Undergoing hematopoietic stem cell transplant (HSCT) within 4 weeks of SARS-CoV-2 infection is associated with an increased risk of death at 90 days after HSCT, according to real-world data presented at the 2022 ASH Annual Meeting.
The results suggest that patients with moderate to severe COVID-19 may need to delay HSCT more than 4 weeks, according to study presenter Meera Mohan, MD, of the Medical College of Wisconsin in Milwaukee.
Dr Mohan noted that current guidelines recommend deferring HSCT for a minimum of 14 days in patients with a positive SARS-CoV-2 test who are asymptomatic. For patients who are symptomatic, the current recommendation is to defer HSCT until clinical recovery and at least 14-20 days from a positive test.
To assess the optimal timing of HSCT after COVID-19 diagnosis, Dr Mohan and colleagues analyzed data from 6410 patients with hematologic malignancies from the National COVID Cohort Collaborative (N3C). Together, leukemia, lymphoma, and multiple myeloma accounted for 82% of malignancies.
A total of 5748 patients did not have a SARS-CoV-2 infection prior to HSCT, and 662 patients did. Among patients with a SARS-CoV-2 infection, 476 (72%) had mild COVID-19, and 186 (28%) had moderate to severe COVID-19.
Patients who received HSCT after SARS-CoV-2 infection were stratified into 3 groups: acute (n=103), early (n=104), and late (n=455). Patients in the acute group received their transplant less than 4 weeks after COVID-19 diagnosis, patients in the early group had an HSCT 4-8 weeks after COVID-19 diagnosis, and patients in the late group had an HSCT more than 8 weeks after COVID-19 diagnosis.
The primary outcome of the study was 90-day mortality by timing and severity of SARS-CoV-2 infection. The 90-day mortality rate was 5.3% for patients without a SARS-CoV-2 infection prior to HSCT and was 6.8% for those with a SARS-CoV-2 infection, a nonsignificant difference (P =.3).
However, patients who were transplanted in the acute setting (less than 4 weeks from COVID-19 diagnosis) had a significantly higher 90-day mortality rate (14%) than patients who did not have a SARS-CoV-2 infection before HSCT (5.7%), patients who had HSCT in the early setting (4-8 weeks after COVID-19 diagnosis; 4.1%), or patients who had HSCT in the late setting (more than 8 weeks after diagnosis; 4.9%; P =.01).
In addition, patients with moderate to severe COVID-19 had a significantly higher 90-day mortality rate (10%) than patients who had mild COVID-19 (5.4%) and those who did not have a SARS-CoV-2 infection prior to HSCT (5.3%; P =.003).
A multivariate analysis indicated that patients who underwent HSCT in the acute setting after moderate to severe SARS-CoV-2 infection had a 3.7 times greater overall mortality risk, when compared with patients who did not have a SARS-CoV-2 infection prior to HSCT.
“The optimal timing of [HSCT] must be individualized, and consider delaying transplant, if permissible, in patients, particularly in the setting of acute, moderate to severe SARS-CoV-2 infection,” Dr Mohan concluded.
She noted that future research directions include studying the effects of COVID-19 vaccination or treatment on HSCT outcomes.
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Mohan M, Verhagen N, Shreenivas A, et al. 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. Presented at ASH 2022. December 10-13, 2022. Abstract 387.