COVID-19 in HSCT recipients: a collaborative study of the Brazilian Society of Marrow Transplantation (SBTMO)

(1)Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Departamento de Pediatria, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.

(2)Laboratório de Pediatria Translacional, Serviço de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.

(3)Unidade de Hematologia e Transplante de Medula Óssea Pediátrica, Serviço de Hematologia Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.

(4)Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Departamento de Pediatria, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.

(5)Hospital Israelita Albert Einstein, São Paulo, Brazil.

(6)Hospital São Rafael, Salvador, Brazil.

(7)Laboratório de Pediatria Translacional, Serviço de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.

(8)Hospital Amaral Carvalho, Jaú, Brazil.

(9)Service of Hematology, Transfusion and Cell Therapy, and Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Hospital das Clinicas, Faculty of Medicine, Sao Paulo University (FM-USP), São Paulo, Brazil.

(10)Hospital Nove de Julho, São Paulo, Brazil.

(11)Hospital Sírio-Libanês, São Paulo, Brazil.

(12)REAL Hospital Português de Beneficência em Pernambuco, Recife, Brazil.

(13)Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil.

(14)Hospital Pequeno Príncipe, Curitiba, Brazil.

(15)Hospital Universitário Walter Cantídio, Fortaleza, Brazil.

(16)Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil.

(17)Hospital Universitário Professor Edgar Santos, Universidade Federal da Bahia, Salvador, Brazil.

(18)Universidade Federal de São Paulo, São Paulo, Brazil.

(19)Instituto de Oncologia Pediátrica - GRAACC/UNIFESP, São Paulo, Brazil.

(20)Hospital Infantil Albert Sabin, Fortaleza, Brazil.

(21)Instituto da Criança do Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.

(22)Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, Brazil.

(23)Hospital Nossa Senhora das Graças, Curitiba, Brazil.

(24)Hospital Universitário de Londrina, Universidade Estadual de Londrina, Londrina, Brazil.

(25)Centro de Oncologia de Sergipe Dr. Oswaldo Leite, Aracaju, Brazil.

(26)Hospital Erasto Gaertner, Curitiba, Brazil.

(27)Hospital Oncopediátrico Erastinho, Curitiba, Brazil.

(28)Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.

(29)Serviço de Oncologia Pediátrica, Unidade de Hematologia Pediátrica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.

(30)Laboratório de Virologia (LIM 52), Instituto de Medicina Tropical, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. 

In the COVID-19 scenario, patients undergoing hematopoietic stem cell transplantation (HSCT) infected with SARS-CoV-2 may have an increased risk of death. Through a national multicenter study, we aimed to describe the impact of COVID-19 on the survival of HSCT recipients in Brazil. Eighty-six patients with a confirmed diagnosis of SARS-CoV-2 (92% by RT-PCR) were included. There were 24 children and 62 adults receiving an autologous (n = 25) and allogeneic (n = 61) HSCT for malignant (n = 72) and non-malignant (n = 14) disorders. Twenty-six patients died, (10 on autologous (38%) and 16 patients (62%) on allogeneic group). The estimated overall survival (OS) at day 40 was 69%. Adults had decreased OS compared to children (66% vs 79%, p = 0.03). The severity of symptoms at the time of diagnosis, ECOG score, laboratory tests (C-reactive protein, urea values) were higher in patients who died (p < 0.05). In conclusion, HSCT recipients infected with SARS-CoV-2 have a high mortality rate mainly in adults and patients with critical initial COVID-19 presentation. These findings show the fragility of HSCT recipients with SARS-CoV-2 infection. Therefore, the importance of adherence to preventive measures is evident, in addition to prioritizing the vaccination of family members and the HSCT team.