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Bozkurt C, Hazar V, Malbora B, Küpesiz A, Aygüneş U, Fışgın T, Karakükçü M, Kuşkonmaz B, Kılıç SÇ, Bayırlı D, Arman Bilir Ö, Yalçın K, Gözmen S, Uygun V, Elli M, Sarbay H, Küpesiz FT, Şaşmaz Hİ, Aksoy BA, Yılmaz E, Okur FV, Tekkeşin F, Yenigürbüz FD, Özek G, Atay AA, Bozkaya İO, Çelen S, Öztürkmen S, Güneş AM, Gürsel O, Güler E, Özcan A, Çetinkaya DU, Aydoğdu S, Özbek NY, Karasu G, Sezgin G, Doğru Ö, Albayrak D, Öztürk G, Aksoylar S, Daloğlu H, Odaman Al I, Evim MS, Akbayram S, Öncül Y, Zengin E, Albayrak C, Timur Ç, Kar YD, Çakmaklı HF, Tüfekçi Ö, Töret E, Antmen B. COVID-19 disease in children and adolescents following allogeneic hematopoietic stem cell transplantation: A report from the Turkish pediatric bone marrow transplantation study group. Pediatr Transplant 2024; 28:e14758. [PMID: 38659218 DOI: 10.1111/petr.14758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 02/27/2024] [Accepted: 04/01/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Data on the risk factors and outcomes for pediatric patients with SARS-CoV-2 infection (COVID-19) following hematopoietic stem cell transplantation (HSCT) are limited. OBJECTIVES The study aimed to analyze the clinical signs, risk factors, and outcomes for ICU admission and mortality in a large pediatric cohort who underwent allogeneic HSCT prior to COVID-19 infection. METHOD In this nationwide study, we retrospectively reviewed the data of 184 pediatric HSCT recipients who had COVID-19 between March 2020 and August 2022. RESULTS The median time from HSCT to COVID-19 infection was 209.0 days (IQR, 111.7-340.8; range, 0-3845 days). The most common clinical manifestation was fever (58.7%). While most patients (78.8%) had asymptomatic/mild disease, the disease severity was moderate in 9.2% and severe and critical in 4.4% and 7.6%, respectively. The overall mortality was 10.9% (n: 20). Deaths were attributable to COVID-19 in nine (4.9%) patients. Multivariate analysis revealed that lower respiratory tract disease (LRTD) (OR, 23.20, p: .001) and lymphopenia at diagnosis (OR, 5.21, p: .006) were risk factors for ICU admission and that HSCT from a mismatched donor (OR, 54.04, p: .028), multisystem inflammatory syndrome in children (MIS-C) (OR, 31.07, p: .003), and LRTD (OR, 10.11, p: .035) were associated with a higher risk for COVID-19-related mortality. CONCLUSION While COVID-19 is mostly asymptomatic or mild in pediatric transplant recipients, it can cause ICU admission in those with LRTD or lymphopenia at diagnosis and may be more fatal in those who are transplanted from a mismatched donor and those who develop MIS-C or LRTD.
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Affiliation(s)
- Ceyhun Bozkurt
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Istinye University School of Medicine, Bahçelievler Medicalpark Hospital, Istanbul, Turkey
| | - Volkan Hazar
- Department of Pediatric Hematology-Oncology, Memorial Health Group, Medstar Yıldız Hospital, Antalya, Turkey
| | - Barış Malbora
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Yeni Yüzyıl University School of Medicine, Istanbul, Turkey
| | - Alphan Küpesiz
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Akdeniz University School of Medicine, Antalya, Turkey
| | - Utku Aygüneş
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Acıbadem Adana Hospital, Adana, Turkey
| | - Tunç Fışgın
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Bahçelievler Medicalpark Hospital, Altınbaş University School of Medicine, Istanbul, Turkey
| | - Musa Karakükçü
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Erciyes University School of Medicine, Kayseri, Turkey
| | - Barış Kuşkonmaz
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Hacettepe University School of Medicine, Ankara, Turkey
| | - Suar Çakı Kılıç
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Derya Bayırlı
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Yeni Yüzyıl University School of Medicine, Istanbul, Turkey
| | - Özlem Arman Bilir
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Ankara City Hospital, Ankara, Turkey
| | - Koray Yalçın
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Medical Park Göztepe Hospital, Istanbul, Turkey
| | - Salih Gözmen
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Behçet Uz Training and Research Hospital, Izmir, Turkey
| | - Vedat Uygun
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Medical Park Antalya Hospital, Antalya, Turkey
| | - Murat Elli
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Medipol University School of Medicine, Istanbul, Turkey
| | - Hakan Sarbay
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Yeni Yüzyıl University School of Medicine, Istanbul, Turkey
| | - Funda Tayfun Küpesiz
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Akdeniz University School of Medicine, Antalya, Turkey
| | - Hatice İlgen Şaşmaz
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Acıbadem Adana Hospital, Adana, Turkey
| | - Başak Adaklı Aksoy
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Bahçelievler Medicalpark Hospital, Altınbaş University School of Medicine, Istanbul, Turkey
| | - Ebru Yılmaz
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Erciyes University School of Medicine, Kayseri, Turkey
| | - Fatma Visal Okur
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Hacettepe University School of Medicine, Ankara, Turkey
| | - Funda Tekkeşin
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Fatma Demir Yenigürbüz
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Gülcihan Özek
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Ege University School of Medicine, İzmir, Turkey
| | - Abdullah Avni Atay
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Yeni Yüzyıl University School of Medicine, Istanbul, Turkey
| | - İkbal Ok Bozkaya
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Ankara City Hospital, Ankara, Turkey
| | - Suna Çelen
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Medical Park Göztepe Hospital, Istanbul, Turkey
| | - Seda Öztürkmen
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Medical Park Antalya Hospital, Antalya, Turkey
| | - Adalet Meral Güneş
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Uludağ University School of Medicine, Bursa, Turkey
| | - Orhan Gürsel
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Elif Güler
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Akdeniz University School of Medicine, Antalya, Turkey
| | - Alper Özcan
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Erciyes University School of Medicine, Kayseri, Turkey
| | - Duygu Uçkan Çetinkaya
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Hacettepe University School of Medicine, Ankara, Turkey
| | - Selime Aydoğdu
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Namık Yaşar Özbek
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Ankara City Hospital, Ankara, Turkey
| | - Gülsün Karasu
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Medical Park Göztepe Hospital, Istanbul, Turkey
| | - Gülay Sezgin
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Çukurova University School of Medicine, Adana, Turkey
| | - Ömer Doğru
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Marmara University School of Medicine, Istanbul, Turkey
| | - Davut Albayrak
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Medical Park Samsun Hospital, Samsun, Turkey
| | - Gülyüz Öztürk
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Serap Aksoylar
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Ege University School of Medicine, İzmir, Turkey
| | - Hayriye Daloğlu
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Medical Park Antalya Hospital, Antalya, Turkey
| | - Işık Odaman Al
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Medipol University School of Medicine, Istanbul, Turkey
| | - Melike Sezgin Evim
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Uludağ University School of Medicine, Bursa, Turkey
| | - Sinan Akbayram
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Yurday Öncül
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Inönü University School of Medicine, Malatya, Turkey
| | - Emine Zengin
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Canan Albayrak
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Çetin Timur
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Yeditepe University School of Medicine, Istanbul, Turkey
| | - Yeter Düzenli Kar
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Afyon Health Sciences University School of Medicine, Afyonkarahisar, Turkey
| | - Hasan Fatih Çakmaklı
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Ankara University School of Medicine, Ankara, Turkey
| | - Özlem Tüfekçi
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Ersin Töret
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Bülent Antmen
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Acıbadem Adana Hospital, Adana, Turkey
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Malherbe JAJ, Boan P, Purtill D, Wright M, Cannell P, Gangatharan SA, Sidiqi H, Cooney J. COVID-19 outcomes in haemopoietic stem cell transplant recipients in Western Australia: the value of vaccination and antiviral therapy. Intern Med J 2024; 54:664-670. [PMID: 38572768 DOI: 10.1111/imj.16368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/30/2024] [Indexed: 04/05/2024]
Abstract
Coronavirus-19 (COVID-19) mortality rates among haemopoietic stem cell transplant (HSCT) patients are high, ranging between 20% and 40%. We prospectively evaluated the mortality outcomes of COVID-19 in Western Australian HSCT patients. A total of 32/492 (6.5%) HSCT recipients contracted COVID-19 during the study, of whom 30/32 (94%) developed mild or asymptomatic disease. Two allogeneic HSCT patients were hospitalised for severe COVID-19; one patient died. Stringent healthcare, social isolation practices, aggressive vaccination programmes and rapid access to COVID-19 antivirals may have promoted mild COVID-19 illness in Western Australian HSCT patients, resulting in one of the lowest COVID-19 mortality rates in HSCT recipients worldwide.
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Affiliation(s)
- Jacques A J Malherbe
- Department of Haematology, Fiona Stanley Hospital, Perth, Western Australia, Australia
- School of Biomedical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Peter Boan
- Department of Infectious Diseases, Fiona Stanley Hospital, Perth, Western Australia, Australia
- PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia
| | - Duncan Purtill
- Department of Haematology, Fiona Stanley Hospital, Perth, Western Australia, Australia
- PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia
| | - Matthew Wright
- Department of Haematology, Fiona Stanley Hospital, Perth, Western Australia, Australia
- PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia
| | - Paul Cannell
- Department of Haematology, Fiona Stanley Hospital, Perth, Western Australia, Australia
- PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia
| | - Shane A Gangatharan
- Department of Haematology, Fiona Stanley Hospital, Perth, Western Australia, Australia
- School of Biomedical Sciences, University of Western Australia, Perth, Western Australia, Australia
- PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia
| | - Hasib Sidiqi
- Department of Haematology, Fiona Stanley Hospital, Perth, Western Australia, Australia
- PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia
| | - Julian Cooney
- Department of Haematology, Fiona Stanley Hospital, Perth, Western Australia, Australia
- PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia
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Zhang Z, Huang J, Wang L, Pan Z, Huang J, Jiang C, Zhang S, Li S, Hu X. COVID-19 in immunocompromised patients after hematopoietic stem cell transplantation: a pilot study. Blood Sci 2024; 6:e00183. [PMID: 38283406 PMCID: PMC10817160 DOI: 10.1097/bs9.0000000000000183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/29/2023] [Indexed: 01/30/2024] Open
Abstract
Data on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients at early stage of immune reconstitution after hematopoietic stem cell transplantation (HSCT) are limited. In the present study, we retrospectively investigated the incidence and clinical features of SARS-CoV-2 infection in patients who underwent HSCT in 2022. Patients (allo-HSCT, n = 80; auto-HSCT, n = 37) were consecutively included in the study. The SARS-CoV-2 infection rate was 59.8%, and the median interval of HSCT to coronavirus disease 2019 (COVID-19) was 4.8 (range: 0.5-12) months. Most patients were categorized as mild (41.4%) or moderate (38.6%), and 20% as severe/critical. No deaths were attributable to COVID-19. Further analysis showed that lower circulating CD8+ T-cell counts and calcineurin inhibitor administration increased the risk of SARS-CoV-2 infection. Exposure to rituximab significantly increased the probability of severe or critical COVID-19 compared with that of mild/moderate illness (P < .001). In the multivariate analysis, rituximab use was associated with severe COVID-19. Additionally, COVID-19 had no significant effect on immune reconstitution. Furthermore, it was found that Epstein-Barr virus infection and rituximab administration possibly increase the risk of developing severe illness. Our study provides preliminary insights into the effect of SARS-CoV-2 on immune reconstitution and the outcomes of allo-HSCT recipients.
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Affiliation(s)
- Zilu Zhang
- National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200025, China
| | - Jingtao Huang
- National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200025, China
| | - Luxiang Wang
- National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200025, China
| | - Zengkai Pan
- National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200025, China
| | - Jiayu Huang
- National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200025, China
| | - Chuanhe Jiang
- National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200025, China
| | - Sujiang Zhang
- National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200025, China
| | - Su Li
- GoBroad Medical Institute of Hematology (Shanghai Center), Shanghai 201418, China
| | - Xiaoxia Hu
- National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200025, China
- Collaborative Innovation Center of Hematology, Shanghai JiaoTong University School of Medicine; Shanghai 200025, China
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Fan S, Mo X, Zhang X, Xu L, Wang Y, Yan C, Chen H, Zhang Y, Cheng Y, Sun Y, Chen Y, Chen Y, Han W, Wang J, Wang F, Xu Z, Huang X. Clinical characteristics and outcomes of allogeneic hematopoietic stem cell transplantation recipients with coronavirus disease 2019 caused by the Omicron variant: a prospective, observational cohort study. Ann Hematol 2024; 103:1333-1344. [PMID: 38381172 DOI: 10.1007/s00277-024-05653-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 02/05/2024] [Indexed: 02/22/2024]
Abstract
We aimed to describe the clinical characteristics, particularly the occurrence and risk factors of severe/critical illness, in allogeneic hematopoietic stem cell (allo-HSCT) recipients infected with coronavirus disease 2019 (COVID-19) caused by Omicron variant in an observational prospective study (n = 311). The median time from allo-HSCT to COVID-19 diagnosis was 8.5 months (range 0.8-106.1) months. Four patients (1.3%) were reported to be asymptomatic during Omicron variant infection, and 135 (43.4%) patients showed lower respiratory tract disease. Thirty-four (10.9%) patients were categorized into serious infection (severe illness n = 25; critical illness n = 9) and the median duration from COVID-19 diagnosis to serious infections was 6 days (range, 0-29) days. Thirteen (4.2%) and 6 (1.9%) patients required intensive care unit care and invasive mechanical ventilation, respectively. Receiving more than 1 type of immunosuppressive therapies at COVID-19 diagnosis was associated with severity and persistence of infection. Six patients (1.9%) died after diagnosis of COVID-19 infection. The 4-week probability of overall survival after COVID-19 diagnosis was 98.7%, which was 100% and 88.2% for non-serious and serious infection group (P < 0.001), respectively. Thus, we observed a relatively low serious infection and mortality rate in allo-HSCT recipients infected with COVID-19 caused by Omicron variant.
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Affiliation(s)
- Shuang Fan
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Xiaodong Mo
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
- Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Chinese Academy of Medical Sciences, Beijing, 2019RU029, China
| | - Xiaohui Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - LanPing Xu
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Yu Wang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Chenhua Yan
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Huan Chen
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Yuanyuan Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Yifei Cheng
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Yuqian Sun
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Yuhong Chen
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Yao Chen
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Wei Han
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Jingzhi Wang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Fengrong Wang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Zhengli Xu
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Xiaojun Huang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.
- Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Chinese Academy of Medical Sciences, Beijing, 2019RU029, China.
- Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China.
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Randi BA, Higashino HR, da Silva VP, Salomão MC, Pignatari ACC, Abdala E, Vasques F, da Silva CAR, da Silva RL, Lazari CDS, Levi JE, Xavier EM, Côrtes MF, Luna-Muschi A, Rocha V, Costa SF. COVID-19 in hematopoietic stem cell transplant recipients during three years of the pandemic: a multicenter study in Brazil. Rev Inst Med Trop Sao Paulo 2024; 66:e17. [PMID: 38511806 PMCID: PMC10946420 DOI: 10.1590/s1678-9946202466017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 03/22/2024] Open
Abstract
Hematopoietic stem cell transplant (HSCT) recipients are at -increased risk for severe COVID-19. The aim of this study was to evaluate the burden of COVID-19 in a cohort of HSCT recipients. This retrospective study evaluated a cohort of adult hospitalized HSCT recipients diagnosed with COVID-19 in two large hospitals in São Paulo, Brazil post-HSCT, from January 2020 to June 2022. The primary outcome was all-cause mortality. Of 49 cases, 63.2% were male with a median age of 47 years. Allogeneic-HSCT (51.2%) and autologous-HSCT (48.9%) patients were included. The median time from HSCT to COVID-19 diagnosis was 398 days (IQR: 1211-134), with 22 (44.8%) cases occurring within 12 months of transplantation. Most cases occurred during the first year of the pandemic, in non-vaccinated patients (n=35; 71.4%). Most patients developed severe (24.4%) or critical (40.8%) disease; 67.3% received some medication for COVID-19, primarily corticosteroids (53.0%). The probable invasive aspergillosis prevalence was 10.2%. All-cause mortality was 40.8%, 51.4% in non-vaccinated patients and 14.2% in patients who received at least one dose of the vaccine. In the multiple regression analyses, the variables mechanical ventilation (OR: 101.01; 95% CI: 8.205 - 1,242.93; p = 0.003) and chest CT involvement at diagnosis ≥50% (OR: 26.61; 95% CI: 1.06 - 664.26; p = 0.04) remained associated with all-cause mortality. Thus, HSCT recipients with COVID-19 experienced high mortality, highlighting the need for full vaccination and infection prevention measures.
