Intractable COVID-19 and Prolonged SARS-CoV-2 Replication in a CAR-T-cell Therapy Recipient: A Case Study

Authors: Hensley M, Bain W, Jacobs J, Nambulli S, Parikh UM, Cillo A, Staines B, Heaps AL, Sobolewski MD, Rennick LJ, Macatangay BJC, Klamar-Blain C, Kitsios GD, Methé B, Somasundaram A, Bruno TC, Cardello C, Shan F, Workman C, Ray P, Ray A, Lee JS, Sethi R, Schwarzmann WE, Ladinsky MS, Bjorkman PJ, Duprex WP, Agha M, Mellors JW, McCormick KD, Morris A, Haidar G
Publication: Clinical Infectious Diseases
Keywords: COVID-19, RNAemia, SARS-CoV-2, severe acute respiratory syndrome-coronavirus 2

Abstract

A chimeric antigen receptor-modified T-cell therapy recipient developed severe coronavirus disease 2019, intractable RNAemia, and viral replication lasting >2 months. Premortem endotracheal aspirate contained >2 × 1010 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA copies/mL and infectious virus. Deep sequencing revealed multiple sequence variants consistent with intrahost virus evolution. SARS-CoV-2 humoral and cell-mediated immunity were minimal. Prolonged transmission from immunosuppressed patients is possible.

By Matthew K Hensley, William Bain, Jana Jacobs, Sham Nambulli, Urvi Parikh, Anthony Cillo, Brittany Staines, Amy Heaps, Michele D Sobolewski, Linda J Rennick, Bernard JC Macatangay, Cynthia Klamar-Blain, Georgios D Kitsios, Barbara Methé, Ashwin Somasundaram, Tullia C Bruno, Carly Cardello, Feng Shan, Creg Workman, Prabir Ray, Anuradha Ray, Janet S Lee, Rahil Sethi, William E Schwarzmann, Mark S Ladinsky, Pamela J Bjorkman, Dario A Vignali, W Paul Duprex, Mounzer E Agha, John W Mellors, Kevin Dylan McCormick
Alison Morris
Ghady Haidar