COVID 19 Infection in Autologous Stem Cell Transplant (ASCT) Recipients-A Single Institution Observational Cohort

Abstract

COVID 19 infection had significant impact, including high mortality rate, in immunosuppressed patients including patients with hematological malignancies undergoing hematopoietic stem cell transplantation. This retrospective study describes the characteristics and outcomes of COVID 19 infection in autologous stem cell transplantation (ASCT) recipients. The time period for the study was Feb 2020 to Feb 2022. During that time 29 patients (28%) out of 102 ASCT recipients became infected with COVID 19 diagnosed by PCR test. 22 and 7 were multiple myeloma (MM) and lymphoma (Ly) patients, respectively. Infection rate was 30.5% among MM patients and 23% among Ly patients. Median age was 59 years, 16 were females, 45% were Caucasians. Eight patients had infection prior to first ASCT, and one prior to second ASCT. Nine developed the infection within 12 months post ASCT. 6 patients had 2nd episode of infection within 8-20 months from 1st episode, only one patient required hospitalization. One MM patient contracted the infection from his relatives while in the hospital undergoing ASCT. He was one of total of 3 deaths from COVID infection. All 3 patients had significant comorbidities including 2 on dialysis and the 3rd had chronic kidney failure stage 3B, all were MM patients within < 1 year from ASCT. Two of them were vaccinated with the primary shots but no boosters. Overall, 8 patients were hospitalized due to COVID infection, 7 had multiple comorbidities and 6 had low absolute lymphocyte counts (ALC). Sixteen patients were noted to have low ALC around the time of infection, 5 were Ly patients. Seven patients had no symptoms, only 3 of them were vaccinated. Overall, 12 were vaccinated at the time of infection. 10 patients received monoclonal antibodies after they became positive for COVID. Evusheld was given to 2 patients. Other treatments used mainly in hospitalized patients include dexamethasone, remdesivir, and fresh frozen plasma. In conclusion, our patient population seems to have done better than published reports with about 10% mortality from COVID infection. Comorbidities, especially advanced renal failure, and low ALC may have contributed to worse morbidity and mortality outcomes.