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Affiliation(s)
- Bruno Azevedo Randi
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
| | - Hermes Ryoiti Higashino
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
- Hospital 9 de Julho, Dasa, São Paulo, São Paulo, Brazil
| | - Vinícius Ponzio da Silva
- Hospital 9 de Julho, Dasa, São Paulo, São Paulo, Brazil
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, São Paulo, Brazil
| | - Matias Chiarastelli Salomão
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
- Hospital 9 de Julho, Dasa, São Paulo, São Paulo, Brazil
| | - Antonio Carlos Campos Pignatari
- Hospital 9 de Julho, Dasa, São Paulo, São Paulo, Brazil
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, São Paulo, Brazil
| | - Edson Abdala
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
- Hospital 9 de Julho, Dasa, São Paulo, São Paulo, Brazil
| | | | - Celso Arrais Rodrigues da Silva
- Hospital 9 de Julho, Dasa, São Paulo, São Paulo, Brazil
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, São Paulo, Brazil
| | | | - Carolina dos Santos Lazari
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Laboratório Central, São Paulo, São Paulo, São Paulo, Brazil
| | | | - Erick Menezes Xavier
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Hematologia, Hemoterapia e Terapia Celular, São Paulo, São Paulo, Brazil
| | - Marina Farrel Côrtes
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Laboratório de Investigação Médica em Protozoologia, Bacteriologia e Resistência Antimicrobiana (LIM-49), São Paulo, São Paulo, Brazil
| | - Alessandra Luna-Muschi
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Laboratório de Investigação Médica em Protozoologia, Bacteriologia e Resistência Antimicrobiana (LIM-49), São Paulo, São Paulo, Brazil
| | - Vanderson Rocha
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Hematologia, Hemoterapia e Terapia Celular, São Paulo, São Paulo, Brazil
| | - Silvia Figueiredo Costa
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Laboratório de Investigação Médica em Protozoologia, Bacteriologia e Resistência Antimicrobiana (LIM-49), São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
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Başkol Elik D, Kaya Ş, Alkan S, Demirdal T, Sener A, Kaya S, Güzel Tunçcan Ö, Kayaaslan B, Güner R, Eser F, Kahraman H, Birengel S, Sarıcaoğlu EM, Eroğlu E, Çölkesen F, Öztürk E, Berk Cam H, Mermutluoğlu Ç, Özer Balin Ş, Sincan G, Altın N, Sili U, Suntur BM, Arslan Gülen T, Deveci B, Saba R, İncecik Ş, Eser Karlıdağ G, Hakko E, Akdağ D, Erdem HA, Sipahi H, Çicek C, Taşbakan MS, Taşbakan M, Pullukçu H, Yamazhan T, Arda B, Ulusoy S, Sipahi OR. The clinical features, treatment and prognosis of neutropenic fever and Coronavirus disease 2019 results of the multicentre teos study. Sci Rep 2024; 14:5218. [PMID: 38433274 PMCID: PMC10909849 DOI: 10.1038/s41598-024-55886-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 02/28/2024] [Indexed: 03/05/2024] Open
Abstract
This multicentre (22 centres in Turkey) retrospective cohort study aimed to assess the clinical outcomes of patients with neutropenic fever and SARS-CoV-2 positivity. Study period was 15 March 2020-15 August 2021. A total of 170 cases (58 female, aged 59 ± 15.5 years) that fulfilled the inclusion criteria were included in the study. One-month mortality rate (OMM) was 44.8%. The logistic regression analysis showed the following significant variables for the mentioned dependent variables: (i) achieving PCR negativity: receiving a maximum of 5 days of favipiravir (p = 0.005, OR 5.166, 95% CI 1.639-16.280); (ii) need for ICU: receiving glycopeptide therapy at any time during the COVID-19/FEN episode (p = 0.001, OR 6.566, 95% CI 2.137-20.172), the need for mechanical ventilation (p < 0.001, OR 62.042, 95% CI 9.528-404.011); (iii) need for mechanical ventilation: failure to recover from neutropenia (p < 0.001, OR 17.869, 95% CI 3.592-88.907), receiving tocilizumab therapy (p = 0.028, OR 32.227, 95% CI 1.469-707.053), septic shock (p = 0.001, OR 15.4 96% CI 3.164-75.897), and the need for ICU (p < 0.001, OR 91.818, 95% CI 15.360-548.873), (iv) OMM: [mechanical ventilation (p = 0.001, OR 19.041, 95% CI 3.229-112.286) and septic shock (p = 0.010, OR 5.589,95% CI 1.509-20.700)]. Although it includes a relatively limited number of patients, our findings suggest that COVID-19 and FEN are associated with significant mortality and morbidity.
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Affiliation(s)
- Dilşah Başkol Elik
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey.
- Infectious Disease and Clinical Microbiology, Turgutlu State Hospital, Manisa, Turkey.
| | - Şafak Kaya
- Department of Infectious Diseases, Gazi Yaşargil Training and Research Hospital, University of Health Sciences, Diyarbakir, Turkey
| | - Sevil Alkan
- Department of Infectious Disease, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Tuna Demirdal
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Alper Sener
- Department of Infectious Disease, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Selçuk Kaya
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Özlem Güzel Tunçcan
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Bircan Kayaaslan
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara Yıldırım Beyazit University, Ankara, Turkey
| | - Rahmet Güner
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara Yıldırım Beyazit University, Ankara, Turkey
| | - Fatma Eser
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara Yıldırım Beyazit University, Ankara, Turkey
| | - Hasip Kahraman
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Serhat Birengel
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Elif Mukime Sarıcaoğlu
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Esma Eroğlu
- Department of Infectious Disease and Clinical Microbiology, Konya Meram State Hospital, Konya, Turkey
| | - Fatma Çölkesen
- Department of Infectious Disease and Clinical Microbiology, Konya Meram State Hospital, Konya, Turkey
| | - Erman Öztürk
- Department of Hematology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Hande Berk Cam
- Department of Infectious Disease and Clinical Microbiology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Çiğdem Mermutluoğlu
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Şafak Özer Balin
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Gülden Sincan
- Department of Hematology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Nilgün Altın
- Department of Infectious Disease and Clinical Microbiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Uluhan Sili
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Bedia Mutay Suntur
- Infectious Diseases, Adana City Training and Research Hospital, Adana, Turkey
| | - Tuğba Arslan Gülen
- Infectious Diseases, Adana City Training and Research Hospital, Adana, Turkey
| | - Burak Deveci
- Department of Hematology and Stem Cell Transplant Unit, Medstar Antalya Hospital, Antalya, Turkey
| | - Rabin Saba
- Department of Hematology and Stem Cell Transplant Unit, Medstar Antalya Hospital, Antalya, Turkey
| | - Şaban İncecik
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Van Yüzüncü Yıl University, Van, Turkey
| | - Gülden Eser Karlıdağ
- Department of Infectious Disease and Clinical Microbiology, Elazığ Fethi Sekin City Hospital, University of Health Sciences, Elazig, Turkey
| | - Elif Hakko
- Department of Infectious Disease and Clinical Microbiology, Anadolu Medical Center, Istanbul, Turkey
| | - Damla Akdağ
- Department of Infectious Diseases and Clinical Microbiology, Basaksehir Cam Sakura City Hospital, Istanbul, Turkey
| | - Hüseyin Aytaç Erdem
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
| | - Hilal Sipahi
- Bornova Directorate of Health, Bornova, Izmir, Turkey
| | - Candan Çicek
- Department of Medical Microbiology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
| | - Mehmet Sezai Taşbakan
- Department of Chest Diseases, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
| | - Meltem Taşbakan
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
| | - Hüsnü Pullukçu
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
| | - Tansu Yamazhan
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
| | - Bilgin Arda
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
| | - Sercan Ulusoy
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
| | - Oguz Resat Sipahi
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
- Department of Infectious Diseases, Bahrain Oncology Center, King Hamad University Hospital, Muharraq, Bahrain
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Kamal M, Baudo M, Joseph J, Geng Y, Mohamed O, Rahouma M, Greenbaum U. Characteristics and Outcomes of Stem Cell Transplant Patients during the COVID-19 Era: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2024; 12:530. [PMID: 38470640 PMCID: PMC10931059 DOI: 10.3390/healthcare12050530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/14/2024] [Accepted: 02/17/2024] [Indexed: 03/14/2024] Open
Abstract
This systematic review and meta-analysis aims to identify the outcomes of stem cell transplant (SCT) patients during the COVID-19 era. Pooled event rates (PER) were calculated, and meta-regression was performed. A random effects model was utilized. In total, 36 eligible studies were included out of 290. The PER of COVID-19-related deaths and COVID-19-related hospital admissions were 21.1% and 55.2%, respectively. The PER of the use of hydroxychloroquine was 53.27%, of the receipt of immunosuppression it was 39.4%, and of the use of antivirals, antibiotics, and steroids it was 71.61%, 37.94%, and 18.46%, respectively. The PER of the time elapsed until COVID-19 infection after SCT of more than 6 months was 85.3%. The PER of fever, respiratory symptoms, and gastrointestinal symptoms were 70.9, 76.1, and 19.3%, respectively. The PER of acute and chronic GvHD were 40.2% and 60.9%, respectively. SCT patients are at a higher risk of severe COVID-19 infection and mortality. The use of dexamethasone improves the survival of hospitalized SCT patients with moderate to severe COVID-19 requiring supplemental oxygen or ventilation. The SCT patient group is a heterogeneous group with varying characteristics. The quality of reporting on these patients when infected with COVID-19 is not uniform and further prospective or registry studies are needed to better guide clinical care in this unique setting.
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Affiliation(s)
- Mona Kamal
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Massimo Baudo
- Department of Cardiac Surgery, Spedali Civili di Brescia, 25123 Brescia, Italy;
| | - Jacinth Joseph
- Hematology and Medical Oncology, University of Pittsburg Medical Center-Hillman Cancer Center, Altoona, PA 16601, USA
| | - Yimin Geng
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Omnia Mohamed
- Department of Medical Oncology, NCI, Cairo 11796, Egypt;
| | - Mohamed Rahouma
- Surgical Oncology Department, National Cancer Institute, Cairo 12613, Egypt;
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY 10065, USA
| | - Uri Greenbaum
- Department of Hematology, Soroka University Medical Center, Beer Sheva 8410501, Israel;
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 8410501, Israel
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Infante MS, Nemirovsky D, Devlin S, DeWolf S, Tamari R, Dahi PB, Lee YJ, Chung DJ, Politikos I, Barker J, Giralt SA, Babady NE, Ramanathan L, Papanicolaou GA, Seo S, Kamboj M, Perales MA, Shah GL. Outcomes and Management of the SARS-CoV2 Omicron Variant in Recipients of Hematopoietic Cell Transplantation and Chimeric Antigen Receptor T Cell Therapy. Transplant Cell Ther 2024; 30:116.e1-116.e12. [PMID: 37806446 DOI: 10.1016/j.jtct.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/10/2023]
Abstract
Hematopoietic cell transplantation (HCT) and chimeric antigen receptor T cell therapy (CAR-T) recipients who develop Coronavirus disease 2019 (COVID-19) can have decreased overall survival (OS), likely due to disease-inherent and therapy-related immunodeficiency. The availability of COVID-19-directed therapies and vaccines have improved COVID-19-related outcomes, but immunocompromised individuals remain vulnerable. Specifically, the effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant infections, including Omicron and its sublineages, particularly in HCT recipients, remain to be defined. The aim of this study was to compare the impact of SARS-CoV-2 Omicron infections in HCT/CAR-T recipients with outcomes previously reported for ancestral SARS-CoV-2 infections early in the pandemic (March to June 2020). This was a retrospective analysis of adult HCT/CAR-T recipients diagnosed with COVID-19 at Memorial Sloan Kettering Cancer Center between July 2021 and July 2022. We identified 353 patients (172 autologous HCT recipients [49%], 152 allogeneic HCT recipients [43%], and 29 CAR-T recipients [8%]), with a median time from HCT/CAR-T to SARS-CoV-2 infection of 1010 days (interquartile range, 300 to 2046 days). Forty-one patients (12%) were diagnosed with COVID-19 during the delta wave, and 312 patients (88%) were diagnosed during the Omicron wave. Risk factors associated with increased odds of COVID-19-related hospitalization were the presence of 2 or more comorbidities (odds ratio [OR], 4.9; 95% confidence interval [CI], 2.4 to 10.7; P < .001), CAR-T therapy compared to allogeneic HCT (OR, 7.7; 95% CI, 3.0 to 20.0; P < .001), hypogammaglobulinemia (OR, 2.71; 95% CI, 1.06 to 6.40; P = .027), and age at COVID-19 diagnosis (OR, 1.03; 95% CI, 1.0 to 1.05; P = .04). In contrast, infection during the Omicron variant BA5/BA4-dominant period compared to variant BA1 (OR, .21; 95% CI, .03 to .73; P = .037) and more than 3 years from HCT/CAR-T therapy to COVID-19 diagnosis compared to early infection at <100 days (OR, .31; 95% CI, .12 to .79; P = .011) were associated with a decreased odds for hospitalization. The OS at 12 months from COVID-19 diagnosis was 89% (95% CI, 84% to 94%), with 6 of 26 deaths attributable to COVID-19. Patients with the ancestral strain of SAR-CoV-2 had a lower OS at 12 months, with 73% (95% CI, 62% to 84%) versus 89% (95% CI, 84% to 94%; P < .001) in the Omicron cohort. Specific COVID-19 treatment was administered in 62% of patients, and 84% were vaccinated with mRNA COVID-19 vaccines. Vaccinated patients had significantly better OS than unvaccinated patients (90% [95% CI, 86% to 95%] versus 82% [95% CI, 72% to 94%] at 12 months; P = .003). No significant difference in OS was observed in patients infected with the Omicron and those infected with the Delta variant (P = .4) or treated with specific COVID-19 treatments compared with those not treated (P = .2). We observed higher OS in HCT and CAR-T recipients infected with the Omicron variants compared to those infected with the ancestral strain of SARS-CoV2. The use of COVID-19 antivirals, mAbs, and vaccines might have contributed to the improved outcomes.
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Affiliation(s)
- Maria-Stefania Infante
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; University Hospital Infanta Leonor, Madrid, Spain.
| | - David Nemirovsky
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Susan DeWolf
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Roni Tamari
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Parastoo B Dahi
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Yeon Joo Lee
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - David J Chung
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Ioannis Politikos
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Juliet Barker
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Sergio A Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - N Esther Babady
- Clinical Microbiology Service, Department of Laboratory Medicine, Memorial SLoan Kettering Cancer Center, New York, New York
| | - Lakshmi Ramanathan
- Clinical Chemistry Service, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Genovefa A Papanicolaou
- Department of Medicine, Weill Cornell Medical College, New York, New York; Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Susan Seo
- Department of Medicine, Weill Cornell Medical College, New York, New York; Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mini Kamboj
- Department of Medicine, Weill Cornell Medical College, New York, New York; Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Gunjan L Shah
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
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Randi BA, Higashino HR, Silva VPD, Xavier EM, Rocha V, Costa SF. COVID-19 in hematopoietic stem-cell transplant recipients: A systematic review and meta-analysis of clinical characteristics and outcomes. Rev Med Virol 2023; 33:e2483. [PMID: 37794598 DOI: 10.1002/rmv.2483] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/10/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023]
Abstract
Patients who undergo hematopoietic stem-cell transplantation (HSCT) are more susceptible to developing severe forms of COVID-19 with an increased risk of mortality. The aim of this study was to analyze, by performing a systematic review and meta-analysis, all studies that evaluated COVID-19 in HSCT adult recipients and present clinical characteristics and outcomes. Studies were eligible for inclusion if they: (I) described the clinical characteristics of COVID-19 in adult (aged 18 years old or above) HSCT recipients; (II) described outcomes of COVID-19 in this population, mainly lethality; (III) were full-text articles. We searched MedLine, Embase, SCOPUS, LILACS and Web of Science for full-text studies that evaluated COVID-19 in adult HSCT patients until 26 Apr 2023. Two independent reviewers screened the articles and extracted the data. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Studies Reporting Prevalence Data was used to assess quality of the included studies. Meta-analysis was performed and the pooled prevalence of severe/critical disease and of death with a 95% CI was calculated with the random-effects model. Sixteen studies were included; seven (43.7%) were multicenter. Most of the studies were from Europe (37.5%). All of them had a low risk of bias using the JBI Checklist. A total of 1186 patients were included. Allogeneic HSCT patients were the majority in most studies, with a total of 861 patients (72.5%). The symptomatic rate was 79.4%. The pooled prevalence of severe/critical COVID-19 was 24.0% (95% CI 0.13-0.36; I2 = 94%; n = 334/990). The pooled prevalence of death for the entire population was 17% (95% CI 0.13-0.22; I2 = 76%; n = 221/1117), 17% (95% CI 0.12-0.23; I2 = 67%; n = 152/822) for allogeneic-HSCT and 14% (95% CI 0.08-0.22; I4 = 65%; n = 48/293) for autologous-HSCT. In conclusion, frequently the infection of SARS-CoV-2 in HSCT was symptomatic and lethality is higher than in general population. Thus, it is essential to focus on the implementation of measures to mitigate the risk of SARS-CoV-2 infection in this population, as well as to carefully assess HSCT recipients who develop COVID-19.
