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2384 COVID-19 and Stem Cell Transplantation; Results from the Prospective Survey By the Infectious Diseases Working Party of the European Society for Blood and Marrow Transplantation (EBMT) and the Spanish Hematopoietic Stem Cell Transplantation and Cell Therapy Group (GETH)

Program: Oral and Poster Abstracts
Session: 721. Clinical Allogeneic Transplantation: Conditioning Regimens, Engraftment, and Acute Transplant Toxicities: Poster II
Hematology Disease Topics & Pathways:
Coronaviruses, SARS-CoV-2/COVID-19, Clinically relevant
Sunday, December 6, 2020, 7:00 AM-3:30 PM

Per Ljungman, MD, PhD1, Rafael De La Camara, MD2, Malgorzata Mikulska3*, Gloria Tridello4*, Beatriz Aguado, MD5*, Yves Beguin, MD, PhD6*, Rodrigo Martino Bufarull7*, Fabio Ciceri, MD8*, Lucía López Corral, MD9*, Claudia Crippa, MD10*, Dries Deeren, MD, PhD11, Rafael F. Duarte, MD, PhD, FRCP12, María Laura Fox13*, Anna Grassi, MD14*, María-José Jimenez, MD15*, Safiye Koculu, MD16*, Mi Kwon, MD, PhD17*, Juan Carlos Vallejo Llamas18*, Jose Luiz Lopez Lorenzo, MD19*, Stephan Mielke, MD20,21, Javier López Jiménez, MD, PhD22*, Zoraida Mesa Morales23*, Kim H. Orchard, MBBS, PhD, FRCP, FRCPath24, Rocio Parody Porras25*, Victoria Potter, MBBS, BSc, FRACP, FRCPA26*, María Suárez-Lledó, MD27*, Nicolaas Schaap, MD, PhD28, Celestine Simand, MD29*, Luisa Sisinni, MD30*, John A Snowden, MD, PhD31*, Daniele Vallisa, MD32, Ipek Yonalhindilerden33*, Alienor Xhaard, MD34*, Nina Simone Knelange35*, Angel Cedillo36*, Nicolaus Kröger, MD37*, Jose Luis Piñana Sanchez38* and Jan Styczynski, MD, PhD39

1Dept. of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, SWE
2Hematology Department, Hospital Universitario de La Princesa, Madrid, Spain
3Division of Infectious Diseases, University of Genova, Ospedale Policlinco San Martino, Genova, Italy
4Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
5Hospital Universitario de La Princesa, Madrid, Spain
6Department of Hematology, University of Liege, Liege, Belgium
7Hospital Santa Creu i Sant Pau, Barcelona, Spain
8Haematology and BMT Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
9Hospital Clínico, Servicio de Hematología, Salamanca, Spain
10Department of Hematology, ASST Spedali Civili di Brescia, Brescia, Italy
11Algemeen Ziekenhuis (AZ) Delta, Roeselare, Belgium
12Hematopoietic Transplantation and Hemato-oncology Section, Institut Català d'Oncologia Hospital Duran i Reynals, Madrid, Spain
13Department of Hematology. Vall d’Hebron Institute of Oncology (VHIO), University Hospital Vall d’Hebron. Barcelona, Spain, Barcelona, Spain
14ASST Papa Giovanni XXIII, Bergamo, ITA
15Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Badalona, Spain
16HSCT Unit, Demiroglu Bilim University, Istanbul, Turkey
17Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
18University Hospital Donostia, San Sebastian, Spain
19Servicio de Hematología y Hemoterapia, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
20Dept. of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska Institute & University Hospital, Stockholm, Stockholms Laen, Sweden
21Department of Laboratory Medicine, Department of Cell Therapy and Allogeneic Stem Cell Transplantation (CAST), Karolinska Institute and University Hospital, Stockholm, Sweden
22Hematology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
23Hospital Universitario "Virgen de las Nieves", Granada, Spain
24Southampton Univ. Hospitals, Southampton, GBR
25ICO Duran i Reynals, BARCELONA, Spain
26Haematological Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
27Hospital Clinic, Dept. of Hematology, IDIBAPS, Barcelona, Spain, Barcelona, Spain
28Nijmegen Medical Centre, Nijmegen, Netherlands
29Clinical Hematology, Strasbourg University Hospital, Strasbourg, France
30Hospital Universitario La Paz, Madrid, ESP
31Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
32Hematology Unit and CTMO, G. da Saliceto Hospital, Piacenza, ITA
33Adult Hematopoietic Stem Cell Transplantation Unit, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
34Department of Hematology Transplantation, St-Louis Hospital, APHP, Bone Marrow, Paris, France
35EBMT Data Office, Leiden, Netherlands
36Grupo Español de Trasplantes Hematopoyéticos y Terapia Celular (GETH), Madrid, Spain
37University Hospital Eppendorf, Hamburg, Germany
38Hematology and hemotherapy department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
39Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland

COVID-19 is a severe infectious complication in patients with underlying medical conditions such as having undergone hematopoietic stem cell transplantation (HCT). This prospective survey reports outcome on 272 COVID-19 patients from 19 countries having undergone allogeneic (n = 175) or autologous (n = 97) HCT reported to the EBMT registry or to the GETH. All patients had the diagnosis of SARS-CoV-2 documented by PCR. Patients were included in this analysis if COVID-19 diagnosis was before April 10, 2020. The overall survival was estimate by using the Kaplan Meier methods, considering the death due to any cause as an event and the time from COVID-19 infection to the latest follow-up as survival time; difference between groups were tested by the log-rank test. Univariate and multivariate risk factor analysis for overall survival were performed with the Cox regression model.

The median age was 54.4 years (1.0 - 80.3) for allogeneic and 60.9 years (7.7 – 73.4) for autologous HCT patients. 20 patients were children (< 18 years of age; median age 11.3 (1.0 – 16.9)). The median time from HCT to diagnosis of COVID-19 was 13.7 months (0.2 - 254.3) in allogeneic and 25.0 months (-0.9 – 350.3) in autologous recipients. Lower respiratory tract disease (LRTD) developed in 84.8% and 21.5% were admitted to an intensive care unit (ICU). At the time of analysis, 68/238 (28.6%) patients had died (47/155 allogeneic patients; 21/83 autologous patients). No follow-up had been received on 34 patients. The median time from infection to death was 19 days (0-102). Five patients were reported to have other primary causes of death than COVID-19. Of the patients reported to be alive, the median follow-up was 44 days. 144 (84.7%) patients (93 allogeneic; 51 autologous) had virologic resolution of the COVID-19 infection having at least one negative PCR. 26 patients were alive and known to be still COVID-19 positive (15 allogeneic; 11 autologous). For 34 patients the resolution status was unknown. Factors influencing the likelihood of resolution in multivariate analysis were underlying diagnosis (p=.01) and longer time from transplant to diagnosis of COVID-19 (p=.035).

Overall survival at 6 weeks from COVID-19 diagnosis was 76.8% and 83.8% in allogeneic and autologous HCT recipients (p =ns), respectively (figure 1). Children (n=20) tended to do better with a 6-week survival of 95.0% although the difference was not significantly different (p =.12). In multivariate analysis of the total population older age (HR 1.26; 95% CI 1.05 – 1.51; p = .01) increased the risk and better performance status decreased the risk for fatal outcome (HR 0.79; 95% CI 0.69 – 0.90; p = .0003). The same factors had significant impact on overall survival in allogeneic HCT recipients (age HR 1.28; 95% CI 1.05 – 1.55; p=.01; performance status HR 0.79; 95% CI 0.68 – 0.92); p=.002) while only age impacted survival among autologous HCT patients (data not shown). Other transplant factors such as underlying diagnosis, time from HCT to diagnosis of COVID-19, graft-vs-host disease, or ongoing immunosuppression did not have a significant impact on overall survival.

We conclude that HCT patients are at an increased risk compared to the general population to develop LRTD, require admission to ICU, and have increased mortality in COVID-19.

Disclosures: Duarte: Incyte Corporation: Other: Has received speaker and advisor fees. Kwon: Jazz: Consultancy, Honoraria; Gilead: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; Pfizer: Consultancy, Honoraria. Mielke: DNA Prime: Honoraria, Other: received via my institution , Speakers Bureau; KIADIS Pharma: Honoraria, Other: received via my institution , Speakers Bureau; Miltenyi: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: received via my institution , Speakers Bureau; Kite/Gilead: Honoraria, Other: received via my institution , Speakers Bureau; Bellicum: Honoraria, Other: received via my institution, Speakers Bureau; Celgene/BMS: Honoraria, Other: received via my institution , Speakers Bureau; Novartis: Honoraria, Other: received via my institution, Speakers Bureau. López Jiménez: MSD: Speakers Bureau; Roche: Research Funding, Speakers Bureau; Takeda: Speakers Bureau; Janssen: Research Funding, Speakers Bureau; Abbvie: Research Funding, Speakers Bureau; Gilead: Research Funding, Speakers Bureau.

*signifies non-member of ASH