Allogeneic hematopoietic cell transplantation after infection with SARS-CoV-2 during the COVID-19 pandemic: a multicenter retrospective analysis - Report - MDSpire
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Allogeneic hematopoietic cell transplantation after infection with SARS-CoV-2 during the COVID-19 pandemic: a multicenter retrospective analysis
Outcomes of Allogeneic Hematopoietic Stem Cell Transplantation Post SARS-CoV-2 Infection
Overview
This multicenter retrospective study evaluated 75 patients undergoing alloHCT after SARS-CoV-2 infection, revealing that COVID-19 severity significantly impacts post-transplant survival and non-relapse mortality. Patients with mild COVID-19 had notably better outcomes compared to those with severe or critical disease.
Background
Allogeneic hematopoietic stem cell transplantation (alloHCT) is a curative therapy for hematological malignancies but carries risks including non-relapse mortality and infection susceptibility. The COVID-19 pandemic introduced challenges in timing alloHCT for patients with prior SARS-CoV-2 infection. Understanding how COVID-19 severity affects transplant outcomes is critical for optimizing patient management during the pandemic.
Data Highlights
COVID-19 Severity
Number of Patients
365-day Relapse Rate (%)
365-day Non-Relapse Mortality (%)
365-day Overall Survival (%)
Mild
31
32.1
0
90.9
Moderate
6
0
33.33
66.7
Severe/Critical
12
27.98
19.64
51.1
Key Findings
Patients with mild COVID-19 prior to alloHCT had the highest 365-day overall survival (90.9%) and zero non-relapse mortality.
Severe/critical COVID-19 was associated with significantly increased non-relapse mortality (19.64%) and lower survival (51.1%).
The Karnofsky Index was a strong independent predictor of disease-free survival, with higher scores (90–100) linked to better outcomes.
Univariate Cox regression showed severe/critical COVID-19 increased hazard of death (HR 7.20) compared to mild disease.
No significant association was found between COVID-19 severity and incidence of graft-versus-host disease.
Improved pandemic management by 2022 correlated with absence of severe COVID-19 cases in the cohort, suggesting benefits of vaccination and antiviral therapies.
Clinical Implications
Assessment of COVID-19 severity and functional status via the Karnofsky Index should be integral to pre-transplant evaluation to better stratify risk and guide timing of alloHCT. Preventive strategies including vaccination and infection control remain essential to improve transplant outcomes in patients with prior SARS-CoV-2 infection.
Conclusion
COVID-19 severity and pre-transplant functional status profoundly influence alloHCT outcomes. Tailored pre-transplant assessments and preventive measures are critical to optimize survival in this vulnerable population.
References
Eberhard Karls University Tübingen Ethics Committee 2021 -- Study Approval
WHO COVID-19 Severity Criteria
Early Pandemic Precautionary Measures in alloHCT Patients [3]
Reports on Severe COVID-19 Impact in Immunocompromised Patients [4,5,6]
No Association Between COVID-19 Severity and GvHD [3,7]
by Osama Ahmad, Nicolaus Kröger, Eva Wagner-Drouet, David Nachbaur, Normann Steiner, Daniel Teschner, Sabrina Kraus, Gesine Bug, Salem Ajib, Johannes Schetelig, Wolfgang Andreas Bethge, Thomas Schroeder, Judith Schaffrath, Lutz Peter Müller, Mareike Verbeek, Edgar Jost, Hatice Soysal, Johanna Tischer, Georg-Nikolaus Franke, Stefan Klein, Udo Holtick, Knut Wendelin, Claudia Lengerke, Martin Bornhäuser, Jan Frederic Weller, Maximilian Christopeit