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Affiliation(s)
- Bruno Azevedo Randi
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Hermes Ryoiti Higashino
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vinícius Ponzio da Silva
- Médico do grupo de infecção em imunodeprimidos da Unifesp/ Escola Paulista de Medicina, São Paulo, Brazil
| | - Erick Menezes Xavier
- Departamento de Hematologia, Hemoterapia e Terapia Celular, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Vanderson Rocha
- Departamento de Hematologia, Hemoterapia e Terapia Celular, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Silvia Figueiredo Costa
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Laboratório de Investigação Médica em Protozoologia, Bacteriologia e Resistência Antimicrobiana - LIM/49, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
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10
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Kampouri E, Hill JA, Dioverti V. COVID-19 after hematopoietic cell transplantation and chimeric antigen receptor (CAR)-T-cell therapy. Transpl Infect Dis 2023; 25 Suppl 1:e14144. [PMID: 37767643 DOI: 10.1111/tid.14144] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023]
Abstract
More than 3 years have passed since Coronavirus disease 2019 (COVID-19) was declared a global pandemic, yet COVID-19 still severely impacts immunocompromised individuals including those treated with hematopoietic cell transplantation (HCT) and chimeric antigen receptor-T-cell therapies who remain at high risk for severe COVID-19 and mortality. Despite vaccination efforts, these patients have inadequate responses due to immunosuppression, which underscores the need for additional preventive approaches. The optimal timing, schedule of vaccination, and immunological correlates for protective immunity remain unknown. Antiviral therapies used early during disease can reduce mortality and severity due to COVID-19. The combination or sequential use of antivirals could be beneficial to control replication and prevent the development of treatment-related mutations in protracted COVID-19. Despite conflicting data, COVID-19 convalescent plasma remains an option in immunocompromised patients with mild-to-moderate disease to prevent progression. Protracted COVID-19 has been increasingly recognized among these patients and has been implicated in intra-host emergence of SARS-CoV-2 variants. Finally, novel SARS-CoV2-specific T-cells and natural killer cell-boosting (or -containing) products may be active against multiple variants and are promising therapies in immunocompromised patients.
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Affiliation(s)
- Eleftheria Kampouri
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Joshua A Hill
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Veronica Dioverti
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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VanOudenhove J, Liu Y, Nelakanti R, Kim D, Busarello E, Ovalle NT, Qi Z, Mamillapalli P, Siddon A, Bai Z, Axtmayer A, Corso C, Kothari S, Foss F, Isufi I, Tebaldi T, Gowda L, Fan R, Seropian S, Halene S. Impact of Memory T Cells on SARS-COV-2 Vaccine Response in Hematopoietic Stem Cell Transplant. bioRxiv 2023:2023.10.26.564259. [PMID: 37961434 PMCID: PMC10634862 DOI: 10.1101/2023.10.26.564259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
During the COVID-19 pandemic, hematopoietic stem cell transplant (HSCT) recipients faced an elevated mortality rate from SARS-CoV-2 infection, ranging between 10-40%. The SARS-CoV-2 mRNA vaccines are important tools in preventing severe disease, yet their efficacy in the post-transplant setting remains unclear, especially in patients subjected to myeloablative chemotherapy and immunosuppression. We evaluated the humoral and adaptive immune responses to the SARS-CoV-2 mRNA vaccination series in 42 HSCT recipients and 5 healthy controls. Peripheral blood mononuclear nuclear cells and serum were prospectively collected before and after each dose of the SARS-CoV-2 vaccine. Post-vaccination responses were assessed by measuring anti-spike IgG and nucleocapsid titers, and antigen specific T cell activity, before and after vaccination. In order to examine mechanisms behind a lack of response, pre-and post-vaccine samples were selected based on humoral and cellular responses for single-cell RNA sequencing with TCR and BCR sequencing. Our observations revealed that while all participants eventually mounted a humoral response, transplant recipients had defects in memory T cell populations that were associated with an absence of T cell response, some of which could be detected pre-vaccination.
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Ge T, Liu H, Wang ZH, Cao Y, Zhang YC, Huang L, Qian WB, Zhou XX. [Characteristics and impact factors of SARS-CoV-2 infection in adult patients with relapsed/refractory B-cell non-Hodgkin lymphoma receiving chimeric antigen receptor T-cell therapy]. Zhonghua Xue Ye Xue Za Zhi 2023; 44:825-831. [PMID: 38049334 PMCID: PMC10694084 DOI: 10.3760/cma.j.issn.0253-2727.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Indexed: 12/06/2023]
Abstract
Objective: To explore the clinical characteristics and treatment of COVID-19 infection in patients with relapsed/refractory B-cell non-Hodgkin lymphoma before and after receiving chimeric antigen receptor T-cell therapy, and study the influencing factors of severe COVID-19 infection in these patients. Methods: The data of 59 patients with relapsed/refractory B-cell non-Hodgkin lymphoma who received chimeric antigen receptor T-cell therapy at the Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology and Department of Hematology, the Second Affiliated Hospital, College of Medicine, Zhejiang University between December 2017 and February 2023, and who were infected with novel coronavirus between December 2022 and February 2023 were retrospectively studied. Patients were divided into light, medium, severe, and critical groups, and the differences between the groups were analyzed using the chi-square test. A univariate logistic regression model was used to evaluate the contribution of each variable and its relationship with severe infection. The chi-square and Fisher's exact tests were used to analyze the differences between the B-cell aplasia and B-cell recovery (BCR) groups. Results: Of the 59 pre- and post-infusion infections, 39 (66.1%) led to mild COVID-19, 9 (15.3%) resulted in moderate COVID-19, 10 (16.9%) resulted in severe COVID-19, and 1 (1.7%) led to critical COVID-19. Moroever, age greater than 55 years, having received autologous hematopoietic stem cell transplantation, progressive disease status, and B-cell aplasia at the time of diagnosis of COVID-19 infection are factors affecting severe infection. Patients with B-cell aplasia had a more severe infection with COVID-19 (P<0.001), a longer duration (P=0.015), a longer antiviral therapy course (P<0.001), and a higher hospitalization rate (P<0.001) than the BCR group. Conclusion: Active prevention and treatment of COVID-19 infection remains a crucial issue requiring urgent attention in managing patients with relapsed/refractory B-cell non-Hodgkin lymphoma treated with chimeric antigen receptor T-cell therapy.
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Affiliation(s)
- T Ge
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - H Liu
- Department of Hematology, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Z H Wang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Y Cao
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Y C Zhang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - L Huang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - W B Qian
- Department of Hematology, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, China
| | - X X Zhou
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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13
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Lian Y, Gao Z, Ti J, Yu Z, Ma L, Wei J. Acute intestinal GVHD following donor-derived CD7-CAR-T-cell infusion in a child with Omicron COVID-19. Blood Sci 2023; 5:269-273. [PMID: 37941920 PMCID: PMC10629738 DOI: 10.1097/bs9.0000000000000170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/16/2023] [Indexed: 11/10/2023] Open
Affiliation(s)
- Yu Lian
- Department of Hematology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhilin Gao
- Department of Hematology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Juanjuan Ti
- Department of Hematology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhuanzhuan Yu
- Department of Hematology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Liangming Ma
- Department of Hematology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jia Wei
- Department of Hematology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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14
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Liang EC, Onstad LE, Carpenter P, Pergam SA, Flowers ME, Lee SJ, Liu C. Association of Self-Reported COVID-19 Vaccination Status with COVID-19 Infection among Adult Long-Term Hematopoietic Cell Transplantation Survivors. Transplant Cell Ther 2023; 29:584.e1-584.e9. [PMID: 37394113 PMCID: PMC10528463 DOI: 10.1016/j.jtct.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 07/04/2023]
Abstract
Hematopoietic cell transplantation (HCT) recipients experience significant morbidity and mortality from coronavirus disease 19 (COVID-19) infection. Data are limited regarding long-term HCT survivors' uptake of and experiences with COVID-19 vaccination and infection. This study aimed to characterize COVID-19 vaccination uptake, use of other prevention measures, and COVID-19 infection outcomes in adult HCT recipients at our institution. Between July 1, 2021, and June 30, 2022, long-term adult HCT survivors were surveyed regarding overall health, chronic graft-versus-host (cGVHD) status, and experiences with COVID-19 vaccinations, prevention measures, and infections. Patients reported COVID-19 vaccination status, vaccine-related adverse effects, use of nonpharmaceutical prevention measures, and infections. Comparisons by response and vaccination status were performed using the chi-square test and Fisher exact test for categorical variables and the Kruskal-Wallis test for continuous variables. Of 4758 adult HCT survivors who underwent HCT between 1971 and 2021 and consented to participate in annual surveys, 1719 (36%) completed the COVID-19 module, and 1598 of 1705 (94%) reported receiving ≥1 dose of COVID-19 vaccine. Severe vaccine-related adverse effects were infrequent (5%). Among respondents receiving an mRNA vaccine, completion of doses according to the Centers for Disease Control and Prevention's vaccine recommendations at the time of survey return was 2 doses in 675 of 759 (89%), 3 doses in 610 of 778 (78%), and 4 doses in 26 of 55 (47%). Two hundred fifty respondents (15%) reported COVID-19 infection; 25 (10%) required hospitalization. Vaccinated respondents reported significantly higher uptake of household vaccination (1284 of 1404 [91%] versus 18 of 88 [20%]; P < .001) and the use of nonpharmaceutical interventions (P < .001). Vaccinated respondents were significantly less likely to have contracted COVID-19 (85 of 1480 [6%] versus 130 of 190 [68%]; P < .001), as were their household members (149 of 1451 [10%] versus 85 of 185 [46%]; P < .001). Receipt of additional COVID-19 vaccine doses beyond the first dose was associated with a reduced risk of COVID-19 infection (odds ratio, .63; 95% confidence interval, .47 to .85; P = .002). Vaccination was well tolerated and associated with a lower risk of COVID-19 infection among HCT survivors and their household contacts. Vaccination and booster doses should be encouraged as part of a multifaceted approach in this high-risk population.
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Affiliation(s)
- Emily C Liang
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Lynn E Onstad
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Paul Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington
| | - Steven A Pergam
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Mary E Flowers
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Catherine Liu
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington.
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15
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Candel FJ, Barreiro P, Salavert M, Cabello A, Fernández-Ruiz M, Pérez-Segura P, San Román J, Berenguer J, Córdoba R, Delgado R, España PP, Gómez-Centurión IA, González Del Castillo JM, Heili SB, Martínez-Peromingo FJ, Menéndez R, Moreno S, Pablos JL, Pasquau J, Piñana JL, On Behalf Of The Modus Investigators Adenda. Expert Consensus: Main Risk Factors for Poor Prognosis in COVID-19 and the Implications for Targeted Measures against SARS-CoV-2. Viruses 2023; 15:1449. [PMID: 37515137 PMCID: PMC10383267 DOI: 10.3390/v15071449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/17/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023] Open
Abstract
The clinical evolution of patients infected with the Severe Acute Respiratory Coronavirus type 2 (SARS-CoV-2) depends on the complex interplay between viral and host factors. The evolution to less aggressive but better-transmitted viral variants, and the presence of immune memory responses in a growing number of vaccinated and/or virus-exposed individuals, has caused the pandemic to slowly wane in virulence. However, there are still patients with risk factors or comorbidities that put them at risk of poor outcomes in the event of having the coronavirus infectious disease 2019 (COVID-19). Among the different treatment options for patients with COVID-19, virus-targeted measures include antiviral drugs or monoclonal antibodies that may be provided in the early days of infection. The present expert consensus is based on a review of all the literature published between 1 July 2021 and 15 February 2022 that was carried out to establish the characteristics of patients, in terms of presence of risk factors or comorbidities, that may make them candidates for receiving any of the virus-targeted measures available in order to prevent a fatal outcome, such as severe disease or death. A total of 119 studies were included from the review of the literature and 159 were from the additional independent review carried out by the panelists a posteriori. Conditions found related to strong recommendation of the use of virus-targeted measures in the first days of COVID-19 were age above 80 years, or above 65 years with another risk factor; antineoplastic chemotherapy or active malignancy; HIV infection with CD4+ cell counts < 200/mm3; and treatment with anti-CD20 immunosuppressive drugs. There is also a strong recommendation against using the studied interventions in HIV-infected patients with a CD4+ nadir <200/mm3 or treatment with other immunosuppressants. Indications of therapies against SARS-CoV-2, regardless of vaccination status or history of infection, may still exist for some populations, even after COVID-19 has been declared to no longer be a global health emergency by the WHO.
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Affiliation(s)
- Francisco Javier Candel
- Clinical Microbiology & Infectious Diseases, Transplant Coordination, Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
| | - Pablo Barreiro
- Regional Public Health Laboratory, Infectious Diseases, Internal Medicine, Hospital General Universitario La Paz, 28055 Madrid, Spain
- Department of Medical Specialities and Public Health, Universidad Rey Juan Carlos, 28922 Madrid, Spain
| | - Miguel Salavert
- Infectious Diseases, Internal Medicine, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - Alfonso Cabello
- Internal Medicine, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), 28041 Madrid, Spain
| | - Pedro Pérez-Segura
- Medical Oncology, Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
| | - Jesús San Román
- Department of Medical Specialities and Public Health, Universidad Rey Juan Carlos, 28922 Madrid, Spain
| | - Juan Berenguer
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28007 Madrid, Spain
| | - Raúl Córdoba
- Haematology and Haemotherapy, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Rafael Delgado
- Clinical Microbiology, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), 28041 Madrid, Spain
| | - Pedro Pablo España
- Pneumology, Hospital Universitario de Galdakao-Usansolo, 48960 Vizcaya, Spain
| | | | | | - Sarah Béatrice Heili
- Intermediate Respiratory Care Unit, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Francisco Javier Martínez-Peromingo
- Department of Medical Specialities and Public Health, Universidad Rey Juan Carlos, 28922 Madrid, Spain
- Geriatrics, Hospital Universitario Rey Juan Carlos, 28933 Madrid, Spain
| | - Rosario Menéndez
- Pneumology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - Santiago Moreno
- Infectious Diseases, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - José Luís Pablos
- Rheumatology, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), 28041 Madrid, Spain
| | - Juan Pasquau
- Infectious Diseases, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain
| | - José Luis Piñana
- Haematology and Haemotherapy, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
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16
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La Rosa C, Chiuppesi F, Park Y, Zhou Q, Yang D, Gendzekhadze K, Ly M, Li J, Kaltcheva T, Ortega Francisco S, Gutierrez MA, Ali H, Otoukesh S, Amanam I, Salhotra A, Pullarkat VA, Aldoss I, Rosenzweig M, Aribi AM, Stein AS, Marcucci G, Dadwal SS, Nakamura R, Forman SJ, Al Malki MM, Diamond DJ. Functional SARS-CoV-2-specific T cells of donor origin in allogeneic stem cell transplant recipients of a T-cell-replete infusion: A prospective observational study. Front Immunol 2023; 14:1114131. [PMID: 36936918 PMCID: PMC10020189 DOI: 10.3389/fimmu.2023.1114131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/17/2023] [Indexed: 03/06/2023] Open
Abstract
In the current post-pandemic era, recipients of an allogeneic hematopoietic stem cell transplant (HCT) deserve special attention. In these vulnerable patients, vaccine effectiveness is reduced by post-transplant immune-suppressive therapy; consequently, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) is often associated with elevated morbidity and mortality. Characterizing SARS-CoV-2 adaptive immunity transfer from immune donors to HCT recipients in the context of immunosuppression will help identify optimal timing and vaccination strategies that can provide adequate protection to HCT recipients against infection with evolving SARS-CoV-2 variants. We performed a prospective observational study (NCT04666025 at ClinicalTrials.gov) to longitudinally monitor the transfer of SARS-CoV-2-specific antiviral immunity from HCT donors, who were either vaccinated or had a history of COVID-19, to their recipients via T-cell replete graft. Levels, function, and quality of SARS-CoV-2-specific immune responses were longitudinally analyzed up to 6 months post-HCT in 14 matched unrelated donor/recipients and four haploidentical donor/recipient pairs. A markedly skewed donor-derived SARS-CoV-2 CD4 T-cell response was measurable in 15 (83%) recipients. It showed a polarized Th1 functional profile, with the prevalence of central memory phenotype subsets. SARS-CoV-2-specific IFN-γ was detectable throughout the observation period, including early post-transplant (day +30). Functionally experienced SARS-CoV-2 Th1-type T cells promptly expanded in two recipients at the time of post-HCT vaccination and in two others who were infected and survived post-transplant COVID-19 infection. Our data suggest that donor-derived SARS-CoV-2 T-cell responses are functional in immunosuppressed recipients and may play a critical role in post-HCT vaccine response and protection from the fatal disease. Clinical trial registration clinicaltrials.gov, identifier NCT04666025.
