Blood and Marrow Transplantation (BMT) within Four Weeks of Sars-Cov-2 Infection Is Associated with Increased Risk of Mortality: A National COVID Cohort Collaborative Study
Year: 2022
Type: article
Study design: Observational Study
Abstract: Introduction The optimal timing of blood and marrow transplant (BMT) following acute SARS-CoV-2 infection is not known. Currently, the American Society for Transplantation and Cellular Therapy recommends proceeding with BMT in 2-3 weeks post-acute SARS-CoV-2 infection particularily in asymptomatic patients. This study aims to determine optimal timing of BMT following SARS-CoV-2 infection. Methods For this analysis, we used patients from National COVID Cohort Collaborative (N3C) centralized-data resource, the largest multisite cohort of cancer and COVID-19 patients nationally. All patients with a diagnosis of hematological cancer who underwent BMT were identified. Among these, patients undergoing BMT after a documented SARS-CoV-2 infection were identified and further stratified according to time from infection to BMT. For this study the following time point were defined- acute SARS-CoV-2 infection is ≤ 4 weeks from test positivity, early SARS-CoV-2 within 4-8 weeks from test positivity and late SARS-CoV-2 >8 weeks after test positivity. Post BMT complications were defined as a composite of all the post-BMT adverse events that occur including hospital readmission but excluding mortality. All analyses were performed in the N3C Data Enclave. Results A total of 5703 patients with hematological malignancies who underwent BMT between January 1st,2020, and July 19th,2022,were included. Most common indication for BMT in this cohort was acute myeloid leukemia (19.6%; n=1107). Among these, 547 (9.6%) patients had documented SARS-CoV-2 infection prior to BMT. Baseline characteristics are summarized in table 1. The median age was 57 (range 40-66) years. About 38% of patients were female and 7.4% were Blacks. Only 59 patients were fully vaccinated against SARS-CoV-2 prior to BMT. Next, we compared the subset of patients with and without SARS-COV-2 infection prior to BMT (table 1). Patients with history of SARS-CoV-2 infection going to BMT were younger (56 vs 57 years; p=0.009).Additionally, SARS-CoV-2 infection were more common in Blacks (11% vs 7.3%; p<0.001) and smokers (30% vs 25% ; p=0.005) compared to those without SARS-CoV-2 infection prior to BMT. In this cohort, 67% (n=372) of SARS-CoV-2 infections were mild to moderate and 30% (n=163) were asymptomatic infections. About 15% (n=83) patients were transplanted in the context of acute SARS-CoV-2 infection and 70% (n= 384) were transplanted in the late post SARS-CoV-2 infection period. Patients with prior SARS-CoV-2 infection had a longer median inpatient length of stay following BMT (17 vs 16 days; p<0.001) with similar rates hospital readmission (30% v 30%; p=0.85). In-hospital mortality following BMT in patients with and without prior SARS-CoV-2 infection were 2.9% and 1.7% (p=0.06),respectively. On multivariable regression analysis, patients with severe SARS-CoV-2 infections were at increased risk of 30-day mortality (OR= 49.6;95% CI 10.0-195; p<0.001). BMT in the context of acute SARS-CoV-2 infection (OR= 4.01; 95%1.14-10.7;p=0.013) was associated with a higher 30 day-post BMT complications. Following adjustment, BMT performed within 4 weeks (acute SARS-CoV-2 infection) was associated with an increased odds of 30-day mortality (aOR 4.63; 95% 1.34 - 12.1; p=0.005) compared to those without prior infection. This increased risk was not observed in patients undergoing BMT 4-8 weeks (aOR 1.17; 95% 0.06 - 5.77; p=0.88) or >8 weeks (aOR 1.45; 95% 0.50 - 3.36; 0.43) after a SARS-CoV-2 infection. Conclusions In this large real-world dataset of patients with mostly asymptomatic to moderate infection, BMT within 4 weeks of SARS-CoV-2 infection was associated with higher 30-day post BMT complication and mortality. Future research is needed to better refine the best timing of BMT in this vulnerable patient population with underlying hematological cancer. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal
Source: Blood
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4310159231