-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.

1467 Clinical Characteristics and Outcomes of COVID-19 in HSCT Recipients

Program: Oral and Poster Abstracts
Session: 721. Clinical Allogeneic Transplantation: Conditioning Regimens, Engraftment, and Acute Transplant Toxicities: Poster I
Hematology Disease Topics & Pathways:
Coronaviruses, SARS-CoV-2/COVID-19, Clinically relevant
Saturday, December 5, 2020, 7:00 AM-3:30 PM

Clarisse MARTINS Machado, MD, PhD1*, Mariana Nassif Kerbauy, MD2*, Iago Colturato, MD3*, Leonardo Javier Arcuri4, Ana Cláudia Ferrari dos Santos, MSc3*, Fernanda Rodrigues Silva, MD3*, Anderson João Simioni3*, Juliana Folloni Fernandes, MD5*, Mair Pedro de Souza, MD6*, Vergilio Rensi Colturato, MD7* and Nelson Hamerschlak, MD, PhD8

1Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
2Hospital Albert EInstein / HSCT Program, Hospital Israelita Albert Einstein, São Paulo, BRA
3Hospital Amaral Carvalho / HSCT Program, Hospital Amaral Carvalho, Jahu, Brazil
4Hospital Albert Einstein / HSCT Program, Hospital Albert Einstein, São Paulo, RJ, BRA
5Department of Hematology and Bone Marrow Transplantation, Hospital Israelita Albert Einstein, Hematology unit, São Paulo, Brazil
6Hospital Amaral Carvalho / HSCT Program, Hospital Amaral Carvalho, Jahu, BRA
7Hospital Amaral Carvalho, Jaú, SP, Brazil
8Hospital Israelita Albert Einstein, Sao Paulo, Brazil

Introduction. COVID-19 pandemic has spread worldwide and reached HSCT centers in many countries. The first proven case of COVID-19 in Brazil was diagnosed in São Paulo by the end of February 2020. The Brazilian Society of Marrow Transplantation (SBTMO) promptly published local recommendations for the diagnosis and management of COVID-19 in HSCT centers. We describe the main clinical findings and outcomes of SARS CoV-2 infection and COVID-19 in 22 HSCT recipients from two Brazilian HSCT centers, followed up for at least 14 days. Methods. The detection of SARS CoV-2 infection was performed by RT-PCR in all transplant candidates before admission, and in all HSCT recipients with respiratory symptoms. Other respiratory viruses were also investigated by direct fluorescent assay (DFA) or RT-PCR. COVID-19 was managed according to the SBTMO recommendations. Results. From March to June 2020, SARS CoV-2 infection was detected in 5 asymptomatic patients (29.4%) and COVID-19 was diagnosed in 17 HSCT recipients with respiratory symptoms (7 AUTO, 6 MRD, 5 MUD and 4 HAPLO) at a median of 94 days after HSCT (range -6 to +1,850). The asymptomatic cases at diagnosis remained so during follow-up. Two asymptomatic patients were receiving the conditioning regimen when SARS CoV-2 was diagnosed. The median age at diagnosis was 39,2 (1-72) years. Five patients were children (1-12 years) and 17 were adults (19-72 years). Eleven patients (50%) had comorbidities, the most frequent being diabetes and hypertension. Fever, cough and diarrhea were the symptoms more frequently observed and occurred in 13 (76.4%), 7 (41.2%), and 5 (29.4%) of the 17 symptomatic patients, respectively. Symptoms such as anosmia and dysgeusia, which have been frequently associated with COVID-19 were not observed in this series. Eleven of the symptomatic patients (64.7%) showed altered CT or X-ray at diagnosis. Glass ground opacities were the images more frequently seen (63.6%). The median lymphocyte count was 619.5 (0-2,604) /mL. C-reactive protein and d-dimer ranged from 0.65 to 339 ng/mL and from 0.39 to 4,530 mg/L, respectively. Four (18%) HSCT recipients died (1 AUTO, 2 HAPLO, 1 MRD). COVID-19 was the cause of death in two of them. In the remaining two HAPLO HSCT recipients, KPC co-infection followed by septic shock had a major role in patients’ death. Median age of patients who died was 39 (11-59) years, and two of them had comorbidities (hypertension and chronic lung disease). Conclusions. Symptoms of COVID-19 mimic other respiratory virus infections and specific diagnosis is mandatory. Interstitial pneumonia was frequent (around 65%). Clinical outcome of SARS Cov-2 infection or COVID-19 was moderate in the majority of the patients in the present series. However, the mortality rates observed in HSCT recipients (14.3% in AUTO; 20% in ALLO) were higher than in general population. Asymptomatic cases were seen in almost 30% of the patients, suggesting that frequent screening is necessary to control transmission in HSCT centers.

Disclosures: No relevant conflicts of interest to declare.

*signifies non-member of ASH