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Affiliation(s)
- Corinna La Rosa
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Flavia Chiuppesi
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Yoonsuh Park
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Qiao Zhou
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Dongyun Yang
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Ketevan Gendzekhadze
- Histocompatibility Laboratory, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Minh Ly
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Jing Li
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Teodora Kaltcheva
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Sandra Ortega Francisco
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Miguel-Angel Gutierrez
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Haris Ali
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Salman Otoukesh
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Idoroenyi Amanam
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Amandeep Salhotra
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Vinod A. Pullarkat
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Michael Rosenzweig
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Ahmed M. Aribi
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Anthony S. Stein
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Guido Marcucci
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | | | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Stephen J. Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Monzr M. Al Malki
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Don J. Diamond
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
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17
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Busca A, Salmanton-García J, Marchesi F, Farina F, Seval GC, Van Doesum J, De Jonge N, Bahr NC, Maertens J, Meletiadis J, Fracchiolla NS, Weinbergerová B, Verga L, Ráčil Z, Jiménez M, Glenthøj A, Blennow O, Tanase AD, Schönlein M, Prezioso L, Khanna N, Duarte RF, Žák P, Nucci M, Machado M, Kulasekararaj A, Espigado I, De Kort E, Ribera-Santa Susana JM, Marchetti M, Magliano G, Falces-Romero I, Ilhan O, Ammatuna E, Zompi S, Tsirigotis P, Antoniadou A, Zambrotta GPM, Nordlander A, Karlsson LK, Hanakova M, Dragonetti G, Cabirta A, Berg Venemyr C, Gräfe S, Van Praet J, Tragiannidis A, Petzer V, López-García A, Itri F, Groh A, Gavriilaki E, Dargenio M, Rahimli L, Cornely OA, Pagano L. Outcome of COVID-19 in allogeneic stem cell transplant recipients: Results from the EPICOVIDEHA registry. Front Immunol 2023; 14:1125030. [PMID: 36911708 PMCID: PMC9999728 DOI: 10.3389/fimmu.2023.1125030] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/01/2023] [Indexed: 03/04/2023] Open
Abstract
Background The outcome of COVID-19 in allogeneic hematopoietic stem cell transplantation (HSCT) recipients is almost uniformely considered poor. The aim of present study was to retrospectively analyse the outcome and risk factors for mortality in a large series of patients who developed COVID-19 infection after an allogeneic HSCT. Methods This multicenter retrospective study promoted by the European Hematology Association - Infections in Hematology Study Working Group, included 326 adult HSCT patients who had COVID-19 between January 2020 and March 2022. Results The median time from HSCT to the diagnosis of COVID-19 was 268 days (IQR 86-713; range 0-185 days). COVID-19 severity was mild in 21% of the patients, severe in 39% and critical in 16% of the patients. In multivariable analysis factors associated with a higher risk of mortality were, age above 50 years, presence of 3 or more comorbidities, active hematologic disease at time of COVID-19 infection, development of COVID-19 within 12 months of HSCT, and severe/critical infections. Overall mortality rate was 21% (n=68): COVID-19 was the main or secondary cause of death in 16% of the patients (n=53). Conclusions Mortality in HSCT recipients who develop COVID-19 is high and largely dependent on age, comorbidities, active hematologic disease, timing from transplant and severity of the infection.
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Affiliation(s)
- Alessandro Busca
- Stem Cell Transplant Center, AOU Citta’ della Salute e della Scienza, Turin, Italy
| | - Jon Salmanton-García
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany
| | - Francesco Marchesi
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | | | | | | | - Nathan C. Bahr
- University of Kansas Medical Center, Kansas, KS, United States
| | - Johan Maertens
- Department of Microbiology, Immunology, and Transplantation, KULeuven, Leuven, Belgium
- Department of Hematology, UZ Leuven, Leuven, Belgium
| | - Joseph Meletiadis
- Clinical Microbiology Laboratory, Medical School, “Attikon” University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Barbora Weinbergerová
- Department of Internal Medicine - Hematology and Oncology, Masaryk University Hospital Brno, Brno, Czechia
| | - Luisa Verga
- Azienda Ospedaliera San Gerardo - Monza, Monza, Italy
- Università Milano-Bicocca, Milan, Italy
| | - Zdeněk Ráčil
- Institute of Hematology and Blood Transfusion, Prague, Czechia
| | - Moraima Jiménez
- Department of Hematology, Vall d’Hebron Hospital Universitari, Experimental Hematology, Vall d’Hebron Institute of Oncology (VHIO), Vall d’Hebron Barcelona Hospital, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andreas Glenthøj
- Department of Hematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Ola Blennow
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Alina Daniela Tanase
- Fundeni Clinical Institute, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Martin Schönlein
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lucia Prezioso
- Hospital University of Parma - Hematology and Bone Marrow Unit, Parma, Italy
| | - Nina Khanna
- Division of Infectious Diseases and Hospital Epidemiology, and Department of Clinical Research, University and University Hospital of Basel, Basel, Switzerland
| | | | - Pavel Žák
- University Hospital Hradec Králové, Hradec Králové, Czechia
| | - Marcio Nucci
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marina Machado
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Austin Kulasekararaj
- King’s College Hospital, London, United Kingdom
- King’s College London, London, United Kingdom
| | - Ildefonso Espigado
- Department of Hematology, University Hospital Virgen Macarena - University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC), Universidad de Sevilla (Departamento de Medicina), Seville, Spain
| | | | | | - Monia Marchetti
- Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | | | | | | | - Sofia Zompi
- Stem Cell Transplant Center, AOU Citta’ della Salute e della Scienza, Turin, Italy
| | - Panagiotis Tsirigotis
- Clinical Microbiology Laboratory, Medical School, “Attikon” University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Antoniadou
- Clinical Microbiology Laboratory, Medical School, “Attikon” University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Anna Nordlander
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Giulia Dragonetti
- Hematology Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy
| | - Alba Cabirta
- Department of Hematology, Vall d’Hebron Hospital Universitari, Experimental Hematology, Vall d’Hebron Institute of Oncology (VHIO), Vall d’Hebron Barcelona Hospital, Barcelona, Spain
| | - Caroline Berg Venemyr
- Department of Hematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Stefanie Gräfe
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany
| | - Jens Van Praet
- Department of Nephrology and Infectious diseases, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
| | | | - Verena Petzer
- Department of Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alberto López-García
- Fundacion Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid, Spain
| | - Federico Itri
- San Luigi Gonzaga Hospital - Orbassano, Orbassano, Italy
| | - Ana Groh
- Infektiologie, Universitätsklinikum Frankfurt am Main, Frankfurt am Main, Germany
| | - Eleni Gavriilaki
- General Hospital of Thessaloniki “George Papanikolaou”, Thessaloniki, Greece
| | | | - Laman Rahimli
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany
| | - Oliver A. Cornely
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Molecular Medicine Cologne (CMMC), Cologne, Germany
- German Centre for Infection Research (DZIF) , Cologne, Germany
| | - Livio Pagano
- Hematology Unit, Università Cattolica del Sacro Cuore, Rome, Italy
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18
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McNerney KO, Richards RM, Aguayo-Hiraldo P, Calkoen FG, Talano JA, Moskop A, Balduzzi A, Krajewski J, Dave H, Vatsayan A, Callahan C, Liu H, Li Y, Davis KL, Maude SL. SARS-CoV-2 infections in pediatric and young adult recipients of chimeric antigen receptor T-cell therapy: an international registry report. J Immunother Cancer 2023; 11:jitc-2022-005957. [PMID: 36707090 PMCID: PMC9884906 DOI: 10.1136/jitc-2022-005957] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Immunocompromised patients are at increased risk of SARS-CoV-2 infections. Patients undergoing chimeric antigen receptor (CAR) T-cell therapy for relapsed/refractory B-cell malignancies are uniquely immunosuppressed due to CAR T-mediated B-cell aplasia (BCA). While SARS-CoV-2 mortality rates of 33%-40% are reported in adult CAR T-cell recipients, outcomes in pediatric and young adult CAR T-cell recipients are limited. METHODS We created an international retrospective registry of CAR T recipients aged 0-30 years infected with SARS-CoV-2 within 2 months prior to or any time after CAR T infusion. SARS-CoV-2-associated illness was graded as asymptomatic, mild, moderate, or severe COVID-19, or multisystem inflammatory syndrome in children (MIS-C). To assess for risk factors associated with significant SARS-CoV-2 infections (infections requiring hospital admission for respiratory distress or supplemental oxygen), univariate and multivariable regression analyses were performed. RESULTS Nine centers contributed 78 infections in 75 patients. Of 70 SARS-CoV-2 infections occurring after CAR T infusion, 13 (18.6%) were classified as asymptomatic, 37 (52.9%) mild, 11 (15.7%) moderate, and 6 (8.6%) severe COVID-19. Three (4.3%) were classified as MIS-C. BCA was not significantly associated with infection severity. Prior to the emergence of the Omicron variant, of 47 infections, 19 (40.4%) resulted in hospital admission and 7 (14.9%) required intensive care, while after the emergence of the Omicron variant, of 23 infections, only 1 (4.3%) required admission and the remaining 22 (95.7%) had asymptomatic or mild COVID-19. Death occurred in 3 of 70 (4.3%); each death involved coinfection or life-threatening condition. In a multivariable model, factors associated with significant SARS-CoV-2 infection included having two or more comorbidities (OR 7.73, CI 1.05 to 74.8, p=0.048) and age ≥18 years (OR 9.51, CI 1.90 to 82.2, p=0.014). In the eight patients infected with SARS-CoV-2 before CAR T, half of these patients had their CAR T infusion delayed by 15-30 days. CONCLUSIONS In a large international cohort of pediatric and young adult CAR-T recipients, SARS-CoV-2 infections resulted in frequent hospital and intensive care unit admissions and were associated with mortality in 4.3%. Patients with two or more comorbidities or aged ≥18 years were more likely to experience significant illness. Suspected Omicron infections were associated with milder disease.
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Affiliation(s)
- Kevin Owen McNerney
- Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA,Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rebecca M Richards
- Hematology, Oncology, and Bone Marrow Transplant, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Paibel Aguayo-Hiraldo
- Cancer and Blood Disease Institute, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Friso G Calkoen
- Division of Pediatric Oncology, Princess Maxima Center, Utrecht, The Netherlands
| | - Julie-An Talano
- Division of Hematology/Oncology/Blood and Marrow TransplantationDepartment of Pediatrics, Medical College of Wisconsin and Children’s Wisconsin, Milwaukee, Wisconsin, USA
| | - Amy Moskop
- Division of Hematology/Oncology/Blood and Marrow TransplantationDepartment of Pediatrics, Medical College of Wisconsin and Children’s Wisconsin, Milwaukee, Wisconsin, USA
| | - Adriana Balduzzi
- Clinica Pediatrica Università degli Studi di Milano Bicocca, Fondazione IRCCS San Gerardo dai Tintori, Milan, Italy
| | - Jennifer Krajewski
- Pediatric Blood and Marrow Transplantation, Hackensack Meridian School of Medicine, Hackensack, New Jersey, USA
| | - Hema Dave
- Cancer Immunology and Microbial Oncology Research Program, Children's National Hospital, Washington, District of Columbia, USA
| | - Anant Vatsayan
- Center for Cancer and Blood Disorders, Children's National Hospital, Washington, District of Columbia, USA
| | - Colleen Callahan
- Division of Oncology and Cancer Immunotherapy Program, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Hongyan Liu
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Yimei Li
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kara Lynn Davis
- Pediatrics, Stanford University School of Medicine, Stanford, California, USA,Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford, California, USA
| | - Shannon L Maude
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA,Division of Oncology, Center for Childhood Cancer Research and Cancer Immunotherapy Program, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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19
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Barkhordar M, Ahmadvand M, Sharifi Aliabadi L, Noorani SS, Bagheri Amiri F, Janbabai G, Sorouri R, Asadi Milani M, Vaezi M. Evaluation of Safety and Immunogenicity of a Recombinant Receptor-Binding Domain (RBD)-Tetanus Toxoid (TT) Conjugated SARS-CoV-2 Vaccine (PastoCovac) in Recipients of Autologous Hematopoietic Stem Cell Transplantation Compared to the Healthy Controls; A Prospective, Open-Label Clinical Trial. Vaccines (Basel) 2023; 11. [PMID: 36679963 DOI: 10.3390/vaccines11010117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 01/06/2023] Open
Abstract
Background: The urgent need for prompt SARS-CoV-2 immunization of hematopoietic stem cell transplant (HSCT) recipients in an endemic area raises many challenges regarding selecting a vaccine platform appropriate for HSCT recipients being economical for widespread use in developing countries. Methods: The trial is a prospective, single-group, open-label study to investigate the safety and serologic response of two doses of the recombinant receptor-binding domain (RBD)-Tetanus Toxoid (TT) conjugated SARS-CoV-2 vaccine (PastoCovac) early after autologous (auto) HSCT. For this reason, a total of 38 patients who completed the two-dose SARS-CoV-2 RBD-based vaccine between three to nine months after auto-HSCT and had an available anti-spike serologic test at three predefined time points of baseline and after the first and second doses and 50 healthy control individuals were included in the analysis. The primary outcome was defined as an increase in IgG Immune status ratio (ISR) to the cut-off value for the positive result (≥1.1) in the semiquantitative test. Findings: The median time between auto-HSCT and vaccination was 127 days. No participant reported any significant adverse effects (Grade 3). Pain at the injection site was the most common adverse event. The ISR increased significantly (p < 0.001) during the three-time point sampling for both patients and healthy control groups. In patients, the mean ISR increased from 1.39 (95% CI: 1.13−1.65) at baseline to 2.48 (1.93−3.03) and 3.73 (3.13−4.38) following the first and second dosages, respectively. In multivariate analysis, the higher count of lymphocytes [OR: 8.57 (95% CI: 1.51−48.75); p = 0.02] and history of obtaining COVID-19 infection before transplantation [OR: 6.24 (95% CI: 1.17−33.15); p = 0.03] remained the predictors of the stronger immune response following two doses of the RBD-TT conjugated vaccine. Moreover, we found that the immunogenicity of the COVID-19 vaccine shortly after transplantation could be influenced by pre-transplant COVID-19 vaccination. Interpretation: The RBD-TT conjugated SARS-CoV-2 vaccine was safe, highly immunogenic, and affordable early after autologous transplants. Funding: This work was mainly financed by the Hematology-Oncology-Stem Cell Transplantation Research Center (HORCSCT) of Tehran University and the Pasteur Institute of Iran.
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20
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Perram J, Purtill D, Bajel A, Butler J, O'Brien T, Teh B, Gilroy N, Ho PJ, Doocey R, Hills T, Perera T, Douglas G, Ramachandran S, Chee L, Trotman J, Weinkove R, Keogh S, Fraser C, Cochrane T, Watson AM, Diamond P, Latimer M, Irving I, Blyth E, Cheah C, Cole T, Milliken S, Yang H, Greenwood M, Bardy P, Kennedy G, Larsen S, Conyers R, Hamad N. Australia and New Zealand Transplant and Cellular Therapies (ANZTCT) position statement: COVID-19 management in patients with haemopoietic stem cell transplant and chimeric antigen receptor T cell. Intern Med J 2023; 53:119-125. [PMID: 36371767 PMCID: PMC9878098 DOI: 10.1111/imj.15978] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/16/2022] [Indexed: 11/15/2022]
Abstract
Patients with post-haemopoietic stem cell transplant or chimeric antigen receptor T -cell (CAR-T) therapy face a significant risk of morbidity and mortality from coronavirus disease 2019 because of their immunosuppressed state. As case numbers in Australia and New Zealand continue to rise, guidance on management in this high-risk population is needed. Whilst we have learned much from international colleagues who faced high infection rates early in the pandemic, guidance relevant to local health system structures, medication availability and emerging therapies is essential to equip physicians to manage our patients optimally.
