MPN-433: Outcomes of COVID-19 in Hematopoietic Stem Cell Transplant Recipients: A Single-Institution, Observational Study

Abstract

ContextHematopoietic stem cell transplant (HSCT) recipients are generally considered high risk for poor outcomes following COVID-19 infection. The CIBMTR observational report published by Sharma et al. found that recipients of allogeneic HSCT who contracted COVID-19 had poor overall survival with a 30-day mortality of 32%. However, there are relatively few other studies that evaluate the effect of COVID-19 on HSCT recipients, especially in the setting of in vivo T-cell depletion protocol.ObjectiveThis is a single-institution, retrospective analysis evaluating outcomes of HSCT recipients who were diagnosed with COVID-19 between March 2020 and April 2021.PatientsThere were 21 patients at our institution who had undergone HSCT and subsequently contracted COVID-19. Their median age was 53 years at the time of diagnosis. Thirteen of the patients were Hispanic (61.9%). Six of the patients received match-related stem cells (28.6%), 7 received cells from match unrelated donors (33.3%), and 7 received cells from haploidentical donors (33.3%). Fifteen of the patients (71.4%) received myeloablative conditioning regimens, whereas 5 (23.8%) received reduced intensity or non-myeloablative regimens. One patient had received an autologous stem cell transplant. Our most common GVHD prophylaxis regimens were PTCy/Tacro/MMF (12 pts, 57.1%) and Tacro/MTX (6 pts, 28.5%).ResultsOur primary endpoint in this retrospective analysis was non-relapse mortality within 60 days of COVID-19 diagnosis. Of the 21 patients with confirmed COVID-19 infection, 1 passed away 20 days after diagnosis, giving us a 4.8% case fatality rate. The median time of COVID-19 diagnosis post-transplant was 469 days. Sixteen of the 21 patients were symptomatic at the time of diagnosis (76.2%). Eight patients received steroids for treatment of COVID-19 (38.1%). Seven of the 21 patients (33.3%) were hospitalized for a median of 7 days (range, 5–17 days), with 2 requiring ICU level of care (9.5%). One patient was intubated and ultimately passed away.ConclusionOur data suggest that our HSCT recipients who contracted COVID-19 have had generally good short-term outcomes. Longer follow-up is required to determine if a COVID-19 diagnosis has any effect on long-term transplant related complications and outcomes in this population.