Clinical course and outcomes of COVID‐19 in hematopoietic cell transplant patients, a regional report from the Middle East

Fakih, Riad El; Haroon, Alfadil; Alfraih, Feras; Al-Khabori, Murtadha; Alzahrani, Mohsen; Alhuraiji, Ahmad; Hamadah, Abdulaziz; AlJohani, Naif I.; Alahmari, Bader; Essa, Mohammed F.; Motabi, Ibraheem; Tailor, Imran K; Almaghrabi, Reem S.; Al-Farsi, Khalil; Abosoudah, Ibraheem; Ayas, Mouhab; Elhassan, Tusneem; Suhebeh, Ashraf M.; Ahmed, Syed Osman; Kaloyannidis, Panayotis; Alsaeed, Ahmad; Anezi, Khalid Al; Alamoudi, Sameer; Damlaj, Moussab; Hashmi, Hani Al; Aljurf, Mahmoud

doi:10.1038/s41409-021-01312-y

Cited by 18 publications

(28 citation statements)

References 44 publications

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“…As reported for other immunocompromised patients (solid organ transplantation (SOT), solid tumors) [ 2 ▪▪ ], most HSCT recipients displayed lymphopenia at the time of infection, while median leukocyte and neutrophil counts were within the normal range [ 2 ▪▪ , 6 ▪▪ , 7 , 9 ▪ , 10 – 12 , 15 ]. In the series from Shah et al [ 9 ▪ ], COVID-19 was associated with a reduction in all lymphocytes subsets, not only including CD4 and CD8 T cells but also B lymphocytes and natural killers.…”

Section: Laboratory Evaluations and Protracted Severe Acute Respiratory Syndrome Coronavirus 2 Shedding In Hematopoietic Stem Cell Transpmentioning

confidence: 97%

“…In the largest published studies focusing on adult HSCT recipients with COVID-19 (Table 1 ), median age ranged from 35 to 67 years and most of patients were men [ 2 ▪▪ , 4 , 6 ▪▪ , 7 , 8 ▪▪ , 9 ▪ , 10 – 12 ].…”

Section: Hematopoietic Stem Cell Transplantation Recipients Display Classical Coronavirus Disease 2019 Clinical Featuresmentioning

confidence: 99%

“…In the series from Shah et al [ 9 ▪ ], COVID-19 was associated with a reduction in all lymphocytes subsets, not only including CD4 and CD8 T cells but also B lymphocytes and natural killers. Whenever reported, inflammatory markers, such as ferritin, C-reactive protein, and IL-6 were elevated [ 6 ▪▪ , 7 , 9 ▪ , 12 , 15 ], whereas renal and hepatic functions were rarely provided.…”

Section: Laboratory Evaluations and Protracted Severe Acute Respiratory Syndrome Coronavirus 2 Shedding In Hematopoietic Stem Cell Transpmentioning

confidence: 99%

“…Nasal swab was the predominant method of COVID-19 diagnosis. Four studies provided data suggesting a consistent protracted viral shedding in HSCT patients [ 6 ▪▪ , 7 , 9 ▪ , 12 ]. The median shedding time among HSCT patients with at least two consecutive positive tests ranged from 26 to 54 days.…”

Section: Laboratory Evaluations and Protracted Severe Acute Respiratory Syndrome Coronavirus 2 Shedding In Hematopoietic Stem Cell Transpmentioning

confidence: 99%

“…Despite an important heterogeneity between studies, these findings suggest a higher mortality among HSCT recipients with COVID-19 compared with the general population. In contrast, favorable outcomes reported by few studies seems attributable to highly selected population of HSCT recipients [ 12 , 18 ].…”

Section: Hematopoietic Stem Cell Transplantation Recipients Exhibit Poor Coronavirus Disease 2019 Outcomesmentioning

confidence: 99%

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Coronavirus disease 2019 in immunocompromised patients: a comprehensive review of coronavirus disease 2019 in hematopoietic stem cell recipients

Lafarge

Mabrouki

Yvin

et al. 2021

Current Opinion in Critical Care

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Purpose of review Immunocompromised patients are notably vulnerable to severe coronavirus disease 2019. This review summarizes COVID-19 features and outcomes in autologous and allogeneic hematopoietic stem cell transplantation (HSCT) recipients. Recent findings Recent findings suggest that HSCT recipients exhibit a high burden of comorbidities and COVID-19 clinical features almost similar to the general COVID population. Furthermore, HSCT recipients exhibit a protracted SARS-CoV-2 shedding, prolonging duration of symptoms and promoting the generation of highly mutated viruses. Last, most of studies report a higher COVID-19 mortality in HSCT recipients, mainly driven by age, comorbidities, time from transplantation, and immunosuppression because of both treatments and underlying hematological malignancy. Summary Further studies are warranted to determine the proper impact of HSCT-related immune disorders on COVID-19 outcomes, and to evaluate specific treatments and vaccination strategy in this high-risk population. Taken together, those findings emphasize the need for more rigorous surveillance and preemptive measures for all HSCT recipients.

