How to manage chimeric antigen receptor T cell recipients upon encountering COVID-19 infection?

Chimeric antigen receptor (CAR) T cell recipients are considered at higher risk of SARS-CoV-2 infection, more severe COVID-19 illness, and poorer outcomes compared to the general population due to their impaired humoral immunity. Managing COVID-19 in these vulnerable patients is particularly challenging. In this review, we provide a brief overview of the characteristics of COVID-19 infection in CAR-T cell recipients, including the pre-treatment assessments and the timing for initiating CAR-T cell therapy, the treatment of COVID-19 during CAR-T cell therapy, and considerations for SARS-CoV-2 vaccination. Our aim is to offer practical strategies to help clinicians conduct safer and more effective CAR-T cell therapies in the post-COVID-19 pandemic era. The therapeutic approach to COVID-19 in this patient population must be individualized. In regions affected by the SARS-CoV-2 outbreak, CAR-T cell therapy is recommended to be conducted at well-established medical centers with expertise in CAR-T. This approach ensures optimal, comprehensive care throughout the treatment process, with the involvement of a multidisciplinary team being essential to the patient’s care.