Researchers have identified various factors associated with mortality following a diagnosis with the COVID-19 virus among recipients of allogeneic hematopoietic cell transplant (alloHCT) and autologous HCT (autoHCT), according to a study presented at the 2021 Transplantation & Cellular Therapy (TCT) Meetings of the American Society of Blood and Marrow Transplantation (ASBMT) and the Center for International Blood and Marrow Transplant Research (CIBMTR).
The analysis included 318 recipients of HCT who were diagnosed with COVID-19 and had been reported to the CIBMTR between March and August 2020. The alloHCT group had a median age of 47 years (range, <1-76) and was 77% Caucasian and 58% male, and most of these patients (78%) had a primary diagnosis of acute leukemia and myelodysplastic syndromes. The autoHCT group had a median age of 60 years (range, 2-78) and was 55% Caucasian and 60% male. Among these patients, the primary diagnosis was 64% plasma cell disorder/multiple myeloma in 64% and lymphoma in 31%.
Among all patients, 49% had mild COVID-19 while 14% had severe disease (requiring mechanical ventilation). At 30 days after COVID-19 diagnosis, the overall probability of survival was 68% (95% CI: 58-77) among the alloHCT group and 67% (95% CI, 55-78) among autoHCT group.
Among recipients of alloHCT, older age (≥50 years; hazard ratio [HR], 2.53; 95% CI, 1.16-5.52; P =.02), male sex (HR, 3.53; 95% CI, 1.44-8.67; P =.006), and development of COVID-19 within 12 months of HCT (HR, 2.67; 95% CI, 1.33-5.36; P =.005) were associated with a higher risk of mortality among alloHCT recipients.
Among recipients of autoHCT, diagnosis of lymphoma (relative to plasma cell disorders) was the only factor associated with higher mortality (HR, 2.41; 95% CI, 1.08-5.38; P =.03). Among all patients, low absolute lymphocyte count (≤ 0.3×109/L) at COVID-19 diagnosis was associated with worse survival (P =.003).
Prior to the investigation, large-scale studies of the impact of COVID-19 infection on outcomes of recipients of HCT were lacking. “The report is the largest series to date summarizing the outcomes of HCT recipients with COVID-19,” the authors wrote.
Sharma A, Bhatt NS, St. Martin A, et al. COVID-19 in hematopoietic cell transplant recipients: a CIBMTR study [TCT Meetings Abstract 5]. Transplant Cell Ther. 2021;27(3S):S4-S5.