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Soni M, Migliori E, Assal A, Chan HT, Ciubotariu R, Pan JB, Cicero K, Pereira M, Mapara MY, Muranski P. Development of T-cell immunity in a liver and hematopoietic stem cell transplant recipient following coronavirus disease 2019 infection. Cytotherapy 2021; 23:980-984. [PMID: 34183244 PMCID: PMC8165078 DOI: 10.1016/j.jcyt.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/06/2021] [Accepted: 05/12/2021] [Indexed: 11/07/2022]
Abstract
The outbreak of coronavirus disease 2019 (COVID-19) has disproportionately affected patients with comorbidities, including recipients of solid organ and hematopoietic stem cell transplants (SCT). Upon recovery from COVID-19, the degree of the immunological protection from reinfection remains unclear. Here we describe a 33-year-old patient with erythropoietic protoporphyria (EPP) who had undergone liver transplantation with splenectomy followed by allogeneic SCT in 2013 after an initial failed liver and umbilical cord transplant. The patient developed mild upper respiratory symptoms in the spring of 2020 and was found to have anti-SARS-CoV2 antibodies suggesting past infection. A comprehensive analysis of T cell functionality in peripheral blood from this patient revealed robust in vitro responses against SARS CoV2 antigens Spike (S) 1 and 2, membrane (M) and nucleoprotein (NP), comparable to the reactivity against common antigens from CMV, EBV, Ad and BK viruses, while only low reactivity was seen in healthy donors without documented history of COVID-19. Moreover, the patient displayed a marked recognition of counterpart antigens from related human coronaviruses (hCoVs) 229E, OC43, NL63 and HKU1. Thus, despite lifelong immunosuppression, this survivor of COVID-19 retained a remarkable degree of immunocompetence and showed broad-spectrum T cell memory specific for SARS-CoV2 and related hCoVs including less studied hCoV M and NP antigens. The study highlights the role of cellular immunity after natural COVID-19 infection, suggesting broader use of T cell assays as a tool for risk stratification, measurement of immunocompetence and/or post-infection or post-vaccination protection, and possible T cell-based adoptive immunotherapy strategies in high-risk patients.
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Affiliation(s)
- Mithil Soni
- Columbia Center for Translational Immunology (CCTI), Division of Hematology/ Oncology, Columbia University Medical Center, New York, New York, USA
| | - Edoardo Migliori
- Columbia Center for Translational Immunology (CCTI), Division of Hematology/ Oncology, Columbia University Medical Center, New York, New York, USA
| | - Amer Assal
- Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center, New York, New York, USA; Department of Medicine, Blood and Marrow Transplantation and Cell Therapy Program, Columbia University Irving Medical Center, New York, New York, USA
| | - Hei T Chan
- Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center, New York, New York, USA
| | - Rodica Ciubotariu
- Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center, New York, New York, USA
| | - Jian B Pan
- Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center, New York, New York, USA
| | - Kara Cicero
- Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center, New York, New York, USA
| | - Marcus Pereira
- Department of Medicine, Division of Infectious Disease, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Markus Y Mapara
- Columbia Center for Translational Immunology (CCTI), Division of Hematology/ Oncology, Columbia University Medical Center, New York, New York, USA; Department of Medicine, Blood and Marrow Transplantation and Cell Therapy Program, Columbia University Irving Medical Center, New York, New York, USA
| | - Pawel Muranski
- Columbia Center for Translational Immunology (CCTI), Division of Hematology/ Oncology, Columbia University Medical Center, New York, New York, USA; Hematology Branch, National Heart, Lung, and Blood Institute, Bethesda, MD, United States..
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Vardhana S, Cicero K, Velez MJ, Moskowitz CH. Strategies for Recognizing and Managing Immune-Mediated Adverse Events in the Treatment of Hodgkin Lymphoma with Checkpoint Inhibitors. Oncologist 2018; 24:86-95. [PMID: 30082490 DOI: 10.1634/theoncologist.2018-0045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/13/2018] [Accepted: 04/23/2018] [Indexed: 12/12/2022] Open
Abstract
The programmed death-1 (PD-1) receptor checkpoint inhibitors nivolumab and pembrolizumab represent an important therapeutic advance in the treatment of relapsed or refractory classical Hodgkin lymphoma (cHL). Clinical trials have shown substantial therapeutic activity and an acceptable safety profile in heavily pretreated patients, resulting in U.S. Food and Drug Administration approval of nivolumab for the treatment of cHL that has relapsed or progressed after either autologous hematopoietic cell transplantation (auto-HCT) and brentuximab vedotin treatment or three or more lines of systemic therapy (including auto-HCT), and of pembrolizumab for adult or pediatric patients with refractory cHL or cHL that has relapsed after three or more prior therapies. Mechanistically, anti-PD-1 therapy prevents inhibitory signaling through PD-1 receptors on T cells, thereby releasing a 'block' to antitumor T-cell responses. However, this disinhibition can also lead to inappropriate T-cell activation and responses against healthy tissues, resulting in immune-mediated adverse events (IMAEs) that affect a number of organ systems. The skin, gastrointestinal, hepatic, and endocrine systems are most commonly involved, typically resulting in rash, colitis, abnormal liver enzyme levels, and thyroiditis, respectively. Notably, pneumonitis is a potentially fatal complication of checkpoint inhibitor immunotherapy. Hematologic oncologists who treat cHL with PD-1 immune checkpoint inhibitors should monitor patients for IMAEs, as early recognition and treatment can rapidly reduce morbidity and mortality. This review focuses on IMAEs during the treatment of relapsed or refractory cHL with nivolumab and pembrolizumab. IMPLICATIONS FOR PRACTICE: This article highlights the importance of monitoring for immune-mediated adverse events (IMAEs) in patients with Hodgkin lymphoma (HL) who receive anti-programmed death-1 (anti-PD-1) therapy, with particular attention given to the recognition and management of such events. The risk of individual IMAEs differs between patients with HL and those with solid tumors, as prior treatments may predispose certain organ systems to specific IMAEs. Accurate and prompt diagnosis of IMAEs is essential for optimal management, allowing PD-1 inhibitor therapy to be restarted in order to maintain disease control. Potential difficulties, such as distinguishing disease progression from pneumonitis, or colitis from diarrhea, are highlighted to raise clinical awareness.
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Affiliation(s)
- Santosha Vardhana
- Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Kara Cicero
- New York-Presbyterian/Columbia University Medical Center, New York City, New York, USA
| | - Moises J Velez
- Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Craig H Moskowitz
- Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami Health System, Miami, Florida, USA
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