COVID-19 in HSCT recipients: a collaborative study of the Brazilian Society of Marrow Transplantation (SBTMO)

Abstract

In the COVID-19 scenario, patients undergoing hematopoietic stem cell transplantation (HSCT) infected with SARS-CoV-2 may have an increased risk of death. Through a national multicenter study, we aimed to describe the impact of COVID-19 on the survival of HSCT recipients in Brazil. Eighty-six patients with a confirmed diagnosis of SARS-CoV-2 (92% by RT-PCR) were included. There were 24 children and 62 adults receiving an autologous (n = 25) and allogeneic (n = 61) HSCT for malignant (n = 72) and non-malignant (n = 14) disorders. Twenty-six patients died, (10 on autologous (38%) and 16 patients (62%) on allogeneic group). The estimated overall survival (OS) at day 40 was 69%. Adults had decreased OS compared to children (66% vs 79%, p = 0.03). The severity of symptoms at the time of diagnosis, ECOG score, laboratory tests (C-reactive protein, urea values) were higher in patients who died (p < 0.05). In conclusion, HSCT recipients infected with SARS-CoV-2 have a high mortality rate mainly in adults and patients with critical initial COVID-19 presentation. These findings show the fragility of HSCT recipients with SARS-CoV-2 infection. Therefore, the importance of adherence to preventive measures is evident, in addition to prioritizing the vaccination of family members and the HSCT team.

Fig. 1. Clinical evolutions of Hematopoietic Stem Cell Transplantations patients with COVID-19 diagnosis.

The parentheses represent the number of patients in each stage of disease evolution. Acute or early, first 7 day from diagnosis; progressive, means maintenance or progression of clinical symptoms after 7 days of diagnosis.

Fig. 2. Flowchart of COVID-19 clinical progression according to initial symptoms (number of patients).

Mild disease: no oxygen supplemented; moderate and severe,  any degree of hypoxemia and supplemental oxygen; and critical, mechanical ventilation and or hemodynamic instability.

Fig. 3

Cumulative survival after COVID-19:A: Severity of the condition at diagnosis (p < 0.001); B: Age (Children × Adults) (p = 0.034); C: Sex (pediatrics) (p = 0.049); D: ECOG (adult patients) (p = 0.003).

Fig. 4. Multivariate Correspondence Analysis between the main factors related to survival.

MCA Multiple Correspondence Analysis, Dim Dimension, Cr serum creatinine mg/dL, Ur serum urea mg/dL, yr years old, HSCT Allo Allogeneic hematopoietic stem cell transplantation, HSCT Auto Autologous hematopoietic stem cell transplantation, ECOG: Eastern Cooperative Oncology Group Performance Status, Severity of clinical presentation: asymptomatic/mild and severe/critical (see text).