Risk factors for a severe disease course in children with SARS-COV-2 infection following hematopoietic cell transplantation in the pre-Omicron period: a prospective multinational Infectious Disease Working Party from the European Society for Blood and Marrow Transplantation group (EBMT) and the Spanish Group of Hematopoietic Stem Cell Transplantation (GETH) study - Scorecard - MDSpire
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Risk factors for a severe disease course in children with SARS-COV-2 infection following hematopoietic cell transplantation in the pre-Omicron period: a prospective multinational Infectious Disease Working Party from the European Society for Blood and Marrow Transplantation group (EBMT) and the Spanish Group of Hematopoietic Stem Cell Transplantation (GETH) study
Clinical Scorecard: Identifying Risk Factors for Severe Outcomes in Pediatric SARS-CoV-2 Cases Post-Hematopoietic Cell Transplantation During the Pre-Omicron Era: Insights from a Multinational Study by the European Society for Blood and Marrow Transplantation and the Spanish Hematopoietic Stem Cell Transplantation Group
At a Glance
Category
Detail
Condition
SARS-CoV-2 infection in pediatric hematopoietic cell transplantation (HCT) recipients
Key Mechanisms
Immunodeficiency post-HCT increases risk of severe COVID-19; factors include neutropenia, lymphocytopenia, graft versus host disease (GVHD), and immunosuppressive therapy
Target Population
Children aged 0–18 years who have undergone allogeneic or autologous HCT
Care Setting
Multinational hematopoietic transplant centers reporting to EBMT and GETH registries
Key Highlights
Children post-HCT have higher risk of severe COVID-19 compared to immunocompetent children, with ~10% requiring ICU care.
Severe disease defined as ICU admission or death within two months of SARS-CoV-2 diagnosis.
Risk factors for severe disease include neutropenia, lymphocytopenia, ongoing immunosuppressive therapy, and presence of acute or chronic GVHD.
Guideline-Based Recommendations
Diagnosis
Confirm SARS-CoV-2 infection by positive PCR on respiratory tract samples.
Assess clinical manifestations including fever, cough, and upper respiratory symptoms.
Perform lung radiology when indicated to detect pulmonary involvement.
Management
Hospitalize children with symptomatic COVID-19 or those requiring oxygen support.
Provide oxygen therapy as needed; consider non-invasive or invasive ventilation for respiratory failure.
Monitor and manage coinfections, primarily viral, when present.
Continue appropriate immunosuppressive therapy as clinically indicated, balancing infection risk.
Monitoring & Follow-up
Monitor neutrophil and lymphocyte counts as markers of immunodeficiency.
Assess for signs of acute or chronic GVHD.
Follow clinical course closely for progression to severe disease requiring ICU admission.
Risks
Children post-HCT are at increased risk of severe COVID-19 outcomes including ICU admission and death.
Neutropenia and lymphocytopenia at time of infection increase risk of severe disease.
Presence of acute or chronic GVHD and ongoing immunosuppressive therapy contribute to worse outcomes.
Patient & Prescribing Data
Pediatric patients (0–18 years) post-allogeneic or autologous HCT diagnosed with SARS-CoV-2 infection before December 16, 2021.
Majority of children were unvaccinated; treatment included supportive care with oxygen and ventilation as needed; immunosuppressive therapy was continued as part of transplant management.
Clinical Best Practices
Early identification and PCR confirmation of SARS-CoV-2 infection in pediatric HCT recipients.
Close monitoring of immunological parameters (neutrophil and lymphocyte counts) to identify patients at risk of severe disease.
Prompt hospitalization and respiratory support for symptomatic children or those with pulmonary involvement.
Multidisciplinary management including transplant specialists to balance immunosuppression and infection control.
Vigilance for coinfections and neurological complications such as meningoencephalitis in severe cases.
by Dina Averbuch, Rafael de la Camara, Gloria Tridello, Nina Simone Knelange, Tatiana A. Bykova, Marianne Ifversen, Veronika Dobsinska, Mouhab Ayas, Amir Ali Hamidieh, Herbert Pichler, Antonio Perez-Martinez, Simone Cesaro, Mikael Sundin, Isabel Badell, Peter Bader, Jan-Erik Johansson, Oana Mirci-Danicar, Petr Sedlacek, Catherine Paillard, Brenda Gibson, Sarah Lawson, Nicolaus Kroeger, Selim Corbacioglu, Malgorzata Mikulska, Jose Luis Piñana, Jan Styczynski, Per Ljungman
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