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Affiliation(s)
- Jacinta Perram
- Haematology Department, Westmead Hospital, Sydney, New South Wales, Australia
| | - Duncan Purtill
- Haematology department, Fiona Stanley Hospital, Western Australia, Perth, Australia
| | - Ashish Bajel
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jason Butler
- Haematology department, Royal Brisbane and Women's Hospital, Queensland, Brisbane, Australia
| | - Tracey O'Brien
- Haematology department, Sydney Children's Hospital, New South Wales, Sydney, Australia
| | - Benjamin Teh
- Haematology department, National Centre for Infections in Cancer and Department of Infectious Diseases, Peter MacCallum Cancer Institute, Victoria, Melbourne, Australia
| | - Nicole Gilroy
- Haematology department, Centre for Infectious Diseases and Microbiology, Westmead Hospital, New South Wales, Sydney, Australia
| | - Phoebe J Ho
- Haematology department, Royal Prince Alfred Hospital and the University of Sydney, New South Wales, Sydney, Australia
| | - Richard Doocey
- Haematology department, Auckland City Hospital, Auckland, New Zealand
| | - Thomas Hills
- Haematology department, Auckland City Hospital, Auckland, New Zealand
| | - Travis Perera
- Haematology department, Wellington Blood and Cancer Centre, Wellington, New Zealand
| | - Genevieve Douglas
- Haematology department, Austin Hospital, Victoria, Melbourne, Australia
| | - Shanti Ramachandran
- Department of Clinical Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Lynette Chee
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Judith Trotman
- Haematology department, Concord Repatriation General Hospital and University of Sydney, New South Wales, Sydney, Australia
| | - Robert Weinkove
- Haematology department, Wellington Blood and Cancer Centre and Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Steven Keogh
- Haematology department, University of Sydney and Westmead Hospital, New South Wales, Sydney, Australia
| | - Chris Fraser
- Haematology department, Children's Health Queensland Hospital and Health Service, Queensland, Brisbane, Australia
| | - Tara Cochrane
- Haematology department, Gold Coast University Hospital, Queensland, Gold Coast, Australia
| | - Anne-Marie Watson
- Haematology department, Liverpool Hospital, New South Wales, Sydney, Australia
| | - Peter Diamond
- Leukaemia Foundation, Sydney, New South Wales, Australia
| | - Maya Latimer
- Haematology department, Canberra Hospital, Australian Capital Territory, Canberra, Australia
| | - Ian Irving
- ICON Cancer Centre, Brisbane, Queensland, Australia
| | - Emily Blyth
- Haematology department, University of Sydney and Westmead Hospital, New South Wales, Sydney, Australia
| | - Chan Cheah
- Haematology department, Sir Charles Gairdner Hospital, Western Australia, Perth, Australia
| | - Theresa Cole
- Haematology department, The Royal Children's Hospital Melbourne, Victoria, Melbourne, Australia
| | - Sam Milliken
- Haematology department, St Vincent's Hospital Sydney and School of Clinical Medicine, Faculty of Medicine and Health, UNSW, New South Wales, Sydney, Australia
| | - Hung Yang
- Australian Bone Marrow Donor Registry, Sydney, New South Wales, Australia
| | - Matthew Greenwood
- Haematology department, Royal North Shore Hospital, New South Wales, Sydney, Australia
| | - Peter Bardy
- Haematology department, Royal Adelaide Hospital, South Australia, Adelaide, Australia
| | - Glen Kennedy
- Haematology department, Royal Brisbane and Women's Hospital, Queensland, Brisbane, Australia
| | - Stephen Larsen
- Haematology department, Royal Prince Alfred Hospital and the University of Sydney, New South Wales, Sydney, Australia
| | - Rachel Conyers
- Haematology department, The Royal Children's Hospital Melbourne, Victoria, Melbourne, Australia
| | - Nada Hamad
- Haematology department, St Vincent's Hospital Sydney and School of Clinical Medicine, Faculty of Medicine and Health, UNSW, New South Wales, Sydney, Australia.,Haematology department, School of Medicine Sydney Campus, University of Notre Dame Australia, New South Wales, Sydney, Australia
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21
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Karhana S, Hussain K, Bint-E-Attar G, Bhurani D, Khan MA. Risk of Mortality in Bone Marrow Transplant Patients During SARS-CoV-2 Infection: A Systematic Review. EXP CLIN TRANSPLANT 2023; 21:1-11. [PMID: 36757164 DOI: 10.6002/ect.2022.0225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVES Recipients of bone marrow transplant with COVID-19 are at high risk of mortality and morbidity from their underlying immunocompromised state. Graft-versus-host disease and other comorbidities lead to poor COVID-19 outcomes in these patients. Understanding the outcomes and clinical characteristics of bone marrow transplant recipients with COVID-19 is needed to devise potential life-saving therapies for patients with hematologic malignancies. Reviewing large data sets from different ethnic groups and regions can lead to better understanding. We conducted a systematic review ofreal-world data from prospective and retrospective observational cohort studies that reported the clinical outcomes of COVID- 19 in bone marrow transplant patients. MATERIALS AND METHODS We used electronic databases (PubMed, ScienceDirect, Google Scholar), with a cut off date of May 31, 2022, to conduct our search. After screening 349 articles, we selected 33 original reports for screening. After screening these articles for eligibility criteria, we selected 12 studies for final data extraction. We extracted data per the preferred reporting items followed for systematic reviews. Quality evaluation was done with a Cochrane risk-of bias tool for nonrandomized studies (ROBINS-1). RESULTS Bone marrow transplant recipients with COVID-19 experienced poor disease outcomes and high mortality rates. Patient age, immunosuppressant intensity, and presence of graft-versus-host disease or other underlying comorbidities directly affected mortality rates of bone marrow transplant recipients with COVID-19. Other factors, like type of malignancy, type of transplant, and time between transplant and COVID-19 diagnosis, did not affect mortality or poor outcomes of COVID-19. CONCLUSIONS Bone marrow transplant recipients have a higher risk of mortality and poor disease outcomes from COVID-19. Because curative therapies for COVID- 19 are not available, the only option available is its prevention. Transplant centers worldwide, as pertheir capacities, should develop and adhere to strict standard operating procedures based on international or national guidelines related to transplant recipients with COVID-19.
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Affiliation(s)
- Sonali Karhana
- From the Centre for Translational & Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi 110062, India
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22
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Ljungman P, Tridello G, Piñana JL, Ciceri F, Sengeloev H, Kulagin A, Mielke S, Yegin ZA, Collin M, Einardottir S, Lepretre SD, Maertens J, Campos A, Metafuni E, Pichler H, Folber F, Solano C, Nicholson E, Yüksel MK, Carlson K, Aguado B, Besley C, Byrne J, Heras I, Dignan F, Kröger N, Robin C, Khan A, Lenhoff S, Grassi A, Dobsinska V, Miranda N, Jimenez MJ, Yonal-Hindilerden I, Wilson K, Averbuch D, Cesaro S, Xhaard A, Knelange N, Styczynski J, Mikulska M, de la Camara R. 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. Front Immunol 2023; 14:1125824. [PMID: 36960069 PMCID: PMC10028143 DOI: 10.3389/fimmu.2023.1125824] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/22/2023] [Indexed: 03/09/2023] Open
Abstract
Introduction COVID-19 has been associated with high morbidity and mortality in allogeneic hematopoietic stem cell transplant (allo-HCT) recipients. Methods This study reports on 986 patients reported to the EBMT registry during the first 29 months of the pandemic. Results The 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. Discussion Although 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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Affiliation(s)
- Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska Comprehensive Cancer Center, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Division of Hematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- *Correspondence: Per Ljungman,
| | - Gloria Tridello
- European Society for Blood and Marrow Transplantation (EBMT) Data Office, Department of Medical Statistics & Bioinformatics, Leiden, Netherlands
| | - Jose Luis Piñana
- Hematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Fundación Investigación del Hospital Clínico de la Comunidad Valenciana (INCLIVA), Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Fabio Ciceri
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Henrik Sengeloev
- Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Alexander Kulagin
- Raisa Memorial (RM) Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia
| | - Stephan Mielke
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska Comprehensive Cancer Center, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Zeynep Arzu Yegin
- Department of Hematology, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Matthew Collin
- Translational and Clinical Research Institute and The National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre, Newcastle, United Kingdom
| | - Sigrun Einardottir
- Department of Hematology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Johan Maertens
- Department of Hematology University Hospital Gasthuisberg, Leuven, Belgium
| | - Antonio Campos
- Marrow Transplant Department Inst. Português de Oncologia do Porto, Porto, Portugal
| | - Elisabetta Metafuni
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica e Ematologia, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Herbert Pichler
- St. Anna Children’s Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Frantisek Folber
- Department of Internal Medicine, Hematology and Oncology University Hospital Brno, Brno, Czechia
- Department of Internal Medicine, Hematology and Oncology Masaryk University, Brno, Czechia
| | - Carlos Solano
- European Society for Blood and Marrow Transplantation (EBMT) Data Office, Department of Medical Statistics & Bioinformatics, Leiden, Netherlands
| | - Emma Nicholson
- Haematology-oncology Unit Royal Marsden Hospital, London, United Kingdom
| | - Meltem Kurt Yüksel
- Department of Hematology, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Kristina Carlson
- Department of Hematology, Uppsala University Hospital, Uppsala, Sweden
| | - Beatriz Aguado
- Department of Hematology, Hospital Universitario de la Princesa, Madrid, Spain
| | - Caroline Besley
- University Hospitals Bristol and Weston National Health Service (NHS) Foundation Trust, Bristol, United Kingdom
| | - Jenny Byrne
- Department of Haematology Nottingham University Hospital, Nottingham, United Kingdom
| | - Immaculada Heras
- Department of Hematology, Hospital Universitario Morales Meseguer, Instituto Murciano de Investigación Biosanitaria (IMIB)-Arrixaca, Universidad de Murcia, Murcia, Spain
| | - Fiona Dignan
- Clinical Haematology Department Manchester Royal Infirmary, Manchester, United Kingdom
| | - Nicolaus Kröger
- Department of Stem cell Transplantation, University Hospital Eppendorf, Hamburg, Germany
| | - Christine Robin
- Assistance Publique-Hôpitaux de Paris (APHP), Henri Mondor Hospital, Department of Hematology, Créteil, France
| | - Anjum Khan
- Department of Haematology Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Stig Lenhoff
- Department of Hematology Skåne’s University Hospital, Lund, Sweden
| | - Anna Grassi
- Bone Marrow Transplantation Unit, Azienda Sociosanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
| | - Veronika Dobsinska
- Department of Pediatric Hematology and Oncology, National Institute of Children’s Diseases, Comenius University, Bratislava, Slovakia
| | - Nuno Miranda
- Department of Haematology Inst. Portugues Oncologia, Lisbon, Portugal
| | - Maria-Jose Jimenez
- Department of Clinical Haematology Institut Catala d'Oncologia (ICO)-Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Ipek Yonal-Hindilerden
- Istanbul Medical Faculty, Adult Hematopoietic Stem Cell Transplant Center, Istanbul University, Istanbul, Türkiye
| | - Keith Wilson
- Blood and Bone Marrow Transplantation Department University of Cardiff, Cardiff, United Kingdom
| | - Dina Averbuch
- Pediatric Infectious Diseases Unit, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Simone Cesaro
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Alienor Xhaard
- Hematology-Transplantation Unit, Department of Hematology: Hôpital St. Louis, Paris, France
| | - Nina Knelange
- European Society for Blood and Marrow Transplantation (EBMT) Leiden Study Unit, European Society for Blood and Marrow Transplantation (EBMT) Data Office, Leiden, Netherlands
| | - Jan Styczynski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Malgorzata Mikulska
- Division of Infectious Diseases, University of Genoa and Ospedale Policlinico San Martino, Genova, Italy
| | - Rafael de la Camara
- Department of Hematology, Hospital Universitario de la Princesa, Madrid, Spain
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23
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Granroth G, Rosenthal A, McCallen M, Coughlin C, Benson H, Palmer J, Castro JE, Munoz J. Supportive Care for Patients with Lymphoma Undergoing CAR-T-cell Therapy: the Advanced Practice Provider's Perspective. Curr Oncol Rep 2022; 24:1863-1872. [PMID: 36336769 PMCID: PMC9638184 DOI: 10.1007/s11912-022-01330-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE OF REVIEW The purpose of our paper is to describe the all-encompassing supportive care for patients with relapsed or refractory lymphoma undergoing cellular therapy, with a focus on the advanced practice provider's (APPs) perspective. RECENT FINDINGS Chimeric antigen receptor-T (CAR-T) cell therapy has become more available for treating relapsed or refractory B-cell hematologic malignancies, requiring proficient and adequate treatment of side effects, complications, and infections that may occur during therapy. APPs often meet these patients during the initial referral and help to support them through the CAR-T cell therapy process. As APPs acquire a complete understanding and comprehensive knowledge of how to treat, support, and guide patients with B-cell malignancies through CAR-T cell therapy, they play a pivotal role in these patients throughout their treatment. Standardization of supportive care is paramount.
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Affiliation(s)
- Ginna Granroth
- Bone and Marrow Transplant, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ, USA.
| | | | | | | | - Hollie Benson
- Bone and Marrow Transplant, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ, USA
| | | | | | - Javier Munoz
- Hematology/Oncology, Mayo Clinic, Phoenix, AZ, USA
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DeWolf S, Laracy JC, Perales MA, Kamboj M, van den Brink MRM, Vardhana S. SARS-CoV-2 in immunocompromised individuals. Immunity 2022; 55:1779-1798. [PMID: 36182669 PMCID: PMC9468314 DOI: 10.1016/j.immuni.2022.09.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/24/2022] [Accepted: 09/08/2022] [Indexed: 12/15/2022]
Abstract
Immunocompromised individuals and particularly those with hematologic malignancies are at increased risk for SARS-CoV-2-associated morbidity and mortality due to immunologic deficits that limit prevention, treatment, and clearance of the virus. Understanding the natural history of viral infections in people with impaired immunity due to underlying conditions, immunosuppressive therapy, or a combination thereof has emerged as a critical area of investigation during the COVID-19 pandemic. Studies focused on these individuals have provided key insights into aspects of innate and adaptive immunity underlying both the antiviral immune response and excess inflammation in the setting of COVID-19. This review presents what is known about distinct states of immunologic vulnerability to SARS-CoV-2 and how this information can be harnessed to improve prevention and treatment strategies for immunologically high-risk populations.
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Affiliation(s)
- Susan DeWolf
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Justin C Laracy
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Mini Kamboj
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marcel R M van den Brink
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA; Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Santosha Vardhana
- Weill Cornell Medical College, New York, NY, USA; Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Brianna, Ling APK, Wong YP. Applying stem cell therapy in intractable diseases: a narrative review of decades of progress and challenges. Stem Cell Investig 2022; 9:4. [PMID: 36238449 PMCID: PMC9552054 DOI: 10.21037/sci-2022-021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/09/2022] [Indexed: 08/10/2023]
Abstract
Background and Objective Stem cell therapy (SCT) is one of the vastly researched branches of regenerative medicine as a therapeutic tool to treat incurable diseases. With the use of human stem cells such as embryonic stem cells (ESCs), adult stem cells (ASCs) and induced pluripotent stem cells (iPSCs), stem cell therapy aims to regenerate or repair damaged tissues and congenital defects. As stem cells are able to undergo infinite self-renewal, differentiate into various types of cells and secrete protective paracrine factors, many researchers have investigated the potential of SCT in regenerative medicine. Therefore, this review aims to provide a comprehensive review on the recent application of SCT in various intractable diseases, namely, haematological diseases, neurological diseases, diabetes mellitus, retinal degenerative disorders and COVID-19 infections along with the challenges faced in the clinical translation of SCT. Methods An extensive search was conducted on Google scholar, PubMed and Clinicaltrials.gov using related keywords. Latest articles on stem cell therapy application in selected diseases along with their challenges in clinical applications were selected. Key content and findings In vitro and in vivo studies involving SCT are shown to be safe and efficacious in treating various diseases covered in this review. There are also a number of small-scale clinical trials that validated the positive therapeutic outcomes of SCT. Nevertheless, the effectiveness of SCT are highly variable as some SCT works best in patients with early-stage diseases while in other diseases, SCT is more likely to work in patients in late stages of illnesses. Among the challenges identified in SCT translation are uncertainty in the underlying stem cell mechanism, ethical issues, genetic instability and immune rejection. Conclusions SCT will be a revolutionary treatment in the future that will provide hope to patients with intractable diseases. Therefore, studies ought to be done to ascertain the long-term effects of SCT while addressing the challenges faced in validating SCT for clinical use. Moreover, as there are many studies investigating the safety and efficacy of SCT, future studies should look into elucidating the regenerative and reparative capabilities of stem cells which largely remains unknown.
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Affiliation(s)
- Brianna
- Applied Biomedical Sciences and Biotechnology, School of Health Sciences, International Medical University, Kuala Lumpur, Malaysia
| | - Anna Pick Kiong Ling
- Applied Biomedical Sciences and Biotechnology, School of Health Sciences, International Medical University, Kuala Lumpur, Malaysia
| | - Ying Pei Wong
- Applied Biomedical Sciences and Biotechnology, School of Health Sciences, International Medical University, Kuala Lumpur, Malaysia
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Strasfeld L. COVID-19 and HSCT (Hematopoietic stem cell transplant). Best Pract Res Clin Haematol 2022; 35:101399. [PMID: 36494150 DOI: 10.1016/j.beha.2022.101399] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 01/26/2023]
Abstract
HSCT recipients are at increased risk for COVID-19-associated morbidity and mortality. Early treatment of symptomatic SARS-CoV-2 infection is an important means to decreasing risk for severe disease and death. While some HSCT recipients, particularly those who are early post-transplant and severely immunosuppressed, may have diminished response to COVID-19 vaccines, the benefits of vaccination are uncontested. Public health, healthcare facility and individual level approaches are all necessary to mitigate risk for infection in this vulnerable population.
