID-19) pandemic.

COVID-19 has caused many disruptions in the administration of CAR T-cell therapy​, says Abid. As such, several considerations need to be taken into account.

To mitigate the risk of severe cytokine release syndrome, ​CAR T-cell therapy should be brought to a temporary halt​, Abid explains. Doing so will prevent dysfunctional T cells and an elevation of inflammatory cytokines.

After stopping CAR T-cell therapy, it is critical to closely monitor patients, Abid concludes.

Muhammad Bilal Abid, MD, MRCP, discusses challenges with CAR-T cell therapy during the coronavirus disease 2019 pandemic.

Dr. Abid on Challenges With CAR T-Cell Therapy During the COVID-19 Pandemic 

Muhammad Bilal Abid, MD, MRCP, assistant professor of medicine in the Divisions of Hematology/Oncology and Infectious Diseases at the Medical College of Wisconsin, discusses the current coronavirus disease 2019 (COVID-19) pandemic and its clinical impact on patients with cancer.

Several observational studies around the globe have unanimously shown that patients ​with cancer who contract COVID-19 have much worse outcomes with COVID-19 compared with individuals who do not have cancer, says Abid. Depending on the tumor type, patients with cancer could have higher rates of ICU admissions, morbidity, and mortality. 

Moreover, recent studies discovered that patients with hematologic malignancies and those who are actively receiving immunosuppressive treatments have a higher risk of developing severe COVID-19​–related complications, Abid concludes.

Muhammad Bilal Abid, MD, MRCP, discusses the current coronavirus disease 2019 pandemic and its clinical impact on patients with cancer.

Muhammad B. Abid, MD, MRCP

Articles

Dr. Abid on Adaptive Lymphodepletion in CAR T-Cell Recipients in R/R B-Cell NHL

Dr. Abid on the Efficacy of a Third COVID-19 Vaccine Dose After Hematopoietic Cell

Dr. Abid on the Potential Impact of CAR T-Cell Therapy on COVID-19 Vaccination

Dr. Abid on Challenges With CAR T-Cell Therapy During the COVID-19 Pandemic

Dr. Abid on the Impact of the COVID-19 Pandemic on Patients With Cancer