Background Haematopoietic stem-cell transplantation (HSCT) recipients are considered at high risk of poor outcomes after COVID-19 on the basis of their immunosuppressed status, but data from large studies in HSCT recipients are lacking. This study describes the characteristics and outcomes of HSCT recipients after developing COVID-19. MethodsIn response to the pandemic, the Center for International Blood and Marrow Transplant Research (CIBMTR) implemented a special form for COVID-19-related data capture on March 27, 2020. All patients-irrespective of age, diagnosis, donor type, graft source, or conditioning regimens-were included in the analysis with data cutoff of Aug 12, 2020. The main outcome was overall survival 30 days after a COVID-19 diagnosis. Overall survival probabilities were calculated using Kaplan-Meier estimator. Factors associated with mortality after COVID-19 diagnosis were examined using Cox proportional hazard models. Findings 318 HSCT recipients diagnosed with COVID-19 were reported to the CIBMTR. The median time from HSCT to COVID-19 diagnosis was 17 months (IQR 8-46) for allogeneic HSCT recipients and 23 months (8-51) for autologous HSCT recipients. The median follow-up of survivors was 21 days (IQR 8-41) for allogeneic HSCT recipients and 25 days (12-35) for autologous HSCT recipients. 34 (18%) of 184 allogeneic HSCT recipients were receiving immunosuppression within 6 months of COVID-19 diagnosis. Disease severity was mild in 155 (49%) of 318 patients, while severe disease requiring mechanical ventilation occurred in 45 (14%) of 318 patients-ie, 28 (15%) of 184 allogeneic HSCT recipients and 17 (13%) of 134 autologous HSCT recipients. At 30 days after the diagnosis of COVID-19, overall survival was 68% (95% CI 58-77) for recipients of allogeneic HSCT and 67% (55-78) for recipients of autologous HSCT. Age 50 years or older (hazard ratio 2•53, 95% CI 1•16-5•52; p=0•020); male sex (3•53; 1•44-8•67; p=0•006), and development of COVID-19 within 12 months of transplantation (2•67, 1•33-5•36; p=0•005) were associated with a higher risk of mortality among allogeneic HSCT recipients, and a disease indication of lymphoma was associated with a higher risk of mortality compared with plasma cell disorder or myeloma (2•41, [1•08-5•38]; p=0•033) in autologous HSCT recipients. Interpretation Recipients of autologous and allogeneic HSCT who develop COVID-19 have poor overall survival. These data emphasise the need for stringent surveillance and aggressive treatment measures in HSCT recipients who develop COVID-19.

BACKGROUND: Previous prediction algorithms to achieve target CD34+ goals have not been widely adopted, with many centers still using a set volume to process for hematopoietic progenitor cell collections. This may be because previous algorithms are challenging to implement. Additionally, no study has yet examined the utility of adjusting the collect flow rate (CFR) based on the donor's preprocedure total mononuclear cell (MNC) count, which correlates with CD34+ yield. ABBREVIATIONS: ACD = anticoagulant citrate dextrose; CE = collection efficiency; CFR = collect flow rate; CMNC = continuous mononuclear cell collection; HPC = hematopoietic progenitor cell; MNC = mononuclear cell; NMDP = National Marrow Donor Program; PB = peripheral blood; TBV = total blood volume. * Benchmark CE used was 55% (between mean and median). CE = collection efficiency; CFR = collect flow rate; NA = not available.Volume 59, February 2019 TRANSFUSION 661 A DUAL STRATEGY TO OPTIMIZE HPC COLLECTIONS 16.5 (3.5-46.9) 16.6 AE 9.0 0.0002 18.3 AE 11.7 21 (8-74) 28 AE 4.0 9.0 (4.5-22.5) NA Median (range) and/or mean AE standard deviation. * First number is multiple myeloma continuous subset, second number is other entities continuous subset. † Excluding large-volume leukaphereses of > 30 L and > 4 TBV processed, where CE was lower. CE = collection efficiency; MNC = mononuclear cell; NA = not available. Volume 59, February 2019 TRANSFUSION 665 A DUAL STRATEGY TO OPTIMIZE HPC COLLECTIONS

Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) has a high death rate in patients with comorbidities or in an immunocompromised state. We report a mild and attenuated SARS CoV-2 infection in a patient who is 17 months post stem cell transplantation and maintained on the JAK/STAT inhibitor ruxolitinib, a proposed novel therapy for SARS CoV-2 pneumonia.

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