CD8+ T cells contribute to survival in patients with COVID-19 and hematologic cancer
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Abstract
Patients with cancer have high mortality from coronavirus disease 2019 (COVID-19), and the immune parameters that dictate clinical outcomes remain unknown. In a cohort of 100 patients with cancer who were hospitalized for COVID-19, patients with hematologic cancer had higher mortality relative to patients with solid cancer. In two additional cohorts, flow cytometric and serologic analyses demonstrated that patients with solid cancer and patients without cancer had a similar immune phenotype during acute COVID-19, whereas patients with hematologic cancer had impairment of B cells and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific antibody responses. Despite the impaired humoral immunity and high mortality in patients with hematologic cancer who also have COVID-19, those with a greater number of CD8 T cells had improved survival, including those treated with anti-CD20 therapy. Furthermore, 77% of patients with hematologic cancer had detectable SARS-CoV-2-specific T cell responses. Thus, CD8 T cells might influence recovery from COVID-19 when humoral immunity is deficient. These observations suggest that CD8 T cell responses to vaccination might provide protection in patients with hematologic cancer even in the setting of limited humoral responses.
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In blood cancer patients, CD8+ T cells may compensate for weak humoral immunity and have been linked to better outcomes, suggesting T cells help protect against SARS-CoV-2.
“in patients with hematological malignancy, CD8+ T cells appear to compensate for lack of humoral immunity and were associated with improved outcomes, indicating a role for T cells in protection against SARS-CoV-2 infection (Bange et al., 2021).”
From Rapid induction of antigen-specific CD4+ T cells is associated with coordinated humoral and cellular immunity to SARS-CoV-2 mRNA vaccination (2021) · cites this paper as Bange et al., 2021
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- Authors
- Bange, E. M., Han, N. A., Wileyto, P., Kim, J. Y., Gouma, S., Robinson, J., Greenplate, A. R., Hwee, M. A., Porterfield, F., Owoyemi, O., Naik, K., Zheng, C., Galantino, M., Weisman, A. R., Ittner, C. A. G., Kugler, E. M., Baxter, A. E., Oniyide, O., Agyekum, R. S., Dunn, T. G., Jones, T. K., Giannini, H. M., Weirick, M. E., McAllister, C. M., Babady, N. E., Kumar, A., Widman, A. J., DeWolf, S., Boutemine, S. R., Roberts, C., Budzik, K. R., Tollett, S., Wright, C., Perloff, T., Sun, L., Mathew, D., Giles, J. R., Oldridge, D. A., Wu, J. E., Alanio, C., Adamski, S., Garfall, A. L., Vella, L. A., Kerr, S. J., Cohen, J. V., Oyer, R. A., Massa, R., Maillard, I. P., Maxwell, K. N., Reilly, J. P., Maslak, P. G., Vonderheide, R. H., Wolchok, J. D., Hensley, S. E., Wherry, E. J., Meyer, N. J., DeMichele, A. M., Vardhana, S. A., Mamtani, R., & Huang, A. C.
- Affiliations
- Abramson Cancer Center (US)
- University of Pennsylvania (US)
- Memorial Sloan Kettering Cancer Center (US)
- Pennsylvania Hospital (US)
- Parker Institute for Cancer Immunotherapy (US)
- Children's Hospital of Philadelphia (US)
- Lancaster General Hospital (US)
- Corresponding author
- Vardhana, Santosha A.
- Mamtani, Ronac
- Huang, Alexander C.
- ORCID
- Bange, Erin M.
- Han, Nicholas A.
- Kim, Justin Y.
- Gouma, Sigrid
- Greenplate, Allison R.
- Owoyemi, Olutosin
- Zheng, Cathy
- Weisman, Ariel R.
- Kugler, Emily M.
- Baxter, Amy E.
- Agyekum, Roseline S.
- Jones, Tiffanie K.
- Giannini, Heather M.
- Weirick, Madison E.
- McAllister, Christopher M.
- Babady, N. Esther
- Kumar, Anita
- Widman, Adam J.
- DeWolf, Susan
- Perloff, Tara
- Sun, Lova
- Mathew, Divij
- Giles, Josephine R.
- Oldridge, Derek A.
- Wu, Jennifer E.
- Alanio, Cécile
- Adamski, Sharon
- Garfall, Alfred L.
- Vella, Laura A.
- Cohen, Justine V.
- Oyer, Randall A.
- Massa, Ryan
- Maillard, Ivan P.
- Maxwell, Kara N.
- Reilly, John P.
- Maslak, Peter G.
- Vonderheide, Robert H.
- Wolchok, Jedd D.
- Hensley, Scott E.
- Wherry, E. John
- Meyer, Nuala J.
- DeMichele, Angela M.
- Vardhana, Santosha A.
- Mamtani, Ronac
- Huang, Alexander C.
- Venue
- Nature Medicine
- Published
- 2021-05-20
- Volume
- 27
- Issue
- 7
- Pages
- 1280-1289
- ISSN
- 1078-8956 (ISSN-L)
- 1546-170X
- PMC
- PMC8291091
- OpenAlex
- W3162400064
- Cited by
- 519
- References
- 66
- Citations by year
- 2026: 21 · 2025: 54 · 2024: 68 · 2023: 111 · 2022: 189 · 2021: 76
- FWCI
- 35.36
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Nature Medicine (publishedVersion)
- Research Square (acceptedVersion, cc-by)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- PubMed Central (submittedVersion, cc-by)
- Funders
- Cancer Research Institute (T32CA009140)
- Leukemia and Lymphoma Society
- American Society of Clinical Oncology
- University of Pennsylvania
- Pershing Square Sohn Cancer Research Alliance
- Parker Institute for Cancer Immunotherapy (AI082630, AI155577)
- Allen Institute for Immunology
- National Institutes of Health (AI201085, COVID-19, AI112521, AI082630, AI117950)
- National Heart, Lung, and Blood Institute (R01HL137915, R01HL137006, T32HL007586)
- National Cancer Institute (K08CA230157, T32CA009140, T32CA009512, P30CA008748, T32CA009679)
- National Institute of Allergy and Infectious Diseases (AI 082630, AI136660, COVID-19, K08AI136660, AI112521, AI 117950, U19AI117950, P01AI112521, AI155577, R01AI155577, R01AI123539, U19AI082630)
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
- Keywords
- COVID-19 pandemic, SARS-CoV-2, CD8+ T cells, hematologic cancer, solid tumors, survival, mortality, humoral immunity, SARS-CoV-2 antibodies, anti-CD20 therapy, T cell response, cancer immunotherapy, hospitalized patients
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