-Author name in bold denotes the presenting author
-Asterisk * with author name denotes a Non-ASH member
Clinically Relevant Abstract denotes an abstract that is clinically relevant.

PhD Trainee denotes that this is a recommended PHD Trainee Session.

Ticketed Session denotes that this is a ticketed session.

140 Risk Factors for Severe Form of COVID-19 after Allogeneic Hematopoietic Stem Cell Transplantation: A SFGM-TC Multicentre Cohort StudyClinically Relevant Abstract

Program: Oral and Poster Abstracts
Type: Oral
Session: 721. Clinical Allogeneic Transplantation: Conditioning Regimens, Engraftment, and Acute Transplant Toxicities I
Hematology Disease Topics & Pathways:
Coronaviruses, SARS-CoV-2/COVID-19, Adult, Pediatric, Study Population, Clinically relevant
Saturday, December 5, 2020: 10:30 AM

Alienor Xhaard, MD1*, Constance Xhaard2*, Maud D'Aveni, MD3*, Hélène Salvator, MD, PhD4*, Marie-Laure Chabi-Charvillat, MD5*, Tereza Coman, MD, PhD6*, Yves Beguin, MD, PhD7*, Yves Chalandon, MD8, Xavier Poire, MD9*, Michael Loschi, MD, PhD10*, Catherine Paillard, MD, PhD11*, Bénédicte Bruno, MD12*, Patrice Ceballos, MD, PhD13*, Jean-Hugues Dalle, MD, PhD14, Karin Bilger, MD15*, Jacques-Olivier Bay, MD, PhD16, Marie Robin, MD, PhD17, Stephanie N'guyen-Quoc, MD, PhD18* and Marie Thérèse Rubio, MD, PhD19*

1Department of Hematology Transplantation, St-Louis Hospital, APHP, Bone Marrow, Paris, France
2Centre d’Investigations Cliniques Plurithématique 1433, INSERM 1116, Université de Lorraine, Nancy, France
3Service d’Hématologie, CHRU de Nancy, France., Vandoeuvre-les-Nancy, France
4Service de pneumologie,, Hopital Foch, Paris, France
5Service de radiologie, Hopital Foch, APHP, Paris, France
6Service Hematologie, Institut Gustave Roussy, Villejuif, France
7Department of Hematology, University of Liege, Liege, Belgium
8Geneva University Hospitals, Geneva, Switzerland
9Cliniques Universitaires Saint-Luc, Brussels, Belgium
10Hematology Department, Cote D'Azur University, CHU of Nice, Nice, France
11Pediatric Hematology Department, Strasbourg University Hospital, Strasbourg, France
12Pediatric Hematology, Hôpital Jeanne de Flandre, CHRU de Lille, Lille, France
13Department of Hematology, Hopital St Eloi CHU de Montpellier, Montpellier, France
14Pediatric Hematology Department, Robert Debre Hospital, AP-HP, Paris, France
15Department of hematology, ICANS, CHU Strasbourg, Strasbourg, France
16Service d'Hematologie Clinique et de Therapie Cellulaire, CHU, Universite d'Auvergne, EA7453, CIC501, Clermont-Ferrand, France
17Hôpital Saint-Louis, APHP, Paris, France
18Hôpital de la Pitié-Sapêtrière, APHP, Paris, France
19CHRU Nancy, Hôpital Brabois, Vandœuvre-les Nancy, France

COVID-19 greatly affected Europe between March and May 2020. Initial reports suggest cancer and haematological malignancies as risk factors for severity and mortality, but the role of allogeneic stem cell transplantation (alloHSCT) remains unclear. The Société Francophone de Greffe de Moelle et Thérapie Cellulaire conducted a multicentre retrospective study of alloHSCT recipients diagnosed with COVID-19. We described the COVID-19 disease characteristics in this population and examined risk factors for severity and mortality.

Data were collected retrospectively from the patients’ charts and the ProMISe database. Diagnosis was retained only if a reverse transcription polymerase chain reaction assay test from a nose swab was positive for SARS-CoV-2. Patients were classified as severe if they were transferred to an intensive care unit (ICU) due to COVID-19 or died of COVID-19, and non-severe in other cases. Comparisons of characteristics were performed using student’s t-tests and Mann-Whitney U tests for normally and abnormally distributed data, respectively, for continuous variables and χ2 or Fisher’s exact tests, when appropriate for categorical variables. Risk factors associated with a severe form of COVID-19 were assessed using both univariate and multivariate logistic regressions. All analyses were performed using SAS version 9.4.6 (SAS Institute Inc., Cary, NC, USA. A two-tailed significance level p<0.05 was used.

Fifty-four patients were diagnosed, including 21 with severe forms (intensive care transfer and/or death). Haematological characteristics did not vary between patients with severe or non-severe forms of COVID-19. Patients with a severe form of COVID-19 were more likely to be diagnosed earlier after alloHSCT (0.78 vs. 2.1 years, p=0.01), to have comorbidities (80.9% vs. 54.5%, p=0.05) and to receive immunosuppressive treatment (81% vs. 51.5%, p=0.03). Severe COVID-19 patients were more likely to have symptoms at COVID-19 diagnosis (100% vs. 81.8%, p=0.04), especially pneumonia and symptoms other than respiratory or digestive (asthenia, neurological symptoms, myalgia, dysgeusia, skin lesions and arthralgia), and to experience co-infection during the course of the disease (52.4% vs. 21.2%, p= 0.001).

At COVID-19 diagnosis, patients with a non-severe form were more likely to have a higher platelet count (226 G/L vs. 98 G/L, p= 0.01), while other biological characteristics did not vary between the two cohorts. In univariate analysis, shorter time from transplant to COVID-19 (before 211 days, p=0.01), pneumonia (OR 12.21 [95% CI 2.43 - 61.46], p=0.002), symptoms other than pulmonary or digestive (OR 1.21 [95% CI 1.02 - 11.16], p=0.04), immunosuppressive treatment (OR 5.97 [95% CI 0.75 - 47.42], p=0.03) , co-infection (OR 5.84 [95% CI 1.65-20.63], p=0.006) and comorbidity (OR 3.54 [95% CI 0.98-12.83], p=0.05) were associated with severe COVID-19. The only biological parameter associated with severity was a lower platelet count <71G/L (OR 28.00 [95% CI 2.07-379.25]), p=0.008. In multivariate analysis, pneumonia and other symptoms retained a significant association with severe COVID-19.

Thirteen patients died of COVID-19: in univariate analysis, risk factors for death from COVID-19 were similar to the risk factors for severe COVID-19 (i.e. shorter time from alloHSCT, p=0.03; pneumonia, p=0.01; co-infection during the course of COVID-19, p<0.01, and lower platelet count, p<0.01). In multivariate analysis, none of the above mentioned factors remained significantly associated with death from COVID-19.

As SARS-CoV-2 continues to spread internationally, given the lack of vaccine or treatment, alloHSCT recipients should maintain a high level of awareness to avoid contamination.

Disclosures: Dalle: Incyte: Consultancy, Membership on an entity's Board of Directors or advisory committees; Gilead: Honoraria; Bellicum: Consultancy, Honoraria; AbbVie Pharmacyclics: Membership on an entity's Board of Directors or advisory committees; Orchard: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; bluebird bio: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Sanofi-Genzyme: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Medac: Consultancy, Honoraria; Jazz Pharmaceuticals: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees. Rubio: MSD: Honoraria; Novartis: Honoraria; Neovii: Research Funding; Medac: Consultancy; Gilead: Honoraria.

<< Previous Abstract | Next Abstract
*signifies non-member of ASH