Table 2.
SARS-CoV-2 infection characteristics and supportive care requirements
| Asymptomatic infection (n=13) |
Mild COVID-19 (n=37) |
Moderate COVID-19 (n=11) |
Severe COVID-19 (n=6)+MIS-C (n=3) | Total | P value | |
| Days following most recent CAR T-cell infusion, median (range) | 90 (21–780) | 732 (21–3180) | 630 (450–2130) | 210.0 (20.0–1230) | 435 (20–3180) | 0.0010 |
| ≤90 days post-CAR T | 7/14 (50.0%) | 5/14 (35.7%) | 0/14 (0.0%) | 2/14 (14.3%) | 14/70 (20.0%) | 0.0040 |
| >90 days post-CAR T | 6/56 (10.7%) | 32/56 (57.1%) | 11/56 (19.6%) | 7/56 (12.5%) | 56/70 (80.0%) | 0.0045 |
| Duration of SARS-CoV-2 Positivity, median (range) (n) | 18.0 (15–21) (2) | 29.5 (8–56) (6) | 30.0 (10–44) (5) | 56.0 (14–215) (5) | 30.0 (8–215) (18) | 0.3786 |
| Time to first negative test, median (range) (n) | 28.0 (0–35) (5) | 75.0 (15–147) (8) | 41.0 (1–52) (5) | 34.0 (20–123) (6) | 32.5 (0–147.0) (24) | 0.3568 |
| SARS-CoV-2 antibody test positivity (%) | 1/5 (20.0) | 3/5 (60.0) | 0/5 (0) | 1/5 (20) | 5/17 (29.4) | 0.2451 |
| Coinfection present (%) | 0/9 (0) | 0/9 (0) | 4/9 (44.4) | 5/9 (55.6) | 9/69 (13.0) | <0.0001 |
| Coinfection bacterial | 3/6 (50.0) | 3/6 (50.0) | 6/9 (66.7) | |||
| Coinfection viral | 0 | 0 | 0 | |||
| Coinfection fungal | 1/1 (100.0) | 0/1 (0.0) | 1/9 (11.1) | |||
| Multiple types of coinfection | 0/2 (0.0) | 2/2 (100.0) | 2/9 (22.2) | |||
| Required hospital admission (%) | 0/20 (0) | 0/20 (0) | 11/20 (55) | 9/20 (45) | 20/70 (28.6) | <0.0001 |
| Reason for admission | 0.0922 | |||||
| Fever | 5/10 (50%) | 5/10 (50%) | 10/20 (20%) | |||
| Respiratory distress | 6/7 (85.7%) | 1/7 (14.3%) | 7/20 (35%) | |||
| Shock | 0/2 (0%) | 2/2 (100%) | 2/20 (10%) | |||
| Other | 0/1 (0%) | 1/1 (100%) | 1/20 (5%) | |||
| Days from SARS-CoV-2+ test to admission, median (range) (n) | 1.0 (0–59) (10) | 11.0 (0–29) (8) | 4.0 (0–59) (18) | 0.9811 | ||
| Duration of hospitalization, median (range) (n) | 5.0 (1–22) (11) | 32 (11–95) (9) | 13.0 (1–95) (20) | 0.0002 | ||
| Required ICU admission | 1/8 (12.5%) | 7/8 (87.5%) | 8/70 (11.4%) | 0.0045 | ||
| Duration of ICU admission, median days (range) (n) | 1 (1–1) (1) | 9.0 (4–85) (7) | 7.0 (1–85) (8) | NA | ||
| Respiratory support required | ||||||
| None | 13/58 (22.4%) | 37/58 (63.8%) | 7/58 (12.1%) | 1/58 (1.7%) | 58/70 (82.9%) | |
| Nasal canula | 4/4 (100%) | 0/4 (0%) | 4/70 (5.7%) | |||
| High-flow nasal canula | 0/2 (0%) | 2/2 (100%) | 2/70 (2.9%) | |||
| Intubation and mechanical ventilation (conventional vent) | 0/2 (0%) | 2/2 (100%) | 2/70 (2.9%) | |||
| Intubation and mechanical ventilation (oscillator) | 0/1 (0%) | 1/1 (100%) | 1/70 (1.4%) | |||
| ECMO | 0/1 (0%) | 1/1 (100%) | 1/70 (1.4%) | |||
| Other | 0/2 (0%) | 2/2 (100%) | 2/70 (2.9%) | |||
| Hypotension/shock | 0/5 (0%) | 0/5 (0%) | 0/5 (0%) | 5/5 (100%) | 5/70 (7.1%) | <0.0001 |
| Required intravenous fluid boluses for hypotension | 0/4 (0%) | 0/4 (0%) | 0/4 (0%) | 4/4 (100%) | 4/70 (5.7%) | <0.0001 |
| Vasopressors required | 0/4 (0%) | 0/4 (0%) | 0/4 (0%) | 4/4 (100%) | 4/70 (5.7%) | <0.0001 |
| Experienced death with SAR-CoV-2 infection | 0/3 (0%) | 0/3 (0%) | 1/3 (33.3%) | 2/3 (66.7%) | 3/70 (4.3%) |
Characteristics of SARS-CoV-2 infections in children and young adult patients who have experienced infection with SARS-CoV-2 following CAR T-cell therapy. Groups are compared with Kruskal-Wallis, χ2 or Fisher’s exact tests with significance of p<0.05.
CAR, chimeric antigen receptor; ECMO, extracorporeal membrane oxygenation; ICU, intensive care unit; MIS-C, multisystem inflammatory syndrome in children; NA, not available.