Improved outcomes over time and higher mortality in CMV seropositive allogeneic stem cell transplantation patients with COVID-19; An infectious disease working party study from the European Society for Blood and Marrow Transplantation registry

Ljungman, Per; Tridello, Gloria; Pinana, Jose Luis; Ciceri, Fabio; Sengeloev, Henrik; Kulagin, Alexander; Mielke, Stephan; Yegin, Zeynep Arzu; Collin, Matthew; Einardottir, Sigrun; Lepretre, Sophie Ducastelle; Maertens, Johan; Campos, Antonio; Metafuni, Elisabetta; Pichler, Herbert; Folber, Frantisek; Solano, Carlos; Nicholson, Emma; Yueksel, Meltem Kurt; Carlson, Kristina; Aguado, Beatriz; Besley, Caroline; Byrne, Jenny; Heras, Immaculada; Dignan, Fiona; Kroeger, Nicolaus; Robin, Christine; Khan, Anjum; Lenhoff, Stig; Grassi, Anna; Dobsinska, Veronika; Miranda, Nuno; Jimenez, Maria-Jose; Yonal-Hindilerden, Ipek; Wilson, Keith; Averbuch, Dina; Cesaro, Simone; Xhaard, Alienor; Knelange, Nina; Styczynski, Jan; Mikulska, Malgorzata; de la Camara, Rafael

doi:10.3389/fimmu.2023.1125824

Improved outcomes over time and higher mortality in CMV seropositive allogeneic stem cell transplantation patients with COVID-19; An infectious disease working party study from the European Society for Blood and Marrow Transplantation registry

Author:

Ljungman, Per

Tridello, Gloria ; Pinana, Jose Luis ; Ciceri, Fabio ; Sengeloev, Henrik ; Kulagin, Alexander ; Mielke, Stephan ; Yegin, Zeynep Arzu ; Collin, Matthew ; Einardottir, Sigrun ; Lepretre, Sophie Ducastelle ; Maertens, Johan ; Campos, Antonio ; Metafuni, Elisabetta ; Pichler, Herbert ; Folber, Frantisek ; Solano, Carlos ; Nicholson, Emma ; Yueksel, Meltem Kurt ; Carlson, Kristina ; Aguado, Beatriz ; Besley, Caroline ; Byrne, Jenny ; Heras, Immaculada ; Dignan, Fiona ; Kroeger, Nicolaus ; Robin, Christine ; Khan, Anjum ; Lenhoff, Stig ; Grassi, Anna ; Dobsinska, Veronika ; Miranda, Nuno ; Jimenez, Maria-Jose ; Yonal-Hindilerden, Ipek ; Wilson, Keith ; Averbuch, Dina ; Cesaro, Simone ; Xhaard, Alienor ; Knelange, Nina ; Styczynski, Jan ; Mikulska, Malgorzata ; de la Camara, Rafael

Keywords:

Science & Technology, Life Sciences & Biomedicine, Immunology, COVID-19, allogeneic, stem cell transplantation, CMV, risk factors, THERAPY, Humans, Middle Aged, Bone Marrow, Transplantation, Homologous, Hematopoietic Stem Cell Transplantation, Communicable Diseases, Cytomegalovirus Infections, Registries, 1107 Immunology, 1108 Medical Microbiology, 3101 Biochemistry and cell biology, 3105 Genetics, 3204 Immunology

Abstract:

INTRODUCTION: COVID-19 has been associated with high morbidity and mortality in allogeneic hematopoietic stem cell transplant (allo-HCT) recipients. METHODS: This study reports on 986 patients reported to the EBMT registry during the first 29 months of the pandemic. RESULTS: The median age was 50.3 years (min - max; 1.0 - 80.7). The median time from most recent HCT to diagnosis of COVID-19 was 20 months (min - max; 0.0 - 383.9). The median time was 19.3 (0.0 - 287.6) months during 2020, 21.2 (0.1 - 324.5) months during 2021, and 19.7 (0.1 - 383.9) months during 2022 (p = NS). 145/986 (14.7%) patients died; 124 (12.6%) due to COVID-19 and 21 of other causes. Only 2/204 (1%) fully vaccinated patients died from COVID-19. There was a successive improvement in overall survival over time. In multivariate analysis, increasing age (p<.0001), worse performance status (p<.0001), contracting COVID-19 within the first 30 days (p<.0001) or 30 - 100 days after HCT (p=.003), ongoing immunosuppression (p=.004), pre-existing lung disease (p=.003), and recipient CMV seropositivity (p=.004) had negative impact on overall survival while patients contracting COVID-19 in 2020 (p<.0001) or 2021 (p=.027) had worse overall survival than patients with COVID-19 diagnosed in 2022. DISCUSSION: Although the outcome of COVID-19 has improved, patients having risk factors were still at risk for severe COVID-19 including death.