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COVID-19 Outcomes in Haematopoietic Cell Transplant Recipients: A Systematic Review and Meta-Analysis

22 Pages Posted: 7 Jan 2022

See all articles by Yeong Jer Lim

Yeong Jer Lim

University of Liverpool

Umair Khan

The Clatterbridge Cancer Centre NHS Foundation Trust

Indrani Karpha

University of Liverpool

Andrew Ross

The Clatterbridge Cancer Centre NHS Foundation Trust

Muhammad Saif

The Clatterbridge Cancer Centre NHS Foundation Trust

Mats Remberger

Uppsala University - Uppsala University Hospital

Nagesh Kalakonda

University of Liverpool

Andrew R. Pettitt

University of Liverpool

Yngvar Floisand

The Clatterbridge Cancer Centre NHS Foundation Trust

More...

Abstract

Background: Up-to-date information on COVID-19 outcomes and risk factors in haematopoietic cell transplantation (HCT) recipients is required to inform on decisions about cancer treatment and COVID-19 mitigation strategies. We performed a meta-analysis with the aim of addressing this knowledge gap. 

Methods: Studies meeting pre-defined inclusion criteria were identified in PubMed, Embase, medRxiv and bioRxiv databases, conference proceedings from international meetings and reference lists of other articles (last updated Dec 30th, 2021). All studies with at least five patients that reported COVID-19 related deaths in HCT recipients were included. The primary outcome was COVID-19 related death. Secondary outcomes were COVID-19 related mechanical ventilation (MV) and intensive care unit (ITU) admission. We utilised random-effects model for the meta-analysis, with chi2 test and I2 statistic to assess for heterogeneity. 

Findings: Eighty-four records were identified, of which 36 English language sources reporting 2141 patients and published between January 2020 to December 2021 met the inclusion criteria. The cumulative COVID-19 related death rate among HCT recipients was 21% (95% CI 18% - 24%), while MV and ITU admission rates were 14% (95% CI 11% - 17%) and 18% (95% CI 14% - 22%), respectively. Subgroup analysis showed higher death rates in patients who developed COVID-19 within 12 months of HCT (RR 1.82, 95% CI 1.09 – 3.03; P = 0.02), within six months of receiving immunosuppressant drugs (RR 2.11, 95% CI 1.38 – 3.20, P = 0.0005) or in the context of active graft-versus-host disease (RR 2.38, 95% CI 1.10 – 5.16; P = 0.03). 

Interpretation:Our findings support the idea that HCT should remain an integral part of cancer treatment during the COVID-19 pandemic but also highlight the need to prioritise surveillance and preventative measures in those patients who are at increased risk of adverse COVID-19 outcomes. 

Funding Information: University of Liverpool, Clatterbridge Cancer Centre NHS Foundation Trust.

Declaration of Interests: None.

Keywords: COVID-19, Haematopoietic cell transplantation, Allogeneic stem cell transplantation, autologous stem cell transplantation, Outcomes

Suggested Citation

Lim, Yeong Jer and Khan, Umair and Karpha, Indrani and Ross, Andrew and Saif, Muhammad and Remberger, Mats and Kalakonda, Nagesh and Pettitt, Andrew R. and Floisand, Yngvar, COVID-19 Outcomes in Haematopoietic Cell Transplant Recipients: A Systematic Review and Meta-Analysis. Available at SSRN: https://ssrn.com/abstract=4003216 or http://dx.doi.org/10.2139/ssrn.4003216

Yeong Jer Lim

University of Liverpool ( email )

Umair Khan

The Clatterbridge Cancer Centre NHS Foundation Trust ( email )

United Kingdom

Indrani Karpha

University of Liverpool ( email )

Chatham Street
Brownlow Hill
Liverpool, L69 7ZA
United Kingdom

Andrew Ross

The Clatterbridge Cancer Centre NHS Foundation Trust ( email )

United Kingdom

Muhammad Saif

The Clatterbridge Cancer Centre NHS Foundation Trust ( email )

United Kingdom

Mats Remberger

Uppsala University - Uppsala University Hospital ( email )

Sweden

Nagesh Kalakonda

University of Liverpool ( email )

Chatham Street
Brownlow Hill
Liverpool, L69 7ZA
United Kingdom

Andrew R. Pettitt

University of Liverpool ( email )

Chatham Street
Brownlow Hill
Liverpool, L69 7ZA
United Kingdom

Yngvar Floisand (Contact Author)

The Clatterbridge Cancer Centre NHS Foundation Trust ( email )

United Kingdom

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