PhD Scientific Days 2025

Conservative Medicine II.

Comparison of Virus-Specific T-Cell Therapy and CD45RA+ T-Cell-Depleted Donor Lymphocyte Infusion Against COVID-19 Among Adult Patients with Hematologic Malignancies

Name of the presenter

Petrik Borisz Rabán

Institute/workplace of the presenter

Semmelweis Doctoral College Károly Rácz Conservative Medicine Divison

Authors

Borisz Rabán Petrik¹, Bálint Gergely Szabó², László Gopcsa³, Marienn Réti³, Péter Reményi³, János Sinkó³, István Vályi-Nagy³

1: Semmelweis Doctoral College Károly Rácz Conservative Medicine Divison
2: Semmelweis University, Department of Hematology and Internal Medicina, Departmental Group of Infectious Diseases
3: South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Department of Hematology

Text of the abstract

Introduction
Treatment of COVID-19 among patients with hematologic malignancies or after hematopoetic stem cell transplantation (HSCT) is challenging, disease severity and prolonged viral shedding are frequent. Adoptive cellular therapies might provide COVID-19 remission.

Aims
Our aim was to compare the use of virus-specific T-cell therapy (VST) and CD45RA+ T-cell depleted donor lymphocyte infusion (DLI).

Methods
A prospective, interventional study was conducted involving adult patients with onco-
hematologic diseases who received either VST or DLI for the treatment of COVID-19.
Eligibility criteria were: (1) inadequate response to at least two prior anti-COVID-19
therapies; (2) presence of persistent pulmonary infiltrates; (3) ongoing clinical symptoms
with continuous respiratory tract SARS-CoV-2 RT-PCR positivity. Allocation to VST or DLI
treatment was based on HLA compatibility and donor availability. All patients were followed
for one year post-infusion. The primary outcome was clinical resolution of COVID-19.
Secondary outcomes included COVID-19 relapse, new onset or progression graft-versus-
host disease (GvHD), hematological relapse, and all-cause mortality at one year.

Results
23 patients were enrolled, with 12 receiving VST and 11 receiving DLI.
The median age was 59 years in the VST group and 46 years in the DLI group (p=0.09). Most
common underlying hematologic malignancies were acute leukemias and non-Hodgkin
lymphomas, post-HSCT status was observed in 7 VST and 10 DLI patients (p=0.26).
Vaccination rates were comparable between groups (75.0% vs. 63.6%, p=0.67). Pneumonitis
was more frequent in the VST group (91.7% vs. 45.5%, p=0.03), viraemia
was observed in 50.0% of VST and 63.6% of DLI patients (p=0.06). No statistically
significant differences were found in hospitalization rates (91.7% vs. 63.6%, p=0.16) or ICU
admissions (25.0% vs. 18.2%, p=1.0). COVID-19 relapse occurred more frequently in the
VST group (58.3% vs. 27.3%, p=0.21). Progression of GVHD was scarce (16.7% vs. 0%, p=1.0). One-year overall survival was similar between groups(50.0% vs. 45.5%, p=1.0). Among patients achieving PCR negativity, one-year COVID-19-free survival was higher in DLI group (20.0% vs. 50.0%, p=0.19).

Conclusion
Both VST and DLI might be effective and safe therapy for difficult-to-control
COVID-19 infection in this special patient population.
Funding: none