Saturday, December 2, 2023
This activity is intended for hematologists/oncologists, nurses, infectious disease clinicians, pharmacists and other members of the healthcare team caring for hematopoietic stem-cell transplantation (HSCT) recipients with or at risk for COVID-19.
The goal of this activity is to describe the characteristics and outcomes of HSCT recipients after developing COVID-19, according to an analysis of new data from the Center for International Blood and Marrow Transplant Research (CIBMTR).
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Patients with cancer have at least twice the risk for COVID-19--associated intensive care unit admission, invasive ventilation, and death compared with the general population. Hematopoietic stem cell transplant (HSCT) recipients may be especially vulnerable because of nascent immune systems or treatment-related organ toxicities.
Among individuals who have received an HSCT, often used in the treatment of blood cancers, rates of survival are poor for those who develop COVID-19.
The probability of survival 30 days after being diagnosed with COVID-19 is only 68% for persons who have received an allogeneic HSCT and 67% for autologous HSCT recipients, according to new data from the Center for International Blood and Marrow Transplant Research (CIBMTR).
These findings underscore the need for "stringent surveillance and aggressive treatment measures" in this population, say authors Akshay Sharma, MBBS, of St Jude Children’s Research Hospital in Memphis, Tennessee, and colleagues.
The findings were published in the March issue of The Lancet Haematology.[1]
The study is "of importance for physicians caring for HSCT recipients worldwide," commented Mathieu Leclerc and Sébastien Maury, Hôpitaux universitaires Henri-Mondor, Créteil, France, in an accompanying editorial.[2]
For their study, Sharma and colleagues analyzed outcomes for all HSCT recipients who developed COVID-19 and whose cases were reported to the CIBMTR. Of 318 such patients, 184 had undergone allogeneic HSCT, and 134 had undergone autologous HSCT.
Overall, about half of these patients (49%) had mild COVID-19.
Severe COVID-19 that required mechanical ventilation developed in 15% and 13% of the allogeneic and autologous HSCT recipients, respectively.
About one-fifth of patients died: 22% and 19% of allogeneic and autologous HSCT recipients, respectively.
Factors associated with greater mortality risk included age of ≥ 50 years (HR = 2.53 [95% CI: 1.16, 5.52]; male sex (HR = 3.53 [95% CI: 1.44, 8.67]); and development of COVID-19 within 12 months of undergoing HSCT (HR = 2.67 [95% CI: 1.33, 5.36]).
Among autologous HSCT recipients, lymphoma was associated with higher mortality risk in comparison with a plasma cell disorder or myeloma (HR = 2.41 [95% CI: 1.08, 5.38]), the authors noted.
"Two important messages can be drawn from the results reported by Sharma and colleagues," Leclerc and Maury wrote in their editorial. "The first is the confirmation that the prognosis of COVID-19 is particularly poor in HSCT recipients, and that its prevention, in the absence of any specific curative treatment with sufficient efficacy, should be at the forefront of concerns."
The second relates to the risk factors for death among HSCT recipients who develop COVID-19. In addition to previously known risk factors, such as age and sex, the investigators identified transplant-specific factors potentially associated with prognosis: namely, the nearly 3-fold increase in death among allogeneic HSCT recipients who develop COVID-19 within 12 months of transplant, they explained.
Still, the findings are limited by a substantial amount of missing data, short follow-up, and the possibility of selection bias, they noted.
"Further large and well-designed studies with longer follow-up are needed to confirm and refine the results," the editorialists wrote.
"[A] better understanding of the distinctive features of COVID-19 infection in HSCT recipients will be a necessary and essential step towards improvement of the remarkably poor prognosis observed in this setting," they added.
The study was funded by the American Society of Hematology; the Leukemia and Lymphoma Society; the National Cancer Institute; the National Heart, Lung, and Blood Institute; the National Institute of Allergy and Infectious Diseases; the National Institutes of Health; the Health Resources and Services Administration; and the Office of Naval Research. Sharma receives support for the conduct of industry-sponsored trials from CRISPR Therapeutics AG; Novartis Pharmaceuticals Corporation; and Vertex Pharmaceuticals, Inc. and consulting fees from Spotlight Therapeutics. Leclerc and Maury have disclosed no relevant financial relationships.
