Universität zu Köln

Schaffrath, Judith, Brummer, Christina, Wolff, Daniel, Holtick, Udo, Kroger, Nicolaus, Bornhauser, Martin, Kraus, Sabrina ORCID: 0000-0001-8954-4220, Hilgendorf, Inken ORCID: 0000-0003-2038-9730, Blau, Igor-Wolfgang, Penack, Olaf, Wittke, Christoph, Steiner, Normann, Nachbaur, David, Thurner, Lorenz, Hindahl, Heidrun, Zeiser, Robert, Maier, Claus-Philipp, Bethge, Wolfgang and Muller, Lutz P. (2022). High Mortality of COVID-19 Early after Allogeneic Stem Cell Transplantation: A Retrospective Multicenter Analysis on Behalf of the German Cooperative Transplant Study Group. Transpl. Cell. Ther., 28 (6). NEW YORK: ELSEVIER SCIENCE INC. ISSN 2666-6367

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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. (c) 2022 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Schaffrath, Judith UNSPECIFIED UNSPECIFIED UNSPECIFIED Brummer, Christina UNSPECIFIED UNSPECIFIED UNSPECIFIED Wolff, Daniel UNSPECIFIED UNSPECIFIED UNSPECIFIED Holtick, Udo UNSPECIFIED UNSPECIFIED UNSPECIFIED Kroger, Nicolaus UNSPECIFIED UNSPECIFIED UNSPECIFIED Bornhauser, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Kraus, Sabrina UNSPECIFIED orcid.org/0000-0001-8954-4220 UNSPECIFIED Hilgendorf, Inken UNSPECIFIED orcid.org/0000-0003-2038-9730 UNSPECIFIED Blau, Igor-Wolfgang UNSPECIFIED UNSPECIFIED UNSPECIFIED Penack, Olaf UNSPECIFIED UNSPECIFIED UNSPECIFIED Wittke, Christoph UNSPECIFIED UNSPECIFIED UNSPECIFIED Steiner, Normann UNSPECIFIED UNSPECIFIED UNSPECIFIED Nachbaur, David UNSPECIFIED UNSPECIFIED UNSPECIFIED Thurner, Lorenz UNSPECIFIED UNSPECIFIED UNSPECIFIED Hindahl, Heidrun UNSPECIFIED UNSPECIFIED UNSPECIFIED Zeiser, Robert UNSPECIFIED UNSPECIFIED UNSPECIFIED Maier, Claus-Philipp UNSPECIFIED UNSPECIFIED UNSPECIFIED Bethge, Wolfgang UNSPECIFIED UNSPECIFIED UNSPECIFIED Muller, Lutz P. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-695796
DOI:	10.1016/j.jtct.2022.03.010
Journal or Publication Title:	Transpl. Cell. Ther.
Volume:	28
Number:	6
Date:	2022
Publisher:	ELSEVIER SCIENCE INC
Place of Publication:	NEW YORK
ISSN:	2666-6367
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language RISK-FACTORS; CLINICAL CHARACTERISTICS; RECIPIENTS; THERAPY Multiple languages Hematology; Immunology; Transplantation Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/69579