A Portrait of SARS-CoV-2 Infection in Patients Undergoing Hematopoietic Cell Transplantation: A Systematic Review of the Literature.

Adrian J M Bailey,Christopher Bredeson,David S Allan,C Arianne Buchan,Aidan M Kirkham,Madeline Monaghan,Risa Shorr

doi:10.3390/curroncol29010030

Adrian J M Bailey, Christopher Bredeson + Show 5 more

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https://doi.org/10.3390/curroncol29010030

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Journal: Current Oncology	Publication Date: Jan 13, 2022
Citations: 15	License type: CC BY 4.0

Affiliation: University of Ottawa, Ottawa Hospital

Abstract

The management of COVID-19 in hematopoietic cell transplant (HCT) recipients represents a special challenge given the variable states of immune dysregulation and altered vaccine efficacy in this population. A systematic search (Ovid Medline and Embase on 1 June 2021) was needed to better understand the presenting features, prognostic factors, and treatment options. Of 897 records, 29 studies were identified in our search. Most studies reporting on adults and pediatric recipients described signs and symptoms that were typical of COVID-19. Overall, the mortality rates were high, with 21% of adults and 6% of pediatric HCT recipients succumbing to COVID-19. The factors reported to be associated with increased mortality included age (HR = 1.21, 95% CI 1.03–1.43, p = 0.02), ICU admission (HR = 4.42, 95% CI 2.25–8.65, p < 0.001 and HR = 2.26, 95% CI 1.22–4.20, p = 0.01 for allogeneic and autologous HCT recipients), and low platelet count (OR = 21.37, 95% CI 1.71–267.11, p = 0.01). Performance status was associated with decreased mortality (HR = 0.83, 95% CI 0.74–0.93, p = 0.001). A broad range of treatments was described, although no controlled studies were identified. The risk of bias, using the Newcastle–Ottawa scale, was low. Patients undergoing HCT are at a high risk of severe morbidity and mortality associated with COVID-19. Controlled studies investigating potential treatments are required to determine the efficacy and safety in this population.

Highlights

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for Coronavirus Disease 2019 (COVID-19), is a zoonotic viral pathogen that has become a widespread global health concern [1,2]
In our systematic review, we provide a comprehensive portrait of the clinical manifestations and outcomes of adult and pediatric Hematopoietic cell transplantation (HCT) recipients diagnosed with COVID-19
Our review highlights the paucity of clinical data on the presentation, outcomes, and treatment of COVID-19 in pediatric HCT patients

Summary

Introduction

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for Coronavirus Disease 2019 (COVID-19), is a zoonotic viral pathogen that has become a widespread global health concern [1,2]. Hematopoietic cell transplantation (HCT) is potentially curative for many patients with hematological malignancies [3,4] but induces marked immunosuppression during and after transplantation [3,5]. This is true in allogeneic HCT where systemic immune suppression is needed to prevent and/or treat graft versus host disease (GVHD). In the context of COVID-19, where deferral of a transplant is not often possible and where HCT patients are unlikely to be vaccinated in the immediate peri-transplant period and/or have a compromised response to vaccination [6], recipients likely remain at a greater risk of adverse outcomes if infected [7]

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