Clinical Report: Outcomes of COVID-19 in Allogeneic Stem Cell Transplant Patients
Overview
In a prospective cohort of 254 allogeneic hematopoietic stem cell transplant (HSCT) survivors evaluated during the COVID-19 pandemic, six patients tested positive for SARS-CoV-2. Despite some requiring hospitalization and respiratory support, all patients recovered without developing severe complications such as ARDS or requiring intensive care.
Background
Patients with hematological malignancies are known to have worse COVID-19 outcomes compared to the general population. Allogeneic HSCT recipients represent a vulnerable group due to immunosuppression and immune reconstitution status. This study from a tertiary care center in Milan, Italy, assessed COVID-19 incidence, clinical features, treatment, and outcomes in HSCT survivors during the early phase of the pandemic. The cohort was closely monitored with telemedicine and in-person visits, and COVID-19 diagnosis was confirmed by RT-PCR testing.
Data Highlights
Parameter
Value/Description
Number of HSCT survivors evaluated
254
Median follow-up after HSCT
5 years (range 1 month–17 years)
Patients reporting COVID-19 compatible symptoms
24
Patients tested for SARS-CoV-2
21
Confirmed COVID-19 cases
6
Hospitalized COVID-19 patients
3
Median hospital stay for hospitalized patients
8 to 37 days
Complications (ARDS, ICU admission)
None reported
Follow-up after symptom onset
Median 282 days (range 53–305)
Key Findings
Six out of 254 HSCT survivors were diagnosed with COVID-19 confirmed by RT-PCR.
Three patients had mild symptoms managed at home without hospitalization.
Three patients required hospitalization with oxygen support but no intensive care or invasive ventilation.
All hospitalized patients received antiviral therapy (lopinavir/ritonavir) and hydroxychloroquine; some received additional immunomodulatory treatments (anakinra, colchicine).
No patients developed severe complications such as ARDS, acute cardiac injury, deep vein thrombosis, or secondary infections.
All patients fully recovered and were alive at last follow-up with two consecutive negative SARS-CoV-2 tests.
Clinical Implications
This study suggests that allogeneic HSCT recipients can recover from COVID-19 without severe complications when closely monitored and treated promptly. Telemedicine follow-up and early access to transplant physicians may facilitate timely management. Immunological recovery status and individualized treatment approaches, including antiviral and immunomodulatory therapies, may contribute to favorable outcomes in this high-risk population.
Conclusion
In this cohort of allogeneic HSCT survivors, COVID-19 infection was relatively rare and associated with predominantly mild to moderate disease. With appropriate clinical vigilance and treatment, these patients can achieve full recovery without critical illness.
References
Italian Hematology Alliance on COVID-19 2020 -- Outcomes of COVID-19 in hematological malignancies
San Raffaele Scientific Institute COVID-19 Cohort Study 2020 -- Prospective observational cohort of COVID-19 in HSCT patients
WHO 2020 -- Laboratory confirmation of SARS-CoV-2 infection
by Maria Teresa Lupo-Stanghellini, Elisabetta Xue, Sara Mastaglio, Chiara Oltolini, Piera Angelillo, Carlo Messina, Simona Piemontese, Stefania Girlanda, Francesca Farina, Lorenzo Lazzari, Maria Pia Cicalese, Federico Erbella, Raffaella Greco, Massimo Locatelli, Raffaella Milani, Jacopo Peccatori, Consuelo Corti, Sarah Marktel, Andrea Assanelli, Fabio Ciceri