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Lim YJ, Khan U, Karpha I, Ross A, Saif M, Remberger M, Kalakonda N, Pettitt AR, Floisand Y. COVID‐19 outcomes in haematopoietic cell transplant recipients: A systematic review and meta‐analysis. eJHaem 2022; 3:862-872. [PMID: 35941880 PMCID: PMC9350043 DOI: 10.1002/jha2.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/11/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022]
Abstract
Up‐to‐date information on coronavirus disease 2019 (COVID‐19) outcomes and risk factors in haematopoietic cell transplantation (HCT) recipients is required to inform on decisions about cancer treatment and COVID‐19 mitigation strategies. We performed a meta‐analysis to address this knowledge gap. All studies with at least five patients who reported COVID‐19‐related deaths in HCT recipients were included. The primary outcome was COVID‐19‐related death. Secondary outcomes were COVID‐19‐related mechanical ventilation (MV) and intensive care unit (ITU) admission. The cumulative COVID‐19‐related death rate among HCT recipients was 21% (95% confidence interval [CI] 18%–24%), while MV and ITU admission rates were 14% (95% CI 11%–17%) and 18% (95% CI 14%–22%), respectively. Subgroup analysis showed higher death rates in patients who developed COVID‐19 within 12 months of HCT (risk ratio [RR] 1.82, 95% CI 1.09–3.03), within 6 months of receiving immunosuppressant drugs (RR 2.11, 95% CI 1.38–3.20) or in the context of active graft‐versus‐host disease (RR 2.38, 95% CI 1.10–5.16). Our findings support the idea that HCT should remain an integral part of cancer treatment during the COVID‐19 pandemic but also highlight the need to prioritise preventative measures in those patients who are at increased risk of adverse COVID‐19 outcomes.
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Affiliation(s)
- Yeong Jer Lim
- Haemato‐oncology Department Clatterbridge Cancer Centre NHS Foundation Trust Liverpool UK
- Institute of Systems, Molecular and Integrative Biology University of Liverpool Liverpool UK
| | - Umair Khan
- Haemato‐oncology Department Clatterbridge Cancer Centre NHS Foundation Trust Liverpool UK
- Institute of Systems, Molecular and Integrative Biology University of Liverpool Liverpool UK
| | - Indrani Karpha
- Haemato‐oncology Department Clatterbridge Cancer Centre NHS Foundation Trust Liverpool UK
- Institute of Systems, Molecular and Integrative Biology University of Liverpool Liverpool UK
| | - Andrew Ross
- Haemato‐oncology Department Clatterbridge Cancer Centre NHS Foundation Trust Liverpool UK
| | - Muhammad Saif
- Haemato‐oncology Department Clatterbridge Cancer Centre NHS Foundation Trust Liverpool UK
| | - Mats Remberger
- Department of Medical Sciences Uppsala University and KFUE Uppsala University Hospital Uppsala Sweden
| | - Nagesh Kalakonda
- Haemato‐oncology Department Clatterbridge Cancer Centre NHS Foundation Trust Liverpool UK
- Institute of Systems, Molecular and Integrative Biology University of Liverpool Liverpool UK
| | - Andrew R. Pettitt
- Haemato‐oncology Department Clatterbridge Cancer Centre NHS Foundation Trust Liverpool UK
- Institute of Systems, Molecular and Integrative Biology University of Liverpool Liverpool UK
| | - Yngvar Floisand
- Haemato‐oncology Department Clatterbridge Cancer Centre NHS Foundation Trust Liverpool UK
- Centre for Cancer Cell Reprogramming, Institute of Clinical Medicine University of Oslo Oslo Norway
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Luque Paz D, Sesques P, Wallet F, Bachy E, Ader F. The burden of SARS-CoV-2 in patients receiving chimeric antigen receptor T cell immunotherapy: everything to lose. Expert Rev Anti Infect Ther 2022; 20:1155-1162. [PMID: 35838042 DOI: 10.1080/14787210.2022.2101448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Chimeric antigen receptor T (CAR-T) cell immunotherapy has revolutionized the prognosis of refractory or relapsed B-cell malignancies. CAR-T cell recipients have immunosuppression generated by B-cell aplasia leading to a higher susceptibility to respiratory virus infections and poor response to vaccination. AREAS COVERED This review focuses on the challenge posed by B-cell targeted immunotherapies: managing long-lasting B-cell impairment during the successive surges of a deadly viral pandemic. We restricted this report to data regarding vaccine efficacy in CAR-T cell recipients, outcomes after developing COVID-19 and specificities of treatment management. We searched in MEDLINE database to identify relevant studies until March 31st 2022. EXPERT OPINION Among available observational studies, the pooled mortality rate reached 40% in CAR-T cell recipients infected by SARS-CoV-2. Additionally, vaccines responses seem to be widely impaired in recipients (seroconversion 20%, T-cell response 50%). In this setting of B-cell depletion, passive immunotherapy is the backbone of treatment. Convalescent plasma therapy has proven to be a highly effective curative treatment with rare adverse events. Neutralizing monoclonal antibodies could be used as pre-exposure prophylaxis or early treatment but their neutralizing activity is constantly challenged by new variants. In order to reduce viral replication, direct-acting antiviral drugs should be considered.
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Affiliation(s)
- David Luque Paz
- Université Rennes-I, Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Rennes, France.,Département des Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, Lyon, France
| | - Pierre Sesques
- Service d'Hématologie clinique, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Florent Wallet
- Service d'Anesthésie, médecine intensive, réanimation, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Emmanuel Bachy
- Service d'Hématologie clinique, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Florence Ader
- Département des Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, Lyon, France.,Centre Hospitalier Universitaire de Lyon, Infectious diseases, Hôpital de la Croix-Rousse, Lyon, France
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Jakharia N, Subramanian AK, Shapiro AE. COVID-19 in the Immunocompromised Host, Including People with Human Immunodeficiency Virus. Infect Dis Clin North Am 2022; 36:397-421. [PMID: 35636907 DOI: 10.1016/j.idc.2022.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This review describes the incidence, epidemiology, and risk factors for mortality of COVID-19 in immunocompromised patients, including persons with human immunodeficiency virus. It describes various preventive measures, including vaccines and their effectiveness and the role of monoclonal antibodies for pre-exposure prophylaxis. It also reviews the different treatment options for immunocompromised individuals, including antivirals, monoclonal antibodies, and immunomodulators. Lastly, it describes the impact of COVID-19 on transplantation and continuity care of this population.
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Abstract
The coronavirus infectious disease (COVID-19) shows a remarkable symptomatic heterogeneity. Several risk factors including advanced age, previous illnesses and a compromised immune system contribute to an unfavorable outcome. In patients with hematologic malignancy, the immune response to severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is significantly reduced explaining why the mortality rate of hematologic patients hospitalized for a SARS-CoV-2 infection is about 34%. Active immunization is an essential pillar to prevent SARS-CoV-2 infections in patients with hematologic malignancy. However, the immune response to SARS-CoV-2 vaccines may be significantly impaired, as only half of patients with hematologic malignancy develop a measurable anti-viral antibody response. The subtype of hematologic malignancy and B-cell depleting treatment predict a poor immune response to vaccination. Recently, antiviral drugs and monoclonal antibodies for pre-exposure or post-exposure prophylaxis and for early treatment of COVID-19 have become available. These therapies should be offered to patients at high risk for severe COVID-19 and vaccine non-responder. Importantly, as the virus evolves, some therapies may lose their clinical efficacy against new variants. Therefore, the ongoing pandemic will remain a major challenge for patients with hematologic malignancy and their caregivers who need to constantly monitor the scientific progress in this area.
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Degarege A, Naveed Z, Kabayundo J, Brett-Major D. Heterogeneity and Risk of Bias in Studies Examining Risk Factors for Severe Illness and Death in COVID-19: A Systematic Review and Meta-Analysis. Pathogens 2022; 11:563. [PMID: 35631084 PMCID: PMC9147100 DOI: 10.3390/pathogens11050563] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 02/07/2023] Open
Abstract
This systematic review and meta-analysis synthesized the evidence on the impacts of demographics and comorbidities on the clinical outcomes of COVID-19, as well as the sources of the heterogeneity and publication bias of the relevant studies. Two authors independently searched the literature from PubMed, Embase, Cochrane library, and CINAHL on 18 May 2021; removed duplicates; screened the titles, abstracts, and full texts by using criteria; and extracted data from the eligible articles. The variations among the studies were examined by using Cochrane, Q.; I2, and meta-regression. Out of 11,975 articles that were obtained from the databases and screened, 559 studies were abstracted, and then, where appropriate, were analyzed by meta-analysis (n = 542). COVID-19-related severe illness, admission to the ICU, and death were significantly correlated with comorbidities, male sex, and an age older than 60 or 65 years, although high heterogeneity was present in the pooled estimates. The study design, the study country, the sample size, and the year of publication contributed to this. There was publication bias among the studies that compared the odds of COVID-19-related deaths, severe illness, and admission to the ICU on the basis of the comorbidity status. While an older age and chronic diseases were shown to increase the risk of developing severe illness, admission to the ICU, and death among the COVID-19 patients in our analysis, a marked heterogeneity was present when linking the specific risks with the outcomes.
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Affiliation(s)
- Abraham Degarege
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA; (Z.N.); (J.K.); (D.B.-M.)
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Gavriilaki E, Papadopoulou A, Touloumenidou T, Stavridou F, Koravou EE, Giannaki M, Papalexandri A, Karavalakis G, Batsis I, Kourelis A, Chatzopoulou F, Chatzidimitriou D, Sotiropoulos D, Yannaki E, Sakellari I, Anagnostopoulos A. Neutralizing antibody and T cell responses to SARS-CoV-2 vaccination in hematopoietic cell transplant recipients. Bone Marrow Transplant 2022; 57:1183-1186. [PMID: 35449455 PMCID: PMC9022618 DOI: 10.1038/s41409-022-01675-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/01/2022] [Accepted: 04/01/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Eleni Gavriilaki
- Hematology Department - Hematopoietic Cell Transplant (HCT) Unit - Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Anastasia Papadopoulou
- Hematology Department - Hematopoietic Cell Transplant (HCT) Unit - Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Tasoula Touloumenidou
- Hematology Department - Hematopoietic Cell Transplant (HCT) Unit - Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Fani Stavridou
- Hematology Department - Hematopoietic Cell Transplant (HCT) Unit - Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Evaggelia-Evdoxia Koravou
- Hematology Department - Hematopoietic Cell Transplant (HCT) Unit - Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Maria Giannaki
- Hematology Department - Hematopoietic Cell Transplant (HCT) Unit - Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Apostolia Papalexandri
- Hematology Department - Hematopoietic Cell Transplant (HCT) Unit - Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Georgios Karavalakis
- Hematology Department - Hematopoietic Cell Transplant (HCT) Unit - Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Ioannis Batsis
- Hematology Department - Hematopoietic Cell Transplant (HCT) Unit - Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Andreas Kourelis
- Microbiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Fani Chatzopoulou
- Microbiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Damianos Sotiropoulos
- Hematology Department - Hematopoietic Cell Transplant (HCT) Unit - Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Evangelia Yannaki
- Hematology Department - Hematopoietic Cell Transplant (HCT) Unit - Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece.
| | - Ioanna Sakellari
- Hematology Department - Hematopoietic Cell Transplant (HCT) Unit - Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Achilles Anagnostopoulos
- Hematology Department - Hematopoietic Cell Transplant (HCT) Unit - Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
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DeVoe C, Pandey S, Shariff D, Arora S, Henrich TJ, Yokoe DS, Langelier CR, Servellita V, Chiu C, Miller S, Babik JM, Chin‐Hong P, Fung M. COVID-19 in vaccinated versus unvaccinated hematologic malignancy patients. Transpl Infect Dis 2022; 24:e13835. [PMID: 35426225 PMCID: PMC9115335 DOI: 10.1111/tid.13835] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/14/2022] [Accepted: 03/09/2022] [Indexed: 01/04/2023]
Abstract
The effect of vaccination on severity of subsequent COVID-19 in patients with hematologic malignancies (HMs) is unknown. In this single-center retrospective cohort study, we found no difference in severity of COVID-19 disease in vaccinated (n = 16) versus unvaccinated (n = 54) HM patients using an adjusted multiple logistic regression model. Recent anti-B-cell therapy was associated with more severe illness.
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Affiliation(s)
- Catherine DeVoe
- Division of Infectious DiseasesDepartment of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Shraddha Pandey
- Division of Infectious DiseasesDepartment of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Dayana Shariff
- Division of Infectious DiseasesDepartment of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Shagun Arora
- Division of Hematology/OncologyDepartment of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Timothy J. Henrich
- Division of Infectious DiseasesDepartment of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA,Division of Experimental MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Deborah S. Yokoe
- Division of Infectious DiseasesDepartment of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Charles R. Langelier
- Division of Infectious DiseasesDepartment of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA,Chan Zuckerberg BiohubSan FranciscoCaliforniaUSA
| | - Venice Servellita
- Department of Laboratory MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Charles Chiu
- Division of Infectious DiseasesDepartment of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA,Department of Laboratory MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Steve Miller
- Department of Laboratory MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Jennifer M. Babik
- Division of Infectious DiseasesDepartment of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Peter Chin‐Hong
- Division of Infectious DiseasesDepartment of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Monica Fung
- Division of Infectious DiseasesDepartment of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
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Sharafeldin N, Bates B, Vachhani P. How the COVID-19 Pandemic Reshaped the Management of Leukemia and Affected Patient Outcomes. Curr Treat Options Oncol 2022; 23:688-702. [PMID: 35334062 PMCID: PMC8951659 DOI: 10.1007/s11864-022-00975-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 11/29/2022]
Abstract
The coronavirus disease-19 (COVID-19) pandemic has posed numerous challenges to the global healthcare system. Of particular gravity is adult and pediatric patients with hematologic malignancies who are among the most vulnerable groups of patients at risk of severe COVID-19 outcomes. In the early phases of the pandemic, several treatment modifications were proposed for patients with leukemia. Largely speaking, these were adopting less-intense therapies and more utilization of the outpatient setting. Over time, our understanding and management have become more nuanced. Furthermore, equipped with vaccinations to prevent COVID-19 infection and availability of treatments in the presence of COVID-19 infection, the recommendations on management of patients with leukemia have evolved. Patient’s leukemia characteristics, possibility of targeted therapy, vaccination status, symptomatology, comorbidities, goal of anti-leukemic therapy, the intensity of therapy, the setting of treatment, as well as loco regional factors like dynamic incidence of COVID-19 in the community and hospital/ICU bed status are among many factors that influence the decisions. Furthermore, the oncology community has adopted delaying the anti-leukemia therapy for a limited time frame, if clinically possible, so as to still deliver most appropriate therapy while minimizing risks. Early adoption of growth factor support and conservative blood transfusion practices have helped as well. In this review, we discuss the impact of COVID-19 on outcomes and share considerations for treatments of leukemias. We describe the impact on both clinical care (from diagnosis to treatment) and research, and cover the literature on vaccines and treatments for COVID-19 in relation to leukemia.
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Affiliation(s)
- Noha Sharafeldin
- Division of Hematology and Oncology and O'Neal Comprehensive Cancer Center, Heersink School of Medicine, University of Alabama at Birmingham (UAB), 1600 7th Avenue South, Lowder 500, Birmingham, AL, 35233, USA.
| | - Benjamin Bates
- The Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA
| | - Pankit Vachhani
- Division of Hematology and Oncology and O'Neal Comprehensive Cancer Center, Heersink School of Medicine, University of Alabama at Birmingham (UAB), 1600 7th Avenue South, Lowder 500, Birmingham, AL, 35233, USA
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35
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Conway S, Keller MD, Bollard CM. Cellular therapies for the treatment and prevention of SARS-CoV-2 infection. Blood 2022:blood. [PMID: 35240679 DOI: 10.1182/blood.2021012249] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/01/2022] [Indexed: 12/15/2022] Open
Abstract
Patients with blood disorders who are immune suppressed are at increased risk for infection with severe acute respiratory syndrome coronavirus 2. Sequelae of infection can include severe respiratory disease and/or prolonged duration of viral shedding. Cellular therapies may protect these vulnerable patients by providing antiviral cellular immunity and/or immune modulation. In this recent review of the field, phase 1/2 trials evaluating adoptive cellular therapies with virus-specific T cells or natural killer cells are described along with trials evaluating the safety, feasibility, and preliminary efficacy of immune modulating cellular therapies including regulatory T cells and mesenchymal stromal cells. In addition, the immunologic basis for these therapies is discussed.
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Schaffrath J, Brummer C, Wolff D, Holtick U, Kröger N, Bornhäuser M, Kraus S, Hilgendorf I, Blau IW, Penack O, Wittke C, Steiner N, Nachbaur D, Thurner L, Hindah H, Zeiser R, Maier CP, Bethge W, Müller LP. High mortality of COVID-19 early after allogeneic stem cell transplantation – a retrospective multicenter analysis on behalf of the German Cooperative Transplant Study Group. Transplant Cell Ther 2022; 28:337.e1-337.e10. [PMID: 35296445 PMCID: PMC8918088 DOI: 10.1016/j.jtct.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/29/2022]
Abstract
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.
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Lafarge A, Mabrouki A, Yvin E, Bredin S, Binois Y, Clere-Jehl R, Azoulay E. Coronavirus disease 2019 in immunocompromised patients: a comprehensive review of coronavirus disease 2019 in hematopoietic stem cell recipients. Curr Opin Crit Care 2022; 28:83-89. [PMID: 34813523 PMCID: PMC8711307 DOI: 10.1097/mcc.0000000000000907] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Immunocompromised patients are notably vulnerable to severe coronavirus disease 2019. This review summarizes COVID-19 features and outcomes in autologous and allogeneic hematopoietic stem cell transplantation (HSCT) recipients. RECENT FINDINGS Recent findings suggest that HSCT recipients exhibit a high burden of comorbidities and COVID-19 clinical features almost similar to the general COVID population. Furthermore, HSCT recipients exhibit a protracted SARS-CoV-2 shedding, prolonging duration of symptoms and promoting the generation of highly mutated viruses. Last, most of studies report a higher COVID-19 mortality in HSCT recipients, mainly driven by age, comorbidities, time from transplantation, and immunosuppression because of both treatments and underlying hematological malignancy. SUMMARY Further studies are warranted to determine the proper impact of HSCT-related immune disorders on COVID-19 outcomes, and to evaluate specific treatments and vaccination strategy in this high-risk population. Taken together, those findings emphasize the need for more rigorous surveillance and preemptive measures for all HSCT recipients.
