COVID-19 outcomes in haematopoietic cell transplant recipients: A systematic review and meta-analysis.

Up-to-date information on coronavirus disease 2019 (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 to address this knowledge gap. All studies with at least five patients who 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. The cumulative COVID-19-related death rate among HCT recipients was 21% (95% confidence interval [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 (risk ratio [RR] 1.82, 95% CI 1.09-3.03), within 6 months of receiving immunosuppressant drugs (RR 2.11, 95% CI 1.38-3.20) or in the context of active graft-versus-host disease (RR 2.38, 95% CI 1.10-5.16). 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 preventative measures in those patients who are at increased risk of adverse COVID-19 outcomes.
Competing Interests: Andrew Ross, Indrani Karpha, Muhammad Saif and Yngvar Floisand are employed by Clatterbridge Cancer Centre NHS Foundation Trust. Yeong Jer Lim, Andrew R. Pettitt and Nagesh Kalakonda are employed by the University of Liverpool. Yeong Jer Lim is supported by the NW MRC fellowship scheme (award number MR/N025989/1). Mats Remberger is employed by Uppsala University Hospital, Sweden and supported by grants from the Swedish Research Council (VR 2017‐00355).
(© 2022 The Authors. eJHaem published by British Society for Haematology and John Wiley & Sons Ltd.)