Frontiers in Immunology (Mar 2023)

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

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

DOI
https://doi.org/10.3389/fimmu.2023.1125824
Journal volume & issue
Vol. 14

Abstract

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IntroductionCOVID-19 has been associated with high morbidity and mortality in allogeneic hematopoietic stem cell transplant (allo-HCT) recipients.MethodsThis study reports on 986 patients reported to the EBMT registry during the first 29 months of the pandemic.ResultsThe 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.DiscussionAlthough the outcome of COVID-19 has improved, patients having risk factors were still at risk for severe COVID-19 including death.

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