High Mortality of COVID-19 Early after Allogeneic Stem Cell Transplantation: A Retrospective Multicenter Analysis on Behalf of the German Cooperative Transplant Study Group

• Published in: Transplantation and cellular therapy 2022-06, Vol.28 (6), p.337.e1-337.e10
• Main Authors: Schaffrath, Judith, Brummer, Christina, Wolff, Daniel, Holtick, Udo, Kröger, Nicolaus, Bornhäuser, Martin, Kraus, Sabrina, Hilgendorf, Inken, Blau, Igor-Wolfgang, Penack, Olaf, Wittke, Christoph, Steiner, Normann, Nachbaur, David, Thurner, Lorenz, Hindahl, Heidrun, Zeiser, Robert, Maier, Claus-Philipp, Bethge, Wolfgang, Müller, Lutz P.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Allogeneic stem cell transplantation; COVID-19; COVID-19 - epidemiology; Full Length; Hematopoietic Stem Cell Transplantation; Humans; Middle Aged; Pandemics; Retrospective Studies; SARS-CoV-2; Young Adult
• ISSN: 2666-6367; 2666-6375; 2666-6367
• DOI: 10.1016/j.jtct.2022.03.010

•Recipients of allogeneic stem cell transplantation show high mortality from COVID-19.•Risk factors include older age, infection early after transplantation, and immunosuppression.•There was no significant decrease in mortality during the course of the pandemic.•The majority of patients developed mild COVID-19; main symptoms included fever, cough, dyspnea, fatigue, and gastrointestinal symptoms. Recipients of allogeneic stem cell transplantation (alloSCT) are at high risk for contracting infectious diseases with high morbidity and mortality. Coronavirus disease 2019 (COVID-19) is a viral respiratory disease that can lead to severe pneumonia and acute respiratory distress syndrome, with a potentially fatal outcome. In this retrospective study conducted on behalf of the German Cooperative Transplant Study Group, we aimed to analyze risk factors, disease course, and outcomes of COVID-19 in patients who underwent alloSCT. AlloSCT recipients who became infected with SARS-CoV-2 at German and Austrian transplant centers between February 2020 and July 2021 were included. Classification of COVID-19 severity into mild, moderate-severe, or critical disease and division of the course of the pandemic into 4 phases were done according to the German Robert Koch Institute. The main endpoint was overall mortality at the end of follow-up. We further analyzed the need for treatment in an intensive care unit (ICU) and the severity of disease. Risk factors were evaluated using univariate and multivariate analyses, and survival analysis was performed using Kaplan-Meier method. The study cohort comprised 130 patients from 14 transplant centers, with a median age at diagnosis of COVID-19 of 59 years (range, 20 to 81 years) and a median interval between alloSCT and COVID-19 of 787 days (range, 19 to 8138 days). The most common underlying diseases were acute myeloid leukemia (45.4%) and lymphoma (10.8%). The majority of patients (84.9%) were infected in the later phases of the pandemic; 20.8% had moderate-severe disease, 12.3% had critical disease, and 19.2% were treated in an ICU. After a median follow-up of 127 days, overall mortality was 16.2%, 52.0% among patients treated in an ICU. Risk factors for mortality in multivariate analysis were active disease (odds ratio [OR], 4.46), infection with SARS-CoV-2 ≤365 days after alloSCT (OR, 5.60), age >60 years (OR, 5.39), and ongoing immunosuppression with cyclosporine (OR, 8.55). Risk factors for developing moderate-severe or critical