High Mortality of COVID-19 Early after Allogeneic Stem Cell Transplantation: A Retrospective Multicenter Analysis on Behalf of the German Cooperative Transplant Study Group.

Autor: Schaffrath J; Department of Internal Medicine IV - Hematology and Oncology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany. Electronic address: judith.schaffrath@uk-halle.de., Brummer C; Department of Internal Medicine III, University Hospital of Regensburg, Regensburg, Germany., Wolff D; Department of Internal Medicine III, University Hospital of Regensburg, Regensburg, Germany., Holtick U; Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany., Kröger N; Department of Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Bornhäuser M; Department of Internal Medicine I, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany., Kraus S; Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany., Hilgendorf I; Department of Internal Medicine II, University Hospital of Jena, Jena, Germany., Blau IW; Department of Hematology, Oncology and Tumorimmunology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany., Penack O; Department of Hematology, Oncology and Tumorimmunology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany., Wittke C; Department of Internal Medicine III, University Hospital of Rostock, Rostock, Germany., Steiner N; University Hospital of Internal Medicine V, Innsbruck Medical University, Innsbruck, Austria., Nachbaur D; University Hospital of Internal Medicine V, Innsbruck Medical University, Innsbruck, Austria., Thurner L; Department of Internal Medicine I, Saarland University, Homburg, Germany., Hindahl H; Department of Internal Medicine II, St.-Johannes-Hospital Dortmund, Dortmund, Germany., Zeiser R; Department of Internal Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany., Maier CP; Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tuebingen, Tuebingen, Germany., Bethge W; Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tuebingen, Tuebingen, Germany., Müller LP; Department of Internal Medicine IV - Hematology and Oncology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
Jazyk: angličtina
Zdroj: Transplantation and cellular therapy [Transplant Cell Ther] 2022 Jun; Vol. 28 (6), pp. 337.e1-337.e10. Date of Electronic Publication: 2022 Mar 13.
DOI: 10.1016/j.jtct.2022.03.010
Abstrakt: Recipients of allogeneic stem cell transplantation (alloSCT) are at high risk for contracting infectious diseases with high morbidity and mortality. Coronavirus disease 2019 (COVID-19) is a viral respiratory disease that can lead to severe pneumonia and acute respiratory distress syndrome, with a potentially fatal outcome. In this retrospective study conducted on behalf of the German Cooperative Transplant Study Group, we aimed to analyze risk factors, disease course, and outcomes of COVID-19 in patients who underwent alloSCT. AlloSCT recipients who became infected with SARS-CoV-2 at German and Austrian transplant centers between February 2020 and July 2021 were included. Classification of COVID-19 severity into mild, moderate-severe, or critical disease and division of the course of the pandemic into 4 phases were done according to the German Robert Koch Institute. The main endpoint was overall mortality at the end of follow-up. We further analyzed the need for treatment in an intensive care unit (ICU) and the severity of disease. Risk factors were evaluated using univariate and multivariate analyses, and survival analysis was performed using Kaplan-Meier method. The study cohort comprised 130 patients from 14 transplant centers, with a median age at diagnosis of COVID-19 of 59 years (range, 20 to 81 years) and a median interval between alloSCT and COVID-19 of 787 days (range, 19 to 8138 days). The most common underlying diseases were acute myeloid leukemia (45.4%) and lymphoma (10.8%). The majority of patients (84.9%) were infected in the later phases of the pandemic; 20.8% had moderate-severe disease, 12.3% had critical disease, and 19.2% were treated in an ICU. After a median follow-up of 127 days, overall mortality was 16.2%, 52.0% among patients treated in an ICU. Risk factors for mortality in multivariate analysis were active disease (odds ratio [OR], 4.46), infection with SARS-CoV-2 ≤365 days after alloSCT (OR, 5.60), age >60 years (OR, 5.39), and ongoing immunosuppression with cyclosporine (OR, 8.55). Risk factors for developing moderate-severe or critical disease were concurrent immunosuppression (OR, 4.06) and age >40 years (OR, 4.08). Patients after alloSCT exhibit a substantially increased mortality risk after COVID-19 infection compared with the normal population, without considerable improvement over the course of the pandemic. Risk factors include age, early infection post-alloSCT, and active immunosuppression. Further studies are needed to improve prevention and treatment in this high-risk patient group.
(Copyright © 2022 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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