COVID‐19 outcomes in haematopoietic cell transplant recipients: A systematic review and meta‐analysis

Abstract

Up‐to‐date information on coronavirus disease 2019 (COVID‐19) outcomes and risk factors in haematopoietic cell transplantation (HCT) recipients is required to inform on decisions about cancer treatment and COVID‐19 mitigation strategies. We performed a meta‐analysis to address this knowledge gap. All studies with at least five patients who reported COVID‐19‐related deaths in HCT recipients were included. The primary outcome was COVID‐19‐related death. Secondary outcomes were COVID‐19‐related mechanical ventilation (MV) and intensive care unit (ITU) admission. The cumulative COVID‐19‐related death rate among HCT recipients was 21% (95% confidence interval [CI] 18%–24%), while MV and ITU admission rates were 14% (95% CI 11%–17%) and 18% (95% CI 14%–22%), respectively. Subgroup analysis showed higher death rates in patients who developed COVID‐19 within 12 months of HCT (risk ratio [RR] 1.82, 95% CI 1.09–3.03), within 6 months of receiving immunosuppressant drugs (RR 2.11, 95% CI 1.38–3.20) or in the context of active graft‐versus‐host disease (RR 2.38, 95% CI 1.10–5.16). Our findings support the idea that HCT should remain an integral part of cancer treatment during the COVID‐19 pandemic but also highlight the need to prioritise preventative measures in those patients who are at increased risk of adverse COVID‐19 outcomes.

COVID-19 in hematopoietic stem cell transplant recipients during three years of the pandemic: a multicenter study in Brazil

“…To the best of our knowledge, this study is the first among COVID-19 HSCT patients to demonstrate an independent association between mechanical ventilation and chest CT involvement at diagnosis with death 1,4,6,[13][14][15][16][17][18][19] . In another meta-analysis, a subgroup analysis revealed a higher risk of death among patients who develop COVID-19 within 12 months of HSCT and in those with GVHD using immunosuppressant drugs 3 .…”

“…A limited number of studies have reported COVID-19 outcomes in the HSCT setting [3][4][5][6] . The objective of this study was to describe COVID-19 burden in a cohort of HSCT recipients who were hospitalized in São Paulo, Brazil during three years of the pandemic.…”

COVID‐19 after hematopoietic cell transplantation and chimeric antigen receptor (CAR)‐T‐cell therapy

“…19 More recently, a meta-analysis of 26 studies which included 2141 HCT recipients showed that the incidence of ICU admission and mechanical ventilation was 18% and 14% respectively, while COVID-19-related death occurred in 21% (95% CI 18%-24%). 20 Outcomes do not appear to be substantially different in allogeneic and autologous HCT-recipients. 16,18 Despite some differences reported in smaller studies, 10,[21][22][23] survival was similar in the two groups at 4 weeks (67%-68%) in one study 17 and 6 weeks (approximately 75%) in another.…”

“…Age above 50, presence of three or more comorbidities, active hematologic disease, COVID‐19 occurring with 12 months from HCT, and severe/critical infection were all independently associated with increased mortality 19 . More recently, a meta‐analysis of 26 studies which included 2141 HCT recipients showed that the incidence of ICU admission and mechanical ventilation was 18% and 14% respectively, while COVID‐19‐related death occurred in 21% (95% CI 18%–24%) 20 …”

Bronchiolitis obliterans syndrome following SARS-CoV-2 infection in an allogeneic hematopoietic stem cell recipient

“…Some scarce studies have shown that the prognosis of HSCT recipients with COVID-19 infection is worse than that of the general population 11 , 12 and especially in cases of active GVHD 13 . To our knowledge, no data exist regarding the impact of SARS-CoV-2 on PFT in HSCT patients.…”