Thread by @AkshaySharmaMD

What happens to hematopoietic transplant recipients who develop #COVID19?

Transplant recipients and transplanters have been asking this question ever since the pandemic began.

Our analysis using @CIBMTR data is out today in @TheLancetHaem thelancet.com/journals/lanha…. 1/

While there have been close to 100,000 papers related to COVID-19 listed on @NCBI @NLM_NIH #Pubmed, there are very few that address outcomes after #COVID19 in #BMTsm patients, a few are listed in the next tweet: 2/

1. Spanish experience from @GETH_info onlinelibrary.wiley.com/doi/10.1002/pb…
2. Chicago (@RushMedical, @UChicago & @NUFeinbergMed) & New York City (@MountSinaiNYC) experience in @LeukemiaJnl nature.com/articles/s4137…
3. @sloan_kettering experience in @jclinicalinvest jci.org/articles/view/… 3/

Several studies had shown that #cancer survivors are at least a 2x risk of #COVID19-associated intensive care unit admission, invasive ventilation, and death compared to the general population. We believed that the risk in #BMTsm recipients would be even higher ☹️ 4/

Previous studies in #BMTsm recipients analyzed data from single centers or small cohorts that didn't have the power to perform detailed statistical analysis.

@CIBMTR had instituted a new form to collect #COVID19 specific data in Mar 2020, which we leveraged for this analysis 5/

Our study included 318 #BMTsm recipients (184 allo and 134 auto) from 6 countries ⏩ The largest database of transplant recipients with #COVID19 reported to date. 6/

All age groups (pediatric to seniors) were included, and the cohort was racially/ethnically representative of the US population. Most alloHCT were for acute leukemias and most autoHCT were for plasma cell disorders. 7/

Median time from #HCT to #COVID19 was 17 months for alloHCT and 23 months for autoHCT recipients. The median duration of follow-up was 21 and 25 days respectively - definitely short, but still informative. 8/

Mild #COVID19 infection (no suppl O2 needed) happened in 49%, moderate (needing suppl O2, but not ventilator) in 24%, and severe (needing mechanical ventilation) in 14% #BMTsm recipients. 9/

21% #HCT recipients reported to the @CIBMTR died:
Among allogeneic HCT recipients, 93% of those reported deceased died due to #COVID19 while among autologous HCT recipients 73% of those reported deceased died due to COVID19 and the remaining due to underlying disease. 10/

The probability of survival at 30 days after #COVID19 diagnosis was 67 and 68% for recipients of autologous and allogeneic #HCT respectively. 11/

In other words, the probability of death in #HCT recipients after #COVID19 was about 30% at 30 days after infection.
In contrast, mortality in the general population after COVID19 is about 1-5%, and in those with cancer twice that of the general population. 12/

In a multivariable analysis, we found that age >50 years, male gender, and having received #HCT within 1 year at the time of #COVID19 diagnosis were all risