The clinical course of COVID-19 in hematopoietic stem cell transplantation (HSCT) recipients

Abstract

Background/aim: The disease caused by SARS-CoV-2 was named as COVID-19.There is as yet insufficient information about the effects of HSCT on the clinical course of COVID-19. In the present study, we aimed to investigate the clinical course of COVID-19 in patients who had undergone HSCT. Materials and methods:We analyzed baseline characteristics, clinical course and findings of COVID-19, hospitalization and death rates, overall survival and case fatality rates of HSCT recipients diagnosed with COVID-19 retrospectively.Results: 57.6% of the patients underwent AHSCT, and 42.4% underwent allo-HSCT. 60.6%, 27.3%, and 12.1% of the patients had mild, moderate and severe COVID-19 or critical illness, respectively. 45.5% were hospitalized, and 12.1% required intensive care. 9.1% necessitated invasive mechanical ventilation. The total CFR was 9.1% in HSCT recipients, 22.2% in patients with active hematologic malignancy and 4.2% in patients without active hematologic malignancy. Conclusion:It can be concluded that mortality of HSCT recipients is lower in patients whose primary disease is in remission compared to ones that are not in remission.Further studies with larger group patients are needed in order to delineate the effects of COVID-19 on HSCT patients.

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

“…17,18,20,22,26,29,31,33 A total of 27 patients had acute GVHD, 17,18,20,29,31,33 and 98 patients has chronic GVHD. 18,29,31,33 Two of the included studies did not specify the type of active GvHD. 22,26 Mushtaq et al and Varma et al reported a higher mortality in patients with active GVHD.…”

“…17,18,22,25,26,29 Radiological abnormalities on chest imaging, including chest x-ray and CT scans, were seen in 47% patients (95% CI 0.35-0.59, I 2 = 89%, n = 293/615) as reported by 10 studies. 15,17,18,21,22,25,26,29,30,33 Severity of COVID-19 was not defined uniformly by studies included in this meta-analysis. Various definitions used to define COVID-19 severity by included studies are detailed in Tables S2-S3.…”

“…Three studies reported a higher mortality with concurrent IST 20,22,31 . Active graft‐versus‐host disease (GVHD) at the time of COVID‐19 diagnosis was reported in 21% (95% CI 0.15–0.27, I 2 = 64%, n = 149/701) patients 17,18,20,22,26,29,31,33 . A total of 27 patients had acute GVHD, 17,18,20,29,31,33 and 98 patients has chronic GVHD 18,29,31,33 .…”

“…Other remarkable laboratory indices included mild anemia (median hemoglobin 11.3 g/dl, range 7–15.6) 22,26,29,30 and elevated inflammatory markers, such as elevated CRP (median 32 mg/L, range 0.6–349), 15,17,20,22,26,29,30 D‐dimer (median 992 ng/ml, range 0.9–15733), 15,22,25,26,29,30 and ferritin (median 1566 ng/ml, range 32–13851) 17,18,22,25,26,29 . Radiological abnormalities on chest imaging, including chest x‐ray and CT scans, were seen in 47% patients (95% CI 0.35–0.59, I 2 = 89%, n = 293/615) as reported by 10 studies 15,17,18,21,22,25,26,29,30,33 …”

“…A total of 19 studies were included in this systematic review and meta-analysis, of which 16 were retrospective studies, and three were prospective studies. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] Of 6711 patients, 2031 patients who had HSCT were evaluated (Table 1). Median age was 56.9 (1-81.6) years, and 63% (n = 632/1001) patients were male according to 15 studies.…”