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

Abstract

Background: Hematopoietic stem cell transplant (HSCT) recipients are at increased risk of mortality and morbidity with coronavirus disease 2019 (COVID-19) due to severe immune dysfunction. Methods:A literature search was performed on PubMed, Cochrane, and Clinical trials.gov from the date of inception to 12/08/2021. We identified 19 original studies reporting data on COVID-19 in HSCT recipients after screening 292 articles.Data were extracted following preferred reporting items for systematic reviews and meta-analysis guidelines. Quality evaluation was done using the National Institutes of Health (NIH) quality assessment tool. Inter-study variance was calculated using Der Simonian-Laird Estimator. Pooled analysis was conducted using MetaXL. A randomeffects model was used to estimate the proportions with 95% confidence intervals (CI).Results: Of 6711 patients in 19 studies, 2031 HSCT patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were analyzed. The median age of patients was 56.9 (range 1-81.6) years, and 63% patients were men according to 14 studies. The median time from transplant to SARS-CoV-2 infection for autologous (auto) and allogeneic (allo) HSCT patients was 23.2 (0.33-350.5) months and 16.4 (0.2-292.7) months, respectively. The median follow-up time after COVID-19 diagnosis was 28 (0-262) days. The COVID-19 mortality rate was 19% (95% CI 0.15-0.24, I 2 = 76%, n = 373/2031). The pooled mortality rate was 17% (95% CI 0.12-0.24, I 2 = 78%, n = 147/904) in auto-HSCT patients and 21% (95% CI 0.16-0.25, I 2 = 60%, n = 231/1103) in allo-HSCT patients.Conclusions: HSCT recipients have a high risk of mortality and clinical complications due to COVID-19. There is a need for ongoing vigilance, masks, and social distancing, vaccination, and aggressive management of SARS-CoV-2 infection in HSCT recipients.

COVID-19 and HSCT (Hematopoietic stem cell transplant)

“…That said, it is uncontested that COVID-19 disease severity and morbidity are increased in the HSCT population, relative to the population at large. A systematic review and meta-analysis that included 19 studies published from the outset of the pandemic through December 31, 2021 reported on outcomes from 2031 HCT recipients who had a median age of 57 years, a median time from transplant of 23 months for autologous recipients and 16 months for allogeneic recipients, and a median time from COVID-19 diagnosis of 28 days (range 0–262); a pooled analysis revealed an intensive care unit admission rate of 29% and a mortality rate of 19% [ 37 ]. There was a slightly higher, though not statistically significant, mortality rate among allogeneic HCT recipients compared with autologous recipients, 21% vs 17%, respectively.…”

Predictors of Covid-19 Vaccination Response After In-Vivo T-Cell–Depleted Stem Cell Transplantation

“… 1 The initial death rates among patients with hematological malignancies were high. 2 , 3 , 4 Although vaccination was rapidly developed, immunosuppressed patients were excluded from the initial studies; questions regarding efficacy and tolerance in these populations are only now being addressed. Responses in patients with hematological malignancies are particularly poor among patients with chronic lymphocytic leukemia and myeloma and further weakened upon exposure to daratumumab and to B cell-depleting agents.…”

Changes in the medical-seeking pattern and daily behavior of hematopoietic stem-cell transplant recipients during the COVID-19 epidemic: An online survey in Hubei Province, China

“…Prior to this survey, there has only been a small amounts of published articles describing how to manage hematopoietic cell transplant during the SARS-CoV-2 pandemic ( 11 , 15 – 19 ). They reported that patients received HSCT are at increased risk of infection with SARS-CoV-2 and COVID-19 ( 18 ).…”