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Section: Laboratory Evaluations and Protracted Severe Acute Respiratory Syndrome Coronavirus 2 Shedding In Hematopoietic Stem Cell Transpmentioning

confidence: 97%

Section: Hematopoietic Stem Cell Transplantation Recipients Display Classical Coronavirus Disease 2019 Clinical Featuresmentioning

confidence: 99%

Section: Laboratory Evaluations and Protracted Severe Acute Respiratory Syndrome Coronavirus 2 Shedding In Hematopoietic Stem Cell Transpmentioning

confidence: 99%

Section: Laboratory Evaluations and Protracted Severe Acute Respiratory Syndrome Coronavirus 2 Shedding In Hematopoietic Stem Cell Transpmentioning

confidence: 99%

Section: Hematopoietic Stem Cell Transplantation Recipients Exhibit Poor Coronavirus Disease 2019 Outcomesmentioning

confidence: 99%

See 3 more Smart Citations

Coronavirus disease 2019 in immunocompromised patients: a comprehensive review of coronavirus disease 2019 in hematopoietic stem cell recipients

Lafarge

Mabrouki

Yvin

et al. 2021

Current Opinion in Critical Care

View full text Add to dashboard Cite

show abstract

Predictors of clinical evolution of SARS‐CoV‐2 infection in hematological patients: A systematic review and meta‐analysis

Carrara

Razzaboni

Azzini

et al. 2022

Hematological Oncology

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Main aim of this systematic review is to quantify the risk and identify predictors of clinical evolution of SARS‐CoV‐2 in hematological patients compared to different control populations. Two independent reviewers screened the literature assessing clinical outcomes of SARS‐CoV‐2 infection in adult patients with active hematological malignancies published up to June 2021. Primary outcome was COVID‐19 related mortality, secondary outcomes were hospital and intensive‐care admission, mechanical ventilation (MV), and thromboembolic events. Variables related to study setting, baseline patients' demographic, comorbidities, underlying hematological disease, ongoing chemotherapy, COVID‐19 presentation, and treatments were extracted. A total of 67 studies including 10,061 hematological patients and 111,143 controls were included. Most of the studies were retrospective cohorts (51 studies, 76%) and only 19 (13%) provided data for a control group. A significant increased risk of clinical progression in the hematological population compared to the controls was found in terms of COVID‐19 related mortality (OR, 2.12; 95% CI, 1.77–2.54), hospitalization (OR, 1.98; 95% CI, 1.15–3.43), intensive‐care admission (OR, 1.77; 95% CI, 1.38–2.26), and MV (OR, 2.17; 95% CI, 1.71–2.75). The risk remained significantly higher in the subgroup analysis comparing hematological patients versus solid cancer. Meta‐regression analysis of uncontrolled studies showed that older age, male sex, and hypertension were significantly related to worse clinical outcomes of COVID‐19 in hematological population. Older age and hypertension were found to be associated also to thromboembolic events. In conclusion, hematological patients have a higher risk of COVID‐19 clinical progression compared to both the general population and to patients with solid cancer.

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COVID‐19 outcomes in haematopoietic cell transplant recipients: A systematic review and meta‐analysis

Lim

Khan

Karpha

et al. 2022

eJHaem

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Up‐to‐date information on coronavirus disease 2019 (COVID‐19) outcomes and risk factors in haematopoietic cell transplantation (HCT) recipients is required to inform on decisions about cancer treatment and COVID‐19 mitigation strategies. We performed a meta‐analysis to address this knowledge gap. All studies with at least five patients who reported COVID‐19‐related deaths in HCT recipients were included. The primary outcome was COVID‐19‐related death. Secondary outcomes were COVID‐19‐related mechanical ventilation (MV) and intensive care unit (ITU) admission. The cumulative COVID‐19‐related death rate among HCT recipients was 21% (95% confidence interval [CI] 18%–24%), while MV and ITU admission rates were 14% (95% CI 11%–17%) and 18% (95% CI 14%–22%), respectively. Subgroup analysis showed higher death rates in patients who developed COVID‐19 within 12 months of HCT (risk ratio [RR] 1.82, 95% CI 1.09–3.03), within 6 months of receiving immunosuppressant drugs (RR 2.11, 95% CI 1.38–3.20) or in the context of active graft‐versus‐host disease (RR 2.38, 95% CI 1.10–5.16). Our findings support the idea that HCT should remain an integral part of cancer treatment during the COVID‐19 pandemic but also highlight the need to prioritise preventative measures in those patients who are at increased risk of adverse COVID‐19 outcomes.

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Clinical course and outcomes of COVID‐19 in hematopoietic cell transplant patients, a regional report from the Middle East

Cited by 18 publications

References 44 publications

Coronavirus disease 2019 in immunocompromised patients: a comprehensive review of coronavirus disease 2019 in hematopoietic stem cell recipients

Coronavirus disease 2019 in immunocompromised patients: a comprehensive review of coronavirus disease 2019 in hematopoietic stem cell recipients

Predictors of clinical evolution of SARS‐CoV‐2 infection in hematological patients: A systematic review and meta‐analysis

COVID‐19 outcomes in haematopoietic cell transplant recipients: A systematic review and meta‐analysis

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