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. 2021 Aug;23(4):e13625.
doi: 10.1111/tid.13625. Epub 2021 May 2.

Clinical presentation and outcomes of COVID-19 following hematopoietic cell transplantation and cellular therapy

Jose F Camargo  1 , Maria A Mendoza  2 , Rick Lin  2 , Ilona V Moroz  1 , Anthony D Anderson  3 , Michelle I Morris  1 , Yoichiro Natori  1 , Akina Natori  4 , Mohammed Raja  1 , Lazaros Lekakis  5 , Amer Beitinjaneh  5 , Antonio Jimenez  5 , Mark Goodman  5 , Trent Wang  5 , Krishna V Komanduri  5 , Denise Pereira  5
Affiliations

Clinical presentation and outcomes of COVID-19 following hematopoietic cell transplantation and cellular therapy

Jose F Camargo et al. Transpl Infect Dis. 2021 Aug.

Abstract

Background: One year into the pandemic, published data on hematopoietic cell transplantation (HCT) recipients with coronavirus disease 2019 (COVID-19) remain limited.

Methods: Single-center retrospective cohort study of adult HCT recipients with polymerase chain reaction (PCR)-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Results: Twenty-eight consecutive transplantation and cellular therapy patients (autologous, n = 12; allogeneic, n = 15; chimeric antigen receptor T-cell therapy [CAR-T], n = 1) with COVID-19 were identified. The median age was 57 years. The median time from HCT to COVID-19 diagnosis was 656 days (interquartile range [IQR], 33-1274). Patients were followed for a median of 59 days (IQR, 40-88). Among assessable patients (n = 19), 10 (53%) had documented virological clearance; median time to clearance was 34 days (range, 21-56). Out of 28, 12 (43%), 6 (21%), and 10 (36%) patients had mild, moderate, and severe/critical disease, respectively. Overall mortality was 25%, nearly identical for autologous and allogeneic HCT, and exclusively seen in hospitalized patients, older than 50 years of age with severe COVID-19. None of the patients with mild (n = 12) or moderate (n = 6) COVID-19 died whereas 7/10 patients (70%) with severe/critical COVID-19 died (P = .0001). Patients diagnosed with COVID-19 within 12 months of HCT exhibited higher mortality (57% vs 14%; P = .04). All-cause 30-day mortality (n = 4) was 14%. A higher proportion of patients who died within 30 days of COVID-19 diagnosis (3/4) were receiving ≥2 immunosuppressants, compared with patients who survived beyond 30 days after COVID-19 diagnosis (2/24; 75% vs. 8%; P = .01).

Conclusions: Mortality in COVID-19 HCT patients is higher than that of the age-comparable general population and largely dependent on age, disease severity, timing from HCT, and intensity of immunosuppression.

Keywords: COVID-19; SARS-CoV-2; hematopoietic cell transplantation.

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Conflict of interest statement

The authors declare no competing financial interests relevant to this manuscript.

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