Patients who have undergone either autologous or allogeneic hematopoietic stem cell transplantation (HSCT) have been found to be at high risk for mortality in the event of a COVID-19 diagnosis, according to research published in The Lancet Haematology.
Patients with cancer who contract the novel coronavirus disease 2019 (COVID-19), which is caused by the SARS-CoV-2 coronavirus, are at increased risk for hospitalization and death compared with the general population. Although there is some evidence that patients who undergo HSCT — a common treatment for hematologic malignancies — are at similarly increased risk, particularly because of immune impairment related to treatment, the degree of increased risk was previously unestablished.
For this study, researchers evaluated data reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) to determine any associations between COVID-19 incidence, HSCT, and patient outcomes.
Overall, between late March and early August 2020, 318 patients who had previously undergone allogeneic or autologous HSCT were diagnosed with COVID-19 and had data reported to the CIBMTR. Among the 184 and 134 patients who underwent allogeneic and autologous transplantation, respectively, the average ages were 47 and 60 years, 77 (40%) and 53 (40%) were women, 141 (77%) and 74 (55%) were White, and the most common diagnoses were acute myeloid leukemia (66; 36%) and plasma cell disorder/multiple myeloma (86; 64%), respectively.
The median follow-up was 21 days in the allogeneic HSCT group and 25 days in the autologous HSCT group; patients who underwent allogeneic HSCT had a median time from transplantation to diagnosis of 17 months vs 23 months among those who underwent autologous HSCT.
In the overall HSCT patient group, 155 (49%) patients had mild COVID-19, while 45 (14%; 28 in the allogenic HSCT group and 17 in the autologous HSCT group) had disease requiring a ventilator. With a COVID-19 diagnosis, 30-day overall survival was 68% (95% CI: 58-77) in the allogeneic transplantation group and 67% (95% CI: 55-78) among those who underwent autologous HSCT.
Patients older than 50 years (hazard ratio [HR], 2.53; P =.02), male patients (HR, 3.53; P =.006), and those who contracted COVID-19 within 1 year of HSCT (HR, 2.67; P =.005) were found to be at increased risk for mortality in the overall group.
“The current data underscore the need for more stringent surveillance and pre-emptive measures for all HSCT recipients,” the authors wrote. “As more data become available, future directions will include assessments of treatment impacts on outcome, associated coinfections, and better determination of risk factors for mortality in HSCT recipients with COVID-19.”
Disclosures: Some authors have declared affiliations with or received funding from the pharmaceutical industry. Please refer to the original study for a full list of disclosures.
Sharma A, Bhatt NS, St Martin A, et al. Clinical characteristics and outcomes of COVID-19 in haematopoietic stem-cell transplantation recipients: an observational cohort study. Lancet Haematol. Published online January 19, 2021. doi:10.1016/S2352-3026(20)30429-4