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Affiliation(s)
- Antoine Lafarge
- Medical Intensive Care Unit, Saint Louis Hospital, Assistance Publique Hôpitaux de Paris (APHP), University de Paris, Paris, France
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Zubarovskaya N, Hofer-Popow I, Idzko M, Haas OA, Lawitschka A. SARS-CoV-2 Infection and Active, Multiorgan, Severe cGVHD After HSCT for Adolescent ALL: More Luck Than Understanding? A Case Report. Front Pediatr 2022; 9:775318. [PMID: 35096703 PMCID: PMC8795895 DOI: 10.3389/fped.2021.775318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/09/2021] [Indexed: 11/30/2022] Open
Abstract
Graft-vs. -host disease (GvHD) is a serious and complex immunological complication of haematopoietic stem cell transplantation (HSCT) and is associated with prolonged immunodeficiency and non-relapse mortality. Standard treatment of chronic GvHD comprises steroids in combination with other immunosuppressive agents. Extracorporeal photopheresis (ECP), with its immunomodulatory mechanism, is applied as part of steroid-sparing regimens for chronic GvHD. Immunocompromised, chronically ill patients are at particular risk of severe disease courses of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. T-cell immunity in SARS-CoV-2 infection is well-described but the role of the humoral immune responses is not fully understood. This case report describes a moderate course of SARS-CoV-2 infection in a patient <9 months after HSCT who was suffering from active, severe, chronic GvHD treated with prednisone and ECP. Following HSCT from a matched unrelated donor to cure acute lymphoblastic leukaemia, the 25-year-old male patient experienced multiple infectious complications associated with cytopenia, B-cell dyshomeostasis and autoantibody production followed by development of severe chronic GvHD thereafter at day +212. The steroid-sparing treatment plan consisted of supportive care, topical treatment, prednisone and ECP. He was diagnosed with SARS-CoV-2 infection at day +252, experiencing loss of smell and taste as well as a cough. The patient's oxygen saturation was between 94 and 97% on room air, and computed tomography images showed evolution of typical of SARS-CoV-2 infiltrates. In addition to cytopenia and immune dyshomeostasis, laboratory tests confirmed macrophage activating syndrome, transaminitis and Epstein-Barr virus viraemia. At that time, anti-SARS-CoV-2 monoclonal antibodies were not available in Austria and remdesivir seemed contraindicated. Surprisingly, despite severe lymphopenia the patient developed SARS-CoV-2-specific antibodies within 15 days, which was followed by clearance of SARS-CoV-2 and EBV with resolution of symptoms. Thereafter, parameters of immune dysregulation such as lymphopenia and B-cell dyshomeostasis, the latter characterised by elevated CD21low B cells and autoantibody expression, normalised. Moreover, we observed complete response of active chronic GvHD to treatment.
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Affiliation(s)
- Natalia Zubarovskaya
- Stem Cell Transplant Unit, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Irene Hofer-Popow
- Stem Cell Transplant Unit, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Marco Idzko
- Department of Pulmonology, Medical University of Vienna, Vienna, Austria
| | - Oskar A. Haas
- Labdia Labordiagnostik GmbH, Vienna, Austria
- St. Anna Children's Cancer Research Institute, Vienna, Austria
- St. Anna Children's Hospital, Pediatric Clinic, Medical University of Vienna, Vienna, Austria
| | - Anita Lawitschka
- Stem Cell Transplant Unit, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
- St. Anna Children's Cancer Research Institute, Vienna, Austria
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Shahzad M, Chaudhary SG, Zafar MU, Hassan MA, Hussain A, Ali F, Anwar I, Ahmed M, Ahmed N, Khurana S, Rauf MA, Anwar F, Hematti P, Callander NS, Abhyankar SH, McGuirk JP, Mushtaq MU. Impact of COVID-19 in Hematopoietic stem cell transplant recipients: A systematic review and meta-analysis. Transpl Infect Dis 2022; 24:e13792. [PMID: 35030267 DOI: 10.1111/tid.13792] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/23/2021] [Accepted: 01/03/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hematopoietic stem cell transplant (HSCT) recipients are at increased risk of mortality and morbidity with Coronavirus Disease 2019 (COVID-19) due to severe immune dysfunction. METHODS A literature search was performed on PubMed, Cochrane, and Clinical trials.gov from the date of inception to 12/08/2021. We identified 19 original studies reporting data on COVID-19 in HSCT recipients after screening 292 articles. Data was extracted following PRISMA guidelines. Quality evaluation was done using the NIH quality assessment tool. Inter-study variance was calculated using Der Simonian-Laird Estimator. Pooled analysis was conducted using MetaXL. A random-effects model was used to estimate the proportions with 95% confidence intervals (CI). RESULTS Of 6711 patients in 19 studies, 2031 HSCT patients with SARS-CoV-2 infection were analyzed. The median age of patients was 56.9 (range 1-81.6) years, and 63% patients were men according to 14 studies. The median time from transplant to SARS-CoV-2 infection for autologous (auto) and allogeneic (allo) HSCT patients was 23.2 (0.33- 350.5) months and 16.4 (0.2- 292.7) months respectively. The median follow-up time after COVID-19 diagnosis was 28 (0-262) days. The COVID-19 mortality rate was 19% (95% CI 0.15- 0.24, I2 = 76%, n = 373/2031). The pooled mortality rate was 17% (95% CI 0.12- 0.24, I2 = 78%, n = 147/904) in auto-HSCT patients and 21% (95% CI 0.16- 0.25, I2 = 60%, n = 231/1103) in allo-HSCT patients. CONCLUSIONS HSCT recipients have a high risk of mortality and clinical complications due to COVID-19. There is a need for ongoing vigilance, masks, and social distancing, vaccination, and aggressive management of SARS-CoV-2 infection in HSCT recipients. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Moazzam Shahzad
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Sibgha Gull Chaudhary
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Muhammad U Zafar
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Maha A Hassan
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Ali Hussain
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Fatima Ali
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Iqra Anwar
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Mamoon Ahmed
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Nausheen Ahmed
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Sharad Khurana
- Division of Hematology/Oncology, University of Arizona College of Medicine, Tucson, AZ
| | - Muhammad A Rauf
- Division of Transplant Surgery, Vanderbilt University, Nashville, TN
| | - Faiz Anwar
- Division of Hematology/Oncology, Cleveland Clinic, Cleveland, OH
| | - Peiman Hematti
- Division of Hematology/Oncology, University of Wisconsin School of Medicine & Public Health, Madison, WI
| | - Natalie S Callander
- Division of Hematology/Oncology, University of Wisconsin School of Medicine & Public Health, Madison, WI
| | - Sunil H Abhyankar
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Joseph P McGuirk
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Muhammad Umair Mushtaq
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
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Bailey AJM, Kirkham AM, Monaghan M, Shorr R, Buchan CA, Bredeson C, Allan DS. A Portrait of SARS-CoV-2 Infection in Patients Undergoing Hematopoietic Cell Transplantation: A Systematic Review of the Literature. Curr Oncol 2022; 29:337-349. [PMID: 35049704 PMCID: PMC8774852 DOI: 10.3390/curroncol29010030] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 12/15/2022] Open
Abstract
The management of COVID-19 in hematopoietic cell transplant (HCT) recipients represents a special challenge given the variable states of immune dysregulation and altered vaccine efficacy in this population. A systematic search (Ovid Medline and Embase on 1 June 2021) was needed to better understand the presenting features, prognostic factors, and treatment options. Of 897 records, 29 studies were identified in our search. Most studies reporting on adults and pediatric recipients described signs and symptoms that were typical of COVID-19. Overall, the mortality rates were high, with 21% of adults and 6% of pediatric HCT recipients succumbing to COVID-19. The factors reported to be associated with increased mortality included age (HR = 1.21, 95% CI 1.03-1.43, p = 0.02), ICU admission (HR = 4.42, 95% CI 2.25-8.65, p < 0.001 and HR = 2.26, 95% CI 1.22-4.20, p = 0.01 for allogeneic and autologous HCT recipients), and low platelet count (OR = 21.37, 95% CI 1.71-267.11, p = 0.01). Performance status was associated with decreased mortality (HR = 0.83, 95% CI 0.74-0.93, p = 0.001). A broad range of treatments was described, although no controlled studies were identified. The risk of bias, using the Newcastle-Ottawa scale, was low. Patients undergoing HCT are at a high risk of severe morbidity and mortality associated with COVID-19. Controlled studies investigating potential treatments are required to determine the efficacy and safety in this population.
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Affiliation(s)
- Adrian J. M. Bailey
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada; (A.J.M.B.); (A.M.K.); (C.A.B.); (C.B.)
| | - Aidan M. Kirkham
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada; (A.J.M.B.); (A.M.K.); (C.A.B.); (C.B.)
| | - Madeline Monaghan
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada;
| | - Risa Shorr
- Medical Library and Learning Services, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada;
| | - C. Arianne Buchan
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada; (A.J.M.B.); (A.M.K.); (C.A.B.); (C.B.)
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada;
- Division of Infectious Disease, Department of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Christopher Bredeson
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada; (A.J.M.B.); (A.M.K.); (C.A.B.); (C.B.)
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada;
- Transplant & Cellular Therapy in the Department of Medicine, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada
| | - David S. Allan
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada; (A.J.M.B.); (A.M.K.); (C.A.B.); (C.B.)
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada;
- Transplant & Cellular Therapy in the Department of Medicine, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada
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Daudt LE, Corso MCM, Kerbauy MN, de Assis LHDS, Rechenmacher C, Colturato I, Barbieri FR, Rocha V, Mariano L, Garcia JL, Dantas VECB, Loth G, Funke VAM, Pelegrina PRD, Duarte FB, da Silva RL, Araújo MAS, Carlesse FADMC, de Sousa AVL, Maia LA, Fernandes JF, Rodrigues CA, Bonfim C, Martins LNGF, Cipolotti R, Xavier EM, Gomes AA, Morales HMP, Simioni AJ, Soares VJ, Michalowski MB, Hamerschlak N, Machado CM. COVID-19 in HSCT recipients: a collaborative study of the Brazilian Society of Marrow Transplantation (SBTMO). Bone Marrow Transplant. [PMID: 35027676 PMCID: PMC8757629 DOI: 10.1038/s41409-021-01561-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 11/18/2021] [Accepted: 12/23/2021] [Indexed: 01/08/2023]
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Pourhassan H, LA Rosa C, Chiuppesi F, Puing A, Aldoss I, Park Y, Zhou Q, Karpinski V, Faircloth K, Kaltcheva T, Johnson D, Ortega Francisco S, Zaia JA, Nakamura R, Al Malki MM, Diamond DJ, Dadwal SS, Forman SJ. Successful outcome of pre-engraftment COVID-19 in an HCT patient: impact of targeted therapies and cellular immunity. Blood Adv 2022:bloodadvances. [PMID: 35008104 DOI: 10.1182/bloodadvances.2021006282] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/23/2021] [Indexed: 12/15/2022] Open
Abstract
We describe the clinical strategy implemented for successful treatment and outcome of pre-engraftment SARS-CoV2 infection in HCT recipient. Robust levels of SARS-CoV-2-specific and functional T cells rapidly expanded early post-HCT and may have contributed to viral clearance.
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has emerged as a global pandemic that upended existing protocols and practices, including those for allogeneic hematopoietic stem cell transplantation (HCT). Here, we describe the successful clinical course and multiple key interventions administered to an acute lymphoblastic leukemia patient, who tested SARS-CoV-2 positive by reverse transcriptase polymerase chain reaction on day −1 of matched unrelated donor (SARS-CoV-2 immunoglobulin G negative) T-cell-replete HCT. This experience allowed for implementing a virologic and immunomonitoring panel to characterize the impact of SARS-CoV-2 on the recipient’s nascent humoral and cellular immune response. The finding of robust, functional, and persistent levels of SARS-CoV-2-specific T cells, starting early after transplant was unexpected, and in combination with the clinical strategy, may have contributed to the favorable outcome. Additionally, it is plausible that preexisting cross-reactive endemic coronavirus immunity in the allogeneic graft reduced recipient susceptibility to COVID-19 disease. This case supports the critical role that T-cell responses may play in mitigating SARS-CoV-2 infection, even in the context of transplant immunosuppression, in which reconstitution of humoral response is commonly delayed. Interventional approaches to transfer SARS-CoV-2-specific cellular immunity such as HCT donor vaccination and adaptive cellular therapy could be of benefit.
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Majcherek M, Matkowska-Kocjan A, Szymczak D, Karasek M, Szeremet A, Kiraga A, Milanowska A, Kuznik E, Kujawa K, Wrobel T, Szenborn L, Czyz A. Two Doses of BNT162b2 mRNA Vaccine in Patients after Hematopoietic Stem Cell Transplantation: Humoral Response and Serological Conversion Predictors. Cancers (Basel) 2022; 14:325. [PMID: 35053487 DOI: 10.3390/cancers14020325] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/30/2021] [Accepted: 01/05/2022] [Indexed: 01/14/2023] Open
Abstract
Simple Summary Vaccination against SARS-CoV-2 is currently the best tool in the fight against the COVID-19 pandemic. However, there are concerns about its efficacy and safety after hematopoietic stem cell transplantation. The aim of the study was to study the efficacy and safety of two doses of BNT162b2 mRNA vaccine in adult patients after autologous or allogeneic transplantation. We examined the presence of anti-SARS-CoV-2 antibodies before and after vaccination. We also searched for the potential predictors of serological conversion after vaccination, including the analysis of the impact of various lymphocyte subpopulations at the time of vaccination on post-vaccine antibody concentration and seroconversion. In addition, patients were followed-up for adverse events after vaccination, and the data on breakthrough SARS-CoV-2 infection were collected. The results of our study broaden the knowledge of the efficacy and safety of BNT162b2 mRNA vaccine in patients after HCT, providing new data on serological conversion predictors. Abstract Vaccination against SARS-CoV-2 is currently the best tool in the fight against the COVID-19 pandemic. However, there are limited data on its efficacy and safety after hematopoietic stem cell transplantation (HCT). We present the results of a prospective analysis of the humoral response to two doses of BNT162b2 mRNA vaccine in 93 adult patients, including 29 after autologous HCT (autoHCT) and 64 after allogeneic HCT (alloHCT). Positive anti-SARS-CoV-2 antibodies were detected before vaccination in 25% of patients despite a negative medical history of COVID-19. Seroconversion after vaccination was achieved in 89% of patients after alloHCT and in 96% after autoHCT, without grade 3/4 adverse events. Post-vaccination anti-SARS-CoV-2 antibody level correlated with the time from transplant and absolute B-cell count at the vaccination. In univariate analysis restricted to the alloHCT group, short time since transplantation, low B-cell count, low intensity conditioning, GvHD, and immunosuppressive treatment at the vaccination were associated with lack of seroconversion. In the multivariate model, the only negative predictor of seroconversion remained treatment with calcineurin inhibitor (CNI). In conclusion, the BNT162b2 mRNA vaccine is highly immunogenic in patients after HCT, but treatment with CNI at the time of vaccination has a strong negative impact on the humoral response
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Shah N, Dahi PB, Ponce DM, Sauter CS, Shaffer BC, Chung DJ, Politikos I, Lin RJ, Giralt SA, Papanicolaou G, Ramanathan LV, Perales MA, Kamboj M, Shah GL, Gyurkocza B. Hematopoietic Cell Transplantation is Feasible in Patients with Prior COVID-19 Infection. Transplant Cell Ther 2022; 28:55.e1-55.e5. [PMID: 34649021 PMCID: PMC8503970 DOI: 10.1016/j.jtct.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/03/2021] [Accepted: 10/05/2021] [Indexed: 01/21/2023]
Abstract
There are limited data on outcomes of patients with prior Coronavirus disease 2019 (COVID-19) who proceeded to autologous or allogeneic hematopoietic cell transplantation (HCT). Whether these patients are more susceptible to poor outcomes and recurrence of COVID-19 is unknown. We report a retrospective analysis of outcomes of 15 consecutive patients with hematologic malignancies who experienced COVID-19 and subsequently underwent autologous (n = 8) or allogeneic (n = 7) HCT between June 17, 2020, and February 17, 2021. The cohort included patients with asymptomatic past infections or symptomatic COVID-19 disease. Data were obtained from chart review. Descriptive statistics were used to summarize patient characteristics. Among eight patients who underwent autologous HCT, four had a diagnosis of multiple myeloma and four had a diagnosis of non-Hodgkin's lymphoma. Four of these eight patients did not test positive for anti-SARS-CoV-2 IgG antibody at any point during the course of treatment. The other four patients had detectable anti-SARS-CoV-2 IgG antibodies before undergoing autologous HCT, but only two of these patients remained anti-SARS-CoV-2 IgG antibody-positive at their last follow-up. One patient died from progression of disease. Seven patients with prior COVID-19 underwent allogeneic HCT for acute lymphoblastic leukemia (n = 3), acute myelogenous leukemia (n = 1), chronic myelogenous leukemia in lymphoid blast crisis (n = 1), myelodysplastic syndrome (n = 1), or myelofibrosis (n = 1). Three of the seven patients tested positive for anti-SARS-CoV-2 IgG antibodies following the initial COVID-19 diagnosis; however, only one of these patients retained anti-SARS-CoV-2 IgG antibody following allogeneic HCT. One patient died of infection (fungal and Pneumocystis jirovecii pneumonia) occurring in the context of ongoing treatment for graft-versus-host disease. None of the 15 patients had recurrent COVID-19 infection. Based on our experience, autologous and allogeneic HCT can be safely performed in selected patients with previous COVID-19 infection.
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Affiliation(s)
- Nishi Shah
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Parastoo B. Dahi
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Doris M. Ponce
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Craig S. Sauter
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Brian C. Shaffer
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - David J. Chung
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Ioannis Politikos
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Richard J. Lin
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Sergio A. Giralt
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Genovefa Papanicolaou
- Infectious Diseases, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Lakshmi V. Ramanathan
- Clinical Chemistry Service, Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Mini Kamboj
- Infectious Diseases, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Gunjan L. Shah
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Boglarka Gyurkocza
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York,Department of Medicine, Weill Cornell Medical College, New York, New York,Correspondence and reprint requests: Boglarka Gyurkocza, MD, Adult BMT Service, Memorial Sloan Kettering Cancer Center, 530 E 74th Street, New York, NY 10021
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Schulz E, Hodl I, Forstner P, Hatzl S, Sareban N, Moritz M, Fessler J, Dreo B, Uhl B, Url C, Grisold AJ, Khalil M, Kleinhappl B, Enzinger C, Stradner MH, Greinix HT, Schlenke P, Steinmetz I. CD19+IgD+CD27- Naïve B Cells as Predictors of Humoral Response to COVID 19 mRNA Vaccination in Immunocompromised Patients. Front Immunol 2021; 12:803742. [PMID: 34950155 PMCID: PMC8688243 DOI: 10.3389/fimmu.2021.803742] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/19/2021] [Indexed: 01/04/2023] Open
Abstract
Immunocompromised patients are considered high-risk and prioritized for vaccination against COVID-19. We aimed to analyze B-cell subsets in these patients to identify potential predictors of humoral vaccination response. Patients (n=120) suffering from hematologic malignancies or other causes of immunodeficiency and healthy controls (n=79) received a full vaccination series with an mRNA vaccine. B-cell subsets were analyzed prior to vaccination. Two independent anti-SARS-CoV-2 immunoassays targeting the receptor-binding domain (RBD) or trimeric S protein (TSP) were performed three to four weeks after the second vaccination. Seroconversion occurred in 100% of healthy controls, in contrast to 67% (RBD) and 82% (TSP) of immunocompromised patients, while only 32% (RBD) and 22% (TSP) achieved antibody levels comparable to those of healthy controls. The number of circulating CD19+IgD+CD27- naïve B cells was strongly associated with antibody levels (ρ=0.761, P<0.001) and the only independent predictor for achieving antibody levels comparable to healthy controls (OR 1.07 per 10-µL increase, 95%CI 1.02-1.12, P=0.009). Receiver operating characteristic analysis identified a cut-off at ≥61 naïve B cells per µl to discriminate between patients with and without an optimal antibody response. Consequently, measuring of naïve B cells in immunocompromised hematologic patients could be useful in predicting their humoral vaccination response.
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Affiliation(s)
- Eduard Schulz
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Isabel Hodl
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Patrick Forstner
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Stefan Hatzl
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Nazanin Sareban
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
| | - Martina Moritz
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
| | - Johannes Fessler
- Institute of Immunology and Pathophysiology, Medical University of Graz, Graz, Austria
| | - Barbara Dreo
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Barbara Uhl
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Claudia Url
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
| | - Andrea J. Grisold
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Michael Khalil
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Barbara Kleinhappl
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | | | - Martin H. Stradner
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Hildegard T. Greinix
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Peter Schlenke
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
| | - Ivo Steinmetz
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
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Meir J, Abid MA, Abid MB. State of the CAR-T: Risk of Infections with Chimeric Antigen Receptor T-Cell Therapy and Determinants of SARS-CoV-2 Vaccine Responses. Transplant Cell Ther 2021; 27:973-87. [PMID: 34587552 DOI: 10.1016/j.jtct.2021.09.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/06/2021] [Accepted: 09/19/2021] [Indexed: 02/08/2023]
Abstract
Chimeric antigen receptor T cell (CAR-T) therapy has shown unprecedented response rates in patients with relapsed/refractory (R/R) hematologic malignancies. Although CAR-T therapy gives hope to heavily pretreated patients, the rapid commercialization and cumulative immunosuppression of this therapy predispose patients to infections for a prolonged period. CAR-T therapy poses distinctive short- and long-term toxicities and infection risks among patients who receive CAR T-cells after multiple prior treatments, often including hematopoietic cell transplantation. The acute toxicities include cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome. The long-term B cell depletion, hypogammaglobulinemia, and cytopenia further predispose patients to severe infections and abrogate the remission success achieved by the living drug. These on-target-off-tumor toxicities deplete B-cells across the entire lineage and further diminish immune responses to vaccines. Early observational data suggest that patients with hematologic malignancies may not mount adequate humoral and cellular responses to SARS-CoV-2 vaccines. In this review, we summarize the immune compromising factors indigenous to CAR-T recipients. We discuss the immunogenic potential of different SARS-CoV-2 vaccines for CAR-T recipients based on the differences in vaccine manufacturing platforms. Given the lack of data related to the safety and efficacy of SARS-CoV-2 vaccines in this distinctively immunosuppressed cohort, we summarize the infection risks associated with Food and Drug Administration-approved CAR-T constructs and the potential determinants of vaccine responses. The review further highlights the potential need for booster vaccine dosing and the promise for heterologous prime-boosting and other novel vaccine strategies in CAR-T recipients. © 2021 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
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Dolan SA, Mulcahy Levy J, Moss A, Pearce K, Butler M, Jung S, Dominguez SR, Mwangi E, Maloney K, Rao S. SARS-CoV-2 persistence in immunocompromised children. Pediatr Blood Cancer 2021; 68:e29277. [PMID: 34453477 PMCID: PMC8661864 DOI: 10.1002/pbc.29277] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES We evaluated the length of time immunocompromised children (ICC) remain positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), identified factors associated with viral persistence, and determined cycle threshold (CT ) values of children with viral persistence as a surrogate of viral load. METHODS We conducted a retrospective cohort study of ICC at a pediatric hospital from March 2020 to March 2021. Immunocompromised status was defined as primary, secondary, or acquired due to medical comorbidities/immunosuppressive treatment. The primary outcome was time to first of two consecutive negative SARS-CoV-2 polymerase chain reaction (PCR) tests at least 24 hours apart. Testing of sequential clinical specimens from the same subject was conducted using the Centers for Disease Control (CDC) 2019-nCoV real-time reverse transcriptase (RT)-PCR Diagnostic Panel assay. Descriptive statistics, Kaplan-Meier curve median event times and log-rank tests were used to compare outcomes between groups. RESULTS Ninety-one children met inclusion criteria. Median age was 15.5 years (interquartile range [IQR] 8-18), 64% were male, 58% were White, and 43% were Hispanic/Latinx. Most (67%) were tested in outpatient settings and 58% were asymptomatic. The median time to two negative tests was 42 days (IQR 25.0-55.0), with no differences in median time by illness presentation or level of immunosuppression. Seven children had more than one sample available for repeat testing, and five of seven (71%) children had initial CT values of <30 (moderate to high viral load); four children had CT values of <30, 3-4 weeks later, suggesting persistent moderate to high viral loads. CONCLUSIONS Most ICC with SARS-CoV-2 infection had mild disease, with prolonged viral persistence >6 weeks and moderate to high viral load.
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Affiliation(s)
- Susan A. Dolan
- Department of EpidemiologyChildren's Hospital ColoradoAuroraColoradoUSA
| | - Jean Mulcahy Levy
- Department of Pediatrics (Center for Cancer and Blood Disorders)University of Colorado School of Medicine and Children's Hospital ColoradoAuroraColoradoUSA,Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital ColoradoAuroraColoradoUSA,Department of PharmacologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Angela Moss
- Children's Hospital Colorado and Adult and Child Center for Health Outcomes Research and Delivery ScienceUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Kelly Pearce
- Department of EpidemiologyChildren's Hospital ColoradoAuroraColoradoUSA
| | - Molly Butler
- Department of Pathology and Laboratory MedicineChildren's Hospital ColoradoAuroraColoradoUSA
| | - Sarah Jung
- Department of Pathology and Laboratory MedicineChildren's Hospital ColoradoAuroraColoradoUSA
| | - Samuel R. Dominguez
- Department of Pediatrics (Infectious Diseases), University of Colorado School of Medicine and Children's Hospital ColoradoAuroraColoradoUSA
| | - Eric Mwangi
- Department of Pathology and Laboratory MedicineChildren's Hospital ColoradoAuroraColoradoUSA
| | - Kelly Maloney
- Department of Pediatrics (Center for Cancer and Blood Disorders)University of Colorado School of Medicine and Children's Hospital ColoradoAuroraColoradoUSA
| | - Suchitra Rao
- Department of Pediatrics (Infectious Diseases and Hospital Medicine and Epidemiology)University of Colorado School of Medicine and Children's Hospital ColoradoAuroraColoradoUSA
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Fernández-Ruiz M, Aguado JM. Severe acute respiratory syndrome coronavirus 2 infection in the stem cell transplant recipient - clinical spectrum and outcome. Curr Opin Infect Dis 2021; 34:654-62. [PMID: 34751184 DOI: 10.1097/QCO.0000000000000790] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW Focusing on large multicenter cohorts reported over the last months, this review aims at summarizing the available evidence by July 2021 on the impact of coronavirus disease 2019 (COVID-19) on hematopoietic stem cell transplant (HSCT) recipients in terms of epidemiology, clinical features, and outcome. RECENT FINDINGS The incidence of COVID-19 in institutional cohorts varied according to different regions and study periods from 0.4% to 8.3%. Clinical presentation was overall comparable to other immunocompromised hosts and the general population. Microbiologically confirmed superinfection occurred in 13-25% of recipients, with most episodes due to hospital-acquired bacteria and few reported cases of COVID-19-associated aspergillosis. Prolonged nasopharyngeal severe acute respiratory syndrome coronavirus 2 shedding has been demonstrated for as long as 210 days. Mortality rates were similar across studies (14.8-28.4%) and did not markedly differ from those observed in nontransplant hematological patients during the first wave. Older age and shorter time from transplantation were associated with mortality, as well as underlying disease status and amount of immunosuppression. No outcome differences were found in most studies between allogeneic and autologous procedures. SUMMARY Considerable advances have been achieved in the characterization of COVID-19 in the HSCT population, although uncertainties remain in the optimal therapeutic management.
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Busca A, Salmanton-García J, Corradini P, Marchesi F, Cabirta A, Di Blasi R, Dulery R, Lamure S, Farina F, Weinbergerová B, Batinić J, Nordlander A, Lopez-Garcia A, Drgona L, Espigado I, Falces-Romero I, Garcia-Sanz R, Garcia-Vidal C, Guidetti A, Khanna N, Kulesekararaj A, Maertens J, Hoenigl M, Klimko N, Koehler P, Pagliuca A, Passamonti F, Cornely O, Pagano L. COVID-19 and CAR-T cells: current challenges and future directions-a report from the EPICOVIDEHA survey by EHA-IDWP. Blood Adv 2021:bloodadvances. [PMID: 34749396 DOI: 10.1182/bloodadvances.2021005616] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/24/2021] [Indexed: 12/15/2022] Open
Abstract
The EHA-IDWP developed an observational registry collecting data on COVID-19 infection in patients who received CAR T-cell therapy. Prevalence of COVID-19 was 4.8%, and overall mortality was 50%, highlighting the need for prevention of infection in these patients.
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50
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Spanjaart AM, Ljungman P, de La Camara R, Tridello G, Ortiz-Maldonado V, Urbano-Ispizua A, Barba P, Kwon M, Caballero D, Sesques P, Bachy E, Di Blasi R, Thieblemont C, Calkoen F, Mutsaers P, Maertens J, Giannoni L, Nicholson E, Collin M, Vaz CP, Metafuni E, Martinez-Lopez J, Dignan FL, Ribera JM, Nagler A, Folber F, Sanderson R, Bloor A, Ciceri F, Knelange N, Ayuk F, Kroger N, Kersten MJ, Mielke S. Poor outcome of patients with COVID-19 after CAR T-cell therapy for B-cell malignancies: results of a multicenter study on behalf of the European Society for Blood and Marrow Transplantation (EBMT) Infectious Diseases Working Party and the European Hematology Association (EHA) Lymphoma Group. Leukemia 2021; 35:3585-3588. [PMID: 34750508 PMCID: PMC8573311 DOI: 10.1038/s41375-021-01466-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 12/23/2022]
Affiliation(s)
- Anne Mea Spanjaart
- Department of Hematology, Amsterdam University Medical Centers, Cancer Center Amsterdam and LYMMCARE, Amsterdam, The Netherlands
| | - Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation (CAST), Karolinska University Hospital Huddinge and Karolinska Comprehensive Cancer Center, Stockholm, Sweden.,Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Rafael de La Camara
- Department of Hematology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Gloria Tridello
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | | | - Pere Barba
- Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron, Barcelona, Spain
| | - Mi Kwon
- Department of Hematology, Institute of Health Research Gregorio Marañon, Hospital G. Universitario Gregorio Marañon, Madrid, Spain
| | - Dolores Caballero
- Department of Hematology, Hospital Universitario de Salamanca, IBSAL, Salamanca, Spain
| | - Pierre Sesques
- Department of Hematology, Hospices Civils de Lyon, Lyon Sud Hospital, Lyon, Pierre-Bénite, France
| | - Emmanuel Bachy
- Department of Hematology, Hospices Civils de Lyon, Lyon Sud Hospital, Lyon, Pierre-Bénite, France
| | - Roberta Di Blasi
- Department of Hematology, Assistance Publique Hôpitaux de Paris-Hopital Saint-Louis, Paris, France
| | - Catherine Thieblemont
- Department of Hematology, Assistance Publique Hôpitaux de Paris-Hopital Saint-Louis, Paris, France
| | - Friso Calkoen
- Department of Stem cell Transplantation,Princess Maxima Centre for Paediatric Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Pim Mutsaers
- Department of Hematology, Erasmus MC Cancer Center, Rotterdam, The Netherlands
| | - Johan Maertens
- Deptartment of Hematology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Livia Giannoni
- Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Emma Nicholson
- Department of Haematology, The Royal Marsden Hospital, London, UK
| | - Matthew Collin
- Adult HSCT Unit, Northern Centre for Bone Marrow Transplantation, Newcastle Tyne, UK
| | - Carlos Pinho Vaz
- BMT Unit, Inst. Português de Oncologia do Porto, Porto, Portugal
| | - Elisabetta Metafuni
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Joaquin Martinez-Lopez
- Department of Hematology, Hospital Univ. 12 de Octubre, CNIO, Complutense University, Madrid, Spain
| | - Fiona L Dignan
- Clinical Haematology Department, Manchester Royal Infirmary, Manchester, UK
| | - Josep-Maria Ribera
- Clinical Hematology Department, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Josep Carreras Research Institute, Barcelona, Spain
| | - Arnon Nagler
- Chaim Sheba Medical Center, Tel Aviv University, Tel HaShomer, Tel Aviv-Yafo, Israel
| | - Frantisek Folber
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czechia
| | - Robin Sanderson
- Department of Haematological Medicine, Kings College Hospital, London, UK
| | - Adrian Bloor
- Adult Leukaemia and Bone Marrow Transplant Unit, Christie NHS Trust Hospital, University of Manchester, Manchester, UK
| | - Fabio Ciceri
- Hematology and BMT Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nina Knelange
- Dept. of Medical Statistics & Bioinformatics, EBMT Data Office, Leiden, The Netherlands
| | - Francis Ayuk
- Department of Stem Cell Transplantation, University Hospital Eppendorf, Hamburg, Germany
| | - Nicolaus Kroger
- Department of Stem Cell Transplantation, University Hospital Eppendorf, Hamburg, Germany
| | - Marie José Kersten
- Department of Hematology, Amsterdam University Medical Centers, Cancer Center Amsterdam and LYMMCARE, Amsterdam, The Netherlands
| | - Stephan Mielke
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation (CAST), Karolinska University Hospital Huddinge and Karolinska Comprehensive Cancer Center, Stockholm, Sweden. .,Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden. .,Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
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