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Among individuals who have received a hematopoietic stem cell transplant (HSCT), often used in the treatment of blood cancers, rates of survival are poor for those who develop COVID-19.
The probability of survival 30 days after being diagnosed with COVID-19 is only 68% for persons who have received an allogeneic HSCT and 67% for autologous HSCT recipients, according to new data from the Center for International Blood and Marrow Transplant Research (CIBMTR).
These findings underscore the need for “stringent surveillance and aggressive treatment measures” in this population, say authors Akshay Sharma, MBBS, of St. Jude Children’s Research Hospital in Memphis, Tennessee, and colleagues.
The findings were published online March 1 in The Lancet Haematology.
The study is “of importance for physicians caring for HSCT recipients worldwide,” comment Mathieu Leclerc and Sébastien Maury, Hôpital Henri Mondor, Créteil, France, in an accompanying editorial.
For their study, Sharma and colleagues analyzed outcomes for all HSCT recipients who developed COVID-19 and whose cases were reported to the CIBMTR. Of 318 such patients, 184 had undergone allogeneic HSCT, and 134 had undergone autologous HSCT.
Overall, about half of these patients (49%) had mild COVID-19.
Severe COVID-19 that required mechanical ventilation developed in 15% and 13% of the allogeneic and autologous HSCT recipients, respectively.
About a third of patients died: 32% and 33% of allogeneic and autologous HSCT recipients, respectively.
Factors associated with greater mortality risk included age of 50 years or older (hazard ratio [HR], 2.53), male sex (HR, 3.53), and development of COVID-19 within 12 months of undergoing HSCT (HR, 2.67).
Among autologous HSCT recipients, lymphoma was associated with higher mortality risk in comparison with a plasma cell disorder or myeloma (HR, 2.41), the authors note.
“Two important messages can be drawn from the results reported by Sharma and colleagues,” Leclerc and Maury write in their editorial.
“The first is the confirmation that the prognosis of COVID-19 is particularly poor in HSCT recipients, and that its prevention, in the absence of any specific curative treatment with sufficient efficacy, should be at the forefront of concerns.”
The second relates to the risk factors for death among HSCT recipients who develop COVID-19. In addition to previously known risk factors, such as age and gender, the investigators identified transplant-specific factors potentially associated with prognosis ― namely, the nearly threefold increase in death among allogeneic HSCT recipients who develop COVID-19 within 12 months of transplant, they explain.
However, the findings are limited by a substantial amount of missing data, short follow-up, and the possibility of selection bias, they note.
“Further large and well designed studies with longer follow-up are needed to confirm and refine the results,” the editorialists write.
“[A] better understanding of the distinctive features of COVID-19 infection in HSCT recipients will be a necessary and essential step towards improvement of the remarkably poor prognosis observed in this setting,” they add.
The study was funded by the American Society of Hematology; the Leukemia and Lymphoma Society; the National Cancer Institute; the National Heart, Lung and Blood Institute; the National Institute of Allergy and Infectious Diseases; the National Institutes of Health; the Health Resources and Services Administration; and the Office of Naval Research. Sharma receives support for the conduct of industry-sponsored trials from Vertex Pharmaceuticals, CRISPR Therapeutics, and Novartis and consulting fees from Spotlight Therapeutics. Leclerc and Maury have disclosed no relevant financial relationships.
Lancet Haematol. Published online March 1, 2021. Full text, Editorial
Sharon Worcester is a reporter for MDedge News, part of the Medscape Professional Network.
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