Excellent Outcomes of Patients of Middle Eastern Ethnic Origin with Autologous Haemopoietic Stem Cell Transplantation and COVID-19: Does a Dampened Immune System Protect Against Severe COVID-19?

Abstract

Introduction Outcomes of patients with hematological cancers and coronavirus disease 2019 (COVID-19) have been reported to be poor with high rates of hospitalization, mechanical ventilation with high case fatality rates, mortality being around 10% or higher. The mortality had been particularly higher among blacks and ethnic minority individuals. There is paucity of data on the outcomes of patients with autologous stem cell transplant and concurrent COVID-19 infections, especially from eastern mediterranean region, no similar studies have been reported so far. Methods Here we describe outcomes of five consecutive patients of middle eastern ethnic origin who had a history of autologous stem cell transplant and developed COVID-19 infection, who were admitted at our tertiary care center between April and June 2020 with a minimum of 10 days follow-up. Results A total of five patients were identified who had undergone autologous stem cell transplantation and had developed COVID-19 infection. There were 3 males and 2 females and the median age was 43 years (range 18-59). Indications for transplant were myeloma (n=3), relapsed Hodgkin lymphoma (n=1), and relapsed diffuse large b cell lymphoma (n=1). Three of five patients had other comorbidities. Median time from transplant was 9 months (range 3-33 months). Four of five patients were on active treatment or maintenance at the time of infection. One patient was on brentuximab, and three were on lenalidomide based therapy. Only one of the five patients had active disease at the time of infection while the rest were in remission. None of the patients had severe disease and four were discharged to home isolation and made full recovery, and one needed admission requiring minimal oxygen and eventually made full recovery. At a median follow up of 70 days (range 12-90) all patients were doing well with no sequelae. Conclusion Our study, albeit small, shows excellent outcomes among patients of middle eastern ethnic origin with hematological cancers who had undergone autologous stem cell transplantation and had developed COVID-19 infection, unlike other studies that have shown high mortality among patients with hematological cancers. However, our cohort is relatively younger, most of them were in remission at the time of infection which may have had a protective effect. At the same time, the majority had transplant within the last nine months and four-fifths of the patients were on some sort of immunosuppressive therapy whilst developing COVID-19 infection. It is possible that a dampened immune system due to transplant and recent therapy might have had a protective effect against cytokine storm or severe COVID-19, in our view. More studies are needed to examine this aspect further, however, these results are encouraging. Disclosures No relevant conflicts of interest to declare.

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

“…Selected studies reported retrospective observational data from single‐centre experiences [4– 6 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ], multicentre experiences [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ] or registry data [ 7 , 8 , 42 , 43 , 44 , 45 ]. Seventeen studies [ 8 , 15 , 18 , 19 , 23 , 24 , 29 , 31 , 33 , 34 , 35 , 37 , 38 , 39 , 41 , 44 , 45 ] were from Europe (1153 patients), seven studies [ 4 , 6 , 17 , 20 , 22 ,…”

“…Seventeen studies [ 8 , 15 , 18 , 19 , 23 , 24 , 29 , 31 , 33 , 34 , 35 , 37 , 38 , 39 , 41 , 44 , 45 ] were from Europe (1153 patients), seven studies [ 4 , 6 , 17 , 20 , 22 , 25 , 36 ] were from North America (238 patients), seven studies [ 5 , 16 , 21 , 26 , 30 , 32 , 42 ] were from the Middle East (185 patients), two studies [ 28 , 40 ] were from South America (41 patients), one study [ 27 ] was from Asia (28 patients) and two studies [ 7 , 43 ] included patients from multiple regions (496 patients). Seventeen studies [ 7 , 8 , 16 , 21 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 35 , 38 , 39 , 40 , 41 , 45 ] included both adult and paediatric transplant recipients, 13 studies […”

“…Seventeen studies [8, 15, 18, 19, 23, 24, 29, 31, 33–35, 37–39, 41, 44, 45] were from Europe (1153 patients), seven studies [4, 6, 17, 20, 22, 25, 36] were from North America (238 patients), seven studies [5, 16, 21, 26, 30, 32, 42] were from the Middle East (185 patients), two studies [28, 40] were from South America (41 patients), one study [27] was from Asia (28 patients) and two studies [7, 43] included patients from multiple regions (496 patients). Seventeen studies [7, 8, 16, 21, 24–30, 35, 38–41, 45] included both adult and paediatric transplant recipients, 13 studies [4–6, 15, 18–20, 22, 23, 34, 36, 42, 43] only included adult patients ≥18 years old and five studies [17, 31–33, 37, 44] only included patients <18 years old. In most studies [4, 5, 8, 16–21, 23–25, 27, 28, 30, 31, 33–44], the diagnosis of COVID‐19 was based on SARS‐CoV‐2 polymerase chain reaction or SARS‐CoV‐2 IgG antibody (IgG) positivity, while six studies [6, 7, 15, 22, 29, 32] additionally included patients with a strong clinical or radiological suspicion of COVID‐19.…”

“…Patient demographics and study characteristics are summarised in Table S1. Selected studies reported retrospective observational data from single‐centre experiences [4–6, 15–26], multicentre experiences [27–41] or registry data [7, 8, 42–45]. Seventeen studies [8, 15, 18, 19, 23, 24, 29, 31, 33–35, 37–39, 41, 44, 45] were from Europe (1153 patients), seven studies [4, 6, 17, 20, 22, 25, 36] were from North America (238 patients), seven studies [5, 16, 21, 26, 30, 32, 42] were from the Middle East (185 patients), two studies [28, 40] were from South America (41 patients), one study [27] was from Asia (28 patients) and two studies [7, 43] included patients from multiple regions (496 patients).…”

“…Selected studies reported retrospective observational data from single‐centre experiences [4–6, 15–26], multicentre experiences [27–41] or registry data [7, 8, 42–45]. Seventeen studies [8, 15, 18, 19, 23, 24, 29, 31, 33–35, 37–39, 41, 44, 45] were from Europe (1153 patients), seven studies [4, 6, 17, 20, 22, 25, 36] were from North America (238 patients), seven studies [5, 16, 21, 26, 30, 32, 42] were from the Middle East (185 patients), two studies [28, 40] were from South America (41 patients), one study [27] was from Asia (28 patients) and two studies [7, 43] included patients from multiple regions (496 patients). Seventeen studies [7, 8, 16, 21, 24–30, 35, 38–41, 45] included both adult and paediatric transplant recipients, 13 studies [4–6, 15, 18–20, 22, 23, 34, 36, 42, 43] only included adult patients ≥18 years old and five studies [17, 31–33, 37, 44] only included patients <18 years old.…”