COVID-19 in HSCT recipients: a collaborative study of the Brazilian Society of Marrow Transplantation (SBTMO)

Abstract

In the COVID-19 scenario, patients undergoing hematopoietic stem cell transplantation (HSCT) infected with SARS-CoV-2 may have an increased risk of death. Through a national multicenter study, we aimed to describe the impact of COVID-19 on the survival of HSCT recipients in Brazil. Eighty-six patients with a confirmed diagnosis of SARS-CoV-2 (92% by RT-PCR) were included. There were 24 children and 62 adults receiving an autologous (n = 25) and allogeneic (n = 61) HSCT for malignant (n = 72) and non-malignant (n = 14) disorders. Twenty-six patients died, (10 on autologous (38%) and 16 patients (62%) on allogeneic group). The estimated overall survival (OS) at day 40 was 69%. Adults had decreased OS compared to children (66% vs 79%, p = 0.03). The severity of symptoms at the time of diagnosis, ECOG score, laboratory tests (C-reactive protein, urea values) were higher in patients who died (p < 0.05). In conclusion, HSCT recipients infected with SARS-CoV-2 have a high mortality rate mainly in adults and patients with critical initial COVID-19 presentation. These findings show the fragility of HSCT recipients with SARS-CoV-2 infection. Therefore, the importance of adherence to preventive measures is evident, in addition to prioritizing the vaccination of family members and the HSCT team.

Risk factors for a severe disease course in children with SARS-COV-2 infection following hematopoietic cell transplantation in the pre-Omicron period: a prospective multinational Infectious Disease Working Party from the European Society for Blood and Marrow Transplantation group (EBMT) and the Spanish Group of Hematopoietic Stem Cell Transplantation (GETH) study

“…Another CIBMTR study that summarized data on 135 children following allo-HCT and 32 children following auto-HCT, reported 6% mortality rate and 4% rate of mechanical ventilation [ 14 ]. A multicenter Brazilian study found higher mortality rates in children post-HCT—5/24 (21%) [ 15 ]—with mortality rates in adults post-HCT comparable with those in the EBMT/GETH study (21/62, 34%). A summary of 54 post-allogeneic pediatric HCT recipients with COVID-19 described in case series and case reports yields figures of 7/27 (26%) ICU admissions and 5/54 (9.3%) mortality [ 16 ].…”

“…In a pediatric CIBMTR study, 45-day survival was lower among recipients transplanted in the centers outside the US and those transplanted between 2014 and 2020 versus 2000–2013 [ 14 ]. In a Brazilian study of 62 adults and 24 children, Eastern Cooperative Oncology Group Performance Status and severity of clinical presentation were associated with mortality in the overall study population, and male gender was associated with mortality in children [ 15 ]. In contrast to our data, other studies also reported a higher proportion of males among immunocompromised children with severe COVID-19 [ 15 , 17 , 19 ].…”

“…In a Brazilian study of 62 adults and 24 children, Eastern Cooperative Oncology Group Performance Status and severity of clinical presentation were associated with mortality in the overall study population, and male gender was associated with mortality in children [ 15 ]. In contrast to our data, other studies also reported a higher proportion of males among immunocompromised children with severe COVID-19 [ 15 , 17 , 19 ]. Higher risk of severe clinical course in children with non-malignant diseases was not reported previously.…”

COVID‐19 in hematopoietic stem‐cell transplant recipients: A systematic review and meta‐analysis of clinical characteristics and outcomes

“…COVID‐19 clinical characteristics, medication used, and lethality are reported in Table 3. From the studies that reported symptomatic rate 7,11,15,21–26 we found 79.4% of symptomatic disease ( n = 624/785, range: 50.0% 26 to 100% 15,23 ). The hospitalization rate varied from 9.2% 26 to 74.0% 10 and the median duration of hospital stay from 14 7 to 8 11 days.…”

“…Median age ranged from 37 25 to 66 15 years old. From the ten articles that described comorbidities, 7,9–11,15,17,20,21,23,24 in eight 9–11,15,17,20,21,23 the most common was hypertension, ranging from 11.7% 15 to 56.3% 9 …”