Hematopoietic Stem Cell Transplantation Dilemma During the COVID-19 Era

Samaha, Ramy; Kattan, Joseph

doi:10.2217/fon-2020-0414

Cited by 16 publications

(23 citation statements)

References 36 publications

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“…Cellular therapies cause profound immune dysregulation that leads to increased susceptibility to infections and associated infectious clinical complications and significant morbidity and mortality 9 , 10 , 11 . Transplant and cellular therapy centers worldwide have been challenged with the pandemic because of the high susceptibility to opportunistic and community-acquired infections and their complications in this unique subset of patients 12 , 13 , 14 . Nonetheless, in certain clinical scenarios, postponing transplantation or cellular therapy can negatively affect the prognosis of the malignancy [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of SARS-CoV-2 in Hematopoietic Stem Cell Transplantation and Chimeric Antigen Receptor T Cell Therapy Recipients

Mushtaq

Shahzad

Chaudhary

et al. 2021

Transplantation and Cellular Therapy

103

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Coronavirus disease 2019 (COVID-19), a respiratory illness caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was declared a pandemic in March 2020, and has caused more than 600,000 deaths in the United States at the time of this report. Hematopoietic stem cell transplantation (HCT) or chimeric antigen receptor T cell (CAR-T) therapy recipients have a higher risk of mortality with COVID-19 owing to profound immune dysregulation. In this study, we investigated the impact of SARS-CoV-2 in HCT/CAR-T therapy recipients. This single-center prospective study included all (n = 58) adult HCT/CAR-T recipients who were diagnosed with COVID-19 at the University of Kansas Medical Center between March 2020 and May 2021. Baseline and disease-related characteristics were ascertained from medical records. Data were analyzed using SPSS version 21 (IBM, Armonk, NY). Bivariate analyses, using the chi-square and t-test, and logistic regression analyses were conducted. The study included 58 HCT/CAR-T patients who acquired SARS-CoV-2 infection, including recipients of allogeneic HCT (n = 32), autologous HCT (n = 23), and CAR-T therapy (n = 3). The median patient age was 58 years (range, 24 to 77 years), and 64% were males. The median time from HCT/CAR-T therapy to SARS-CoV-2 infection was 17.7 months (range, 0.2 to 201.9 months), and 22% of the patients acquired SARS-CoV-2 within the first 100 days post-HCT/CAR-T therapy. The primary hematologic disorders were plasma cell (36%), myeloid (38%), and lymphoid (26%) malignancies. Myeloablative conditioning was performed in 62% of patients. Donors were autologous (45%), matched sibling (15%), matched unrelated (21%), and haploidentical (19%). Prior history of grade II-IV acute graft-versus-host disease (GVHD), active GVHD, and current immunosuppressive therapy (IST) was noted in 22%, 31%, and 36% of patients, respectively. Concurrent infections were observed in 19%. Lymphopenia ( P = .049) and high serum ferritin concentration ( P = .020) were associated with mortality. COVID-19 severity was mild in 50% of the patients, moderate in 22%, and severe in 28%. Clinical findings included pneumonia or abnormal chest imaging (in 50%), hypoxia (28%), intensive care unit admission (19%), and mechanical ventilation (10%). Therapies included remdesivir (in 41%), convalescent plasma (35%), dexamethasone (22%), monoclonal antibodies (19%), and tocilizumab (3%). The median duration of viral shedding (positive SARS-CoV-2 PCR) was 7.7 weeks (range, 2 to 18.7 weeks), and 2 patients had a persistent infection for >5 months post-CAR-T therapy. After a median follow-up of 6.1 months (range, 0.5-13.6 months), the mortality rate was 16% in all patients and 28% in allogeneic HCT recipients. Among 9 patients who died, the median survival after SARS-CoV-2 infection was 23 days (range, 14 to 140 days). In survivors with moderate-severe COVID-19, the median time to recovery was 4.2 weeks (range, 1.1 to 24.7 weeks). Among allogeneic HCT...

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Section: Introductionmentioning

confidence: 99%

Impact of SARS-CoV-2 in Hematopoietic Stem Cell Transplantation and Chimeric Antigen Receptor T Cell Therapy Recipients

Mushtaq

Shahzad

Chaudhary

et al. 2021

Transplantation and Cellular Therapy

103

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“…Allogeneic recipients frequently require hospital admissions, 100 with evidence suggesting that outcomes are typically poor following intensive care unit admission in this group. 101 A further concern in patients undergoing allogeneic transplantation is that SARS-CoV-2 can be detected in blood, although to date there have been no reports of transmission from donor to recipient either in the transfusion of blood products or cellular therapies. 102 …”

Section: Specific Recommendationsmentioning

confidence: 99%

“…103 , 104 EBMT recommends that non-urgent transplants should be delayed. 104 In patients for whom urgent transplants are required, there are several considerations. Pretransplantation, community transmission of SARS-CoV-2 should be considered, with patients self-isolating to minimise infection risk before they undergo transplantation.…”

Section: Specific Recommendationsmentioning

confidence: 99%

Supportive care in patients with cancer during the COVID-19 pandemic

Aapro¹,

Lyman²,

Bokemeyer³

et al. 2021

ESMO Open

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“…Moreover, hematopoietic stem cell transplantation should only be performed when and where the risk of SARS-CoV-2 infection is low and only for patients with high disease activity, when other therapies were not effective [50].…”

Section: Patients With Multiple Sclerosismentioning

confidence: 99%

SARS-CoV-2 Infection: Symptoms of the Nervous System and Implications for Therapy in Neurological Disorders

Losy

2020

Neurol Ther

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In this paper, the neurological aspects of COVID-19 are presented, which may be of significance for physicians. Knowledge about the neurological symptoms of COVID-19 infection should help physicians in diagnoses and in taking appropriate precautions, as some manifestations can appear before typical pulmonary symptoms. Various mechanisms of SARS-CoV-2 neuroinvasion are discussed and symptoms are described, which can be subdivided into manifestations of the central nervous system (CNS) (headache, dizziness, stroke, impaired consciousness, encephalitis, meningitis, seizures) and peripheral nervous system (PNS) (characteristic hyposmia and hypogeusia, Guillain Barré syndrome, myalgia). Additionally, the implications of COVID-19 infection for treatment of patients with common neurological diseases and their management is presented. It can be concluded that neurological symptoms are part of a clinical spectrum of COVID-19 infection, involving the CNS and PNS. COVID-19 may influence decisions regarding the treatment of neurological disorders, especially those with an immune background.

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Hematopoietic Stem Cell Transplantation Dilemma During the COVID-19 Era

Abstract: Community viral respiratory infection can occur in about half of HSCT recipients, and infectious complications have been reported to be as high as 92% "

Cited by 16 publications

References 36 publications

Impact of SARS-CoV-2 in Hematopoietic Stem Cell Transplantation and Chimeric Antigen Receptor T Cell Therapy Recipients

Impact of SARS-CoV-2 in Hematopoietic Stem Cell Transplantation and Chimeric Antigen Receptor T Cell Therapy Recipients

Supportive care in patients with cancer during the COVID-19 pandemic

SARS-CoV-2 Infection: Symptoms of the Nervous System and Implications for Therapy in Neurological Disorders

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