-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.

3554 Impact of Allogeneic Hematopoietic Cell Transplantation Post-Sars-Cov-2 Infection: A Retrospective Analysis By the German Cooperative Transplant Study Group

Program: Oral and Poster Abstracts
Session: 723. Allogeneic Transplantation: Long-term Follow-up, Complications, and Disease Recurrence: Poster II
Hematology Disease Topics & Pathways:
Research, Clinical Research, Real-world evidence
Sunday, December 8, 2024, 6:00 PM-8:00 PM

Osama Ahmad1*, Jan Frederic Weller, MD1*, Nicolaus Kröger, MD2*, Eva Wagner Drouet3*, David Nachbaur, M.D.4*, Normann Steiner4*, Daniel Teschner, MD5*, Sabrina Kraus5*, Gesine Bug6*, Salem Ajib6*, Johannes Schetelig, MD, MSc7, Wolfgang Andreas Bethge, MD8*, Thomas Schroeder9*, Judith Schaffrath, MD10*, Lutz Peter Hermann Mueller, MD11*, Mareike Verbeek, MD12*, Edgar Jost, MD13*, Hatice Soysal, MD13*, Georg-Nikolaus Franke, MD14*, Stefan Klein, MD15, Udo Holtick16*, Knut Wendelin17*, Claudia Lengerke, MD18, Martin Bornhäuser, MD7* and Maximilian Christopeit1,19*

1Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tuebingen, Tuebingen, Germany
2University Medical Center Hamburg, Hamburg, Germany
3Universitätsmedizin der Johannes Gutenberg-Universität, Mainz, Germany
4University Hospital of Internal Medicine V (Hematology and Oncology), Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
5Division of Hematology, University Hospital of Wurzburg, Wurzburg, Germany, Würzburg, Germany
6Dept. of Medicine 2, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
7Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
8Department of Internal Medicine II, Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tuebingen, Tübingen, Germany
9Dept. of Hematology and Stem Cell Transplantation West German Cancer Centre University Hospital Essen Essen, Germany, Essen, Germany
10Department of Internal Medicine IV, Hematology and Oncology, Martin Luther University Halle-Wittenberg, Halle, Germany
11Department of Internal Medicine IV, University Hospital Halle Martin Luther, University Halle-Wittenberg, Halle, Germany
12Department of Medicine III, Hematology and Oncology, Technical University of Munich (TUM), School of Medicine and Health, Munich, Germany
13Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, RWTH Aachen University, Medical Faculty, Aachen, Germany
14Department for Hematology, Cell Therapy, Hemostaseology and Infectious Diseases, University of Leipzig Medical Center, Leipzig, Germany
15Universitätsmedizin Mannheim, Mannheim, Germany
16Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group, University of Cologne, Cologne, Germany
17Med Clinic 5, Klinikum Nürnberg, Nuernberg, Germany
18Department for Internal Medicine II, Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tuebingen, Tuebingen, Germany
19University Cancer Center Hamburg, Department of Medicine II - Oncology, Hematology and Bone Marrow Transplantation With Section Pneumology, Hamburg, Germany

Introduction

Allogeneic hematopoietic cell transplantation (alloHCT) is a curative treatment for hematologic malignancies, but it carries a significant risk of non-relapse mortality (NRM) to infections. The emergence of the COVID-19 pandemic introduced the challenge for the correct timing and safety of alloHCT in patients with prior SARS-CoV-2 infection.

Methods

This retrospective analysis, conducted by the German Cooperative Transplant Study Group, evaluated the outcomes of 75 patients who underwent alloHCT after having survived COVID-19. Data were collected from May 2020 to May 2022 at 15 German and Austrian centers using standardized questionnaires. All patients were SARS-CoV-2-PCR negative before alloHCT.

Results

The cohort included 75 patients (40 (53%) female, 35 (47%) male) with a median age of 56 (range 22-77) years and varying COVID-19 severity: 31 with mild, 6 with moderate, 12 with severe, and 26 with unknown severity after WHO-grading. Time from diagnosis of neoplasia to COVID-19 (median 125 (range 0-3,990) days) and time from COVID-19 diagnosis to alloHCT (median 141 (range 1-661) days) did not differ significantly between severity groups (p=0.09 and p=0.40, respectively). 12 (16%) patients suffered from ALL, while 38 (52%) had an AML and 23 (32%) had other diagnosis (2 unknown). Myeloablative conditioning was chosen in 29 (62%) patients, while 18 (38%) received reduced intensity conditioning (unknown=28). Peak C-reactive protein (CRP) during COVID-19 was 5 mg/dl in mild, 7 mg/dl in moderate and 8 mg/dl in severe disease (p=0.9), while IL-6 was 71 ng/l in mild, 92 ng/l in moderate and 122 ng/l in severe disease (p=0.8) and PCT was 0.61 ng/ml in mild, 1.34 ng/ml in moderate and 0.38 ng/ml in severe disease. COVID-19 duration did not correlate significantly with COVID-19 severity (>30 days= 10 (38%) mild, 3 (50%) moderate, 2 (40%) severe. ≤30 days: 16 (62%) mild, 3 (50%) moderate, 3 (60%) severe; p=0.7). There was no statistically significant difference in the timing of alloHCT in relation to the interval between COVID-19 diagnosis and alloHCT (p=0.38, day 178, maximally selected rank statistics).

Patients with previous severe COVID-19 had a significantly lower 365-day survival rate (51.1%) compared to those with previous mild cases (90.9%, p=0.03). NRM at 365 days was higher in severe cases (19.6%) compared to mild cases (0%, p=0.03). There was no observed difference in acute (p=0.4) or chronic Graft-versus-Host-disease (p=0.4). Patients with a high Karnofsky index and mild COVID-19 had the best survival outcomes (p=0.12), while normal pre-transplant lung function, especially DLCO, was associated with better outcomes (HR: 0.91, p=0.04). Despite missing DRI (disease risk index) covariates, COVID-19 severity was not significantly associated with higher cytogenetic risk (64% abnormal in mild vs. 45.5% in severe disease, p= 0.37). However, patients with severe COVID-19 were less likely to be transplanted in CR (mild disease= 70.8% in CR at alloHCT, severe disease = 37.5% in CR, p= 0.21)

Discussion

Severe COVID-19 significantly impacts post-alloHCT survival, highlighting the need for rigorous prevention, comprehensive pre-transplant evaluation, and tailored management strategies for alloHCT patients. These findings support the deferral of aggressive treatments in symptomatic COVID-19 cases and the prioritization of antiviral treatments to mitigate risk. We aim to highlight the necessity of lung function testing following symptomatic COVID-19.

Disclosures: Kröger: Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Neovii: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; BMS: Membership on an entity's Board of Directors or advisory committees; Therakos: Honoraria, Speakers Bureau; Alexion: Honoraria, Speakers Bureau; Kite/Gilead: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; DKMS: Research Funding; Sanofi: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Takeda: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Provirex: Consultancy. Schetelig: Janssen: Consultancy, Honoraria; MSD: Consultancy; Novartis: Honoraria; Eurocept: Honoraria; Astellas: Honoraria; Medac: Honoraria; AstraZeneca: Consultancy, Honoraria. Mueller: Squibb: Honoraria, Other: travel grant; BMS: Honoraria, Other: Travel grant; Abbvie: Honoraria, Other: travel grant; Amgen: Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees; Gilead: Membership on an entity's Board of Directors or advisory committees, Other: travel grant; Pfizer: Membership on an entity's Board of Directors or advisory committees. Holtick: Roche: Honoraria.

*signifies non-member of ASH