Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
Muhammad Umair Mushtaq , Mary Luder , Moazzam Shahzad , Nausheen Ahmed , Haitham Abdelhakim , Rajat Bansal , Ramesh Balusu , Sibgha Gull Chaudhary , Shaun DeJarnette , Clint Divine , Robert Kribs , Leyla Shune , Anurag K Singh , Sunil H. Abhyankar , Siddhartha Ganguly , Joseph McGuirk
Background: The Coronavirus Disease 2019 (COVID-19) has caused over 25 million infections in the US with over 0.4 million deaths. Hematogenic stem cell transplant (HCT) or cellular therapy (CT) recipients have a high risk of mortality with COVID-19 due to profound immune dysregulation. We aimed to assess the outcomes with COVID-19 in HCT/CT recipients. Methods: A single-center prospective study was conducted, including all (n=40) adult HCT/CT patients who were diagnosed with COVID-19 at the University of Kansas from Apr 2020 to Jan 2021. Baseline and disease-related characteristics were ascertained from medical records. Data were analyzed using SPSS version 21 (SPSS Inc, Chicago, IL). Bivariate analyses, using chi-square and t-test, and logistic regression analyses were conducted. Results: The study included 40 COVID-19 patients (72.5% Oct 2020-Jan 2021), including allogeneic HCT (n=25), autologous HCT (n=13) and CAR-T CT (n=2) with median time since HCT/CT of 12.4 (1-201.9), 37.2 (0.4-118.7), and 3.8 (2.8-4.8) months. Seventy percent were Caucasians and 17.5 were Hispanics. Primary hematologic malignancy was myeloid (37.5%), lymphoid (35%) or plasma cell disorder (27.5%). Myeloablative conditioning was performed in 65% of patients. Donors were autologous (37.5%), matched sibling (17.5%), matched unrelated (22.5%) and haploidentical (22.5%). COVID-19 was mild (42.5%), moderate (42.5%) or severe (15%). Clinical findings included pneumonia (62.5%), hypoxia (25%) and ICU admission (17.5%) while therapies included remdesivir (47.5%), convalescent plasma (40%), dexamethasone (25%) and monoclonal antibodies (17.5%). Concurrent cancer treatment, other infections and active GVHD were reported in 25% (all myeloma), 20% and 32.5% of patients. After a median follow-up of 74 days (7-269), the mortality rate was 12.5% in all patients and 20% in allo-HCT patients. Significant predictors of COVID-19 severity included allogeneic HCT, concurrent immune suppression and elevated inflammatory markers. (Table). Conclusions: Hematopoietic stem cell transplant recipients have an increased risk of mortality with COVID-19. Our findings confirm the need for vaccination prioritization, close monitoring, and aggressive treatment in HCT/CT patients.
Total (n=40) | Mild COVID (n=17) | Moderate-severe COVID (n=23) | P value | Deaths (n=5) | |
---|---|---|---|---|---|
Age yrs, median (range) | 58 (24-77) | 55.5 (24-72) | 60 (25-77) | 0.273 | 62 (25-72) |
Males, n (%) | 27 (67.5) | 11 (65) | 16 (70) | 0.746 | 4 (80) |
Months since HCT/CT, mean (SD) | 35 (41) | 44 (32) | 28 (32) | 0.279 | 42 (47) |
Allogeneic HCT, n (%) | 25 (62.5) | 7 (41) | 18 (78) | 0.017 | 5 (100) |
Autologous HCT/CAR-T, n (%) | 15 (37.5) | 10 (59) | 5 (22) | 0.017 | 0 |
Concurrent immune suppression, n (%) | 19 (47.5) | 4 (23.5) | 15 (65) | 0.009 | 5 (100) |
CRP, mean (SD) | 0.1 | 0. 1 (0.2) | 5.7 (5.2) | <0.001 | 7 (5.3) |
Ferritin, mean (SD) | 1535 (2109) | 129 (377) | 2275 (2274) | 0.001 | 2451 (1739) |
Neutrophil-lymphocyte ratio, mean (SD) | 15 (24) | 5.5 (6.3) | 19.7 (28) | 0.041 | 42.5 (45.6) |
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Abstract Disclosures
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