Background: Patients after allogeneic stem cell transplantation (alloSCT) are at high risk for contracting infectious diseases with high morbidity and mortality. COVID-19 is a viral respiratory disease that can lead to severe pneumonia and ARDS with potentially fatal outcome. Objectives: We aimed to analyze risk factors, disease course and outcome of COVID-19 in patients after alloSCT. Study design: Patients after alloSCT who became infected with SARS-CoV-2 at German and Austrian transplant centers between February 2020 and July 2021 were included in our retrospective study on behalf of the German Cooperative Transplant Study Group. Classification of COVID-19 severity into mild, moderate-severe and critical disease and the division of the course of the pandemic into 4 phases were performed according to the German Robert Koch Institute (RKI). Main endpoint was overall mortality at the end of follow up. We further analyzed need for treatment on an intensive care unit (ICU) and severity of disease. Risk factors were evaluated using univariate and multivariate analysis, survival analysis was performed using Kaplan-Meier method. Results: 130 patients from 14 transplant centers with a median age at diagnosis of COVID-19 of 59 (20-81) years and a median time between alloSCT and COVID-19 of 787 (19-8138) days were included. 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 % developed moderate-severe and 12.3 % critical disease, 19.2 % were treated on an ICU. After a median follow up of 127 days overall mortality was 16.2 %, among patients on ICU 52.0 %. Risk factors for mortality in multivariate analysis were active disease (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). Conclusion: Patients after alloSCT exhibit a substantially increased mortality risk after COVID-19 infection compared to 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.

Fuente: Transplantation and Cellular Therapy
Available online 13 March 2022