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COVID-19 survival poor for hematopoietic stem cell transplant recipients

The Lancet Haematology
Reuters Health - 02/02/2021 - Approximately one in three hematopoietic stem-cell transplant recipients who develop COVID-19 infections die within 30 days of diagnosis, according to a new study that also identifies factors associated with even greater mortality risk.

Researchers examined data on 318 hematopoietic stem-cell transplant (HSCT) recipients diagnosed with COVID-19 from March 27, 2020, to August 12, 2020. The primary endpoint was overall survival 30 days after diagnosis, with median follow-up of 21 days for allogenic HSCT recipients and 25 days for autologous HSCT recipients.

At 30 days, overall survival was 68% for allogenic HSCT and 67% for autologous HSCT, researchers report in The Lancet Haematology.

"The overall survival estimates … at 30-days after COVID infection are quite poor," said lead study author Dr. Akshay Sharma of St. Jude Children's Research Hospital in Memphis, Tennessee.

"We did not perform a systematic comparison with other cancer patients or general populations, but this survival is less than what has been published for these other groups," Dr. Sharma said by email.

For allogenic HSCT recipients, mortality risk was higher for patients 50 years and older (hazard ratio 2.53), males (HR 3.53), and patients who developed COVID-19 within 12 months of transplantation (HR 2.67).

Among autologous HSCT recipients, mortality risk was higher for patients with lymphoma (HR 2.41) than for patients with plasma cell disorder or myeloma.

A total of 155 (49%) of patients had mild disease severity, but there were also 45 (14%) patients who required mechanical ventilation.

One limitation of the study is that a significant amount of data was missing for individual patients, including data to assess the impact of comorbidities or receipt of active therapy, the study team notes. In addition, the follow-up period was relatively brief.

It's also unclear how different COVID-19 treatment protocols might influence survival outcomes in this patient population.

"All that we can say right now is that prevention is the best management strategy at the moment," Dr. Sharma said.

While social distancing, wearing a mask and frequent hand washing are advisable for everyone, it is even more important for transplant recipients, Dr. Sharma stressed.

"Currently, we cannot recommend any treatment strategies that are helpful or effective to treat transplant recipients who develop COVID based on the available data," Dr. Sharma said.

Stem cell transplant patients are known to be more sensitive to other viral lung infections with influenza, Respiratory Syncytial Virus (RSV), or Herpesviridae such as HSV or VZV, noted Dr. Sebastien Maury of Hopital Henri Mondor in Creteil, France, who coauthored a commentary accompanying the study.

"This translates in more severe forms of infections that may lead to acute respiratory distress syndromes," Dr. Maury said by email. "Exactly as it is the case for influenza each year, patients and their relatives should be strongly incited to receive COVID-19 vaccination, in order to reduce the risk of severe forms of viral infection."

SOURCE: https://bit.ly/3oFwajO and https://bit.ly/3jifMEH The Lancet Haematology, online January 19, 2021.

By Lisa Rapaport

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