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. 2023 Oct 10;7(19):5982-5993.
doi: 10.1182/bloodadvances.2023009786.

Clinical impact of cryopreservation of allogeneic hematopoietic cell grafts during the onset of the COVID-19 pandemic

Steven M Devine  1 , Stephanie Bo-Subait  1 , Michelle Kuxhausen  1 , Stephen R Spellman  1 , Caitrin Bupp  1 , Kwang Woo Ahn  2   3 , Heather E Stefanski  1 , Jeffery J Auletta  1 , Brent R Logan  2   3 , Bronwen E Shaw  2
Affiliations

Clinical impact of cryopreservation of allogeneic hematopoietic cell grafts during the onset of the COVID-19 pandemic

Steven M Devine et al. Blood Adv. .

Abstract

At the onset of the COVID-19 pandemic, the National Marrow Donor Program mandated the cryopreservation of hematopoietic cell grafts from volunteer unrelated donors because of numerous patient and donor safety concerns and logistical hurdles. Using the Center for International Blood and Marrow Transplant Research outcomes database, we report the impact of cryopreservation on overall survival (OS) and other outcomes within 1 year after hematopoietic cell transplantation (HCT). We analyzed 1543 recipients of cryopreserved allografts receiving HCT at US centers during the first 6 months of the pandemic and compared them with 2499 recipients of fresh allografts during a 6-month period in 2019. On multivariable regression analysis, we observed no difference in the OS (P = .09), nonrelapse mortality (P = .89), graft-versus-host disease (GVHD), or GVHD- and relapse-free survival (P = .58) in recipients of cryopreserved vs fresh allografts. Disease-free survival (DFS) was lower in the cryopreserved allograft recipients (P = .006) because of a higher risk of relapse (P = .01) compared with the fresh allograft recipients. Primary graft failure was higher (P = .01), and the risk of chronic GVHD was lower (P = .001) with cryopreservation compared with fresh grafts. In conclusion, although there was no negative impact of cryopreservation on OS, relapse was higher, and DFS was lower than that with no cryopreservation. Fresh grafts are recommended as the pandemic-related logistical hurdles resolve. Cryopreservation should be considered an option for patients when fresh grafts are not feasible.

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Conflict of interest statement

Conflict-of-interest disclosure: H.E.S. is on the advisory board and speakers bureau for Novartis. S.M.D. claims Orca Bio for consultancy. B.E.S. declares consultancy for Orca Bio and Mallinkrodt. The remaining authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Complete donor chimerism in recipients of fresh or frozen allografts assessed at days 30+ and 100+, 6 months, and 1 year after HCT in a subset of cohorts. The differences are statistically significant (P = .02) at 6 months only.
Figure 2.
Figure 2.
Clinical endpoints. Adjusted curves comparing fresh (green dotted lines) and cryopreserved (blue lines) allografts for clinical outcomes including OS (A), DFS (B), aGVHD grade II-IV (C), aGVHD grades III-IV (D), NRM (E), relapse (F), moderate-to-severe cGVHD (G), GRFS (H), neutrophil recovery (I), and platelet recovery (J).
Figure 3.
Figure 3.
Forest plot comparing HRs for clinical outcomes in multivariable analysis comparing fresh and cryopreserved allografts. The OR is presented for primary graft failure.
See this image and copyright information in PMC

Comment in

References

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