Allojeneik Kök Hücre Nakli Sürecinde COVID-19 Sıklığı ve Seyri

Abstract

Objective: This study aimed to retrospectively investigate the frequency and course of COVID-19 and evaluate the factors that may affect the prognosis of COVID-19, including vaccination status, patient and donor characteristics among patients who underwent allogeneic stem cell transplantation (ASCT) in our center one year before and after the COVID-19 pandemic. Patients and Methods: Demographic characteristics, diagnoses, donor characteristics, COVID-19 and vaccination status, COVID-19-related mortality (CRM), non-relapse mortality (NRM) and overall survival (OS) of patients who underwent ASCT in our center between January 2019 and July 2022 were investigated. Results: After exclusion of cases from the 236 consecutive ASCTs, 204 patients had a median age of 50 (18-76), and a median follow-up of 21.2 months [%95 confidence interval (CI): 18.5-23.9] after ASCT. The common diagnoses were acute leukemia and myelodysplastic syndrome (72.6%, 6.4% (n= 13) had CRM. Unvaccinated patients constituted 39.7% (n= 81). Patients vaccinated at least once before ASCT were 22.1% (n= 45). Cumulative CRM was 3.0% (95% CI: 1.04-4.96), 5.0% (95% CI: 1.08-8.92), 7.0% (95% CI: 3.08-10.92) and 7.0% (95% CI: 3.08-10.92) at the 1 st , 3 rd , 6 th , and 12 th months after ASCT, respectively. NRM was higher and OS was lower in patients with less than two doses of vaccination (p< 0.001 and p< 0.001, respectively). Being unvaccinated was an independent risk factor for OS, NRM and CRM. Transplantation from an HLA-matched unrelated donor was an independent risk factor for OS and NRM. Conclusion: COVID-19 is an important cause of mortality in the post-ASCT period. The mortality risk is higher during the first six months following ASCT. Patients who received at least two doses of vaccine has significantly improved mortality and survival rates. The negative survival outcomes observed in transplants from HLA-matched unrelated donors may be due to the restricted access to international marrow registries and the use of frozen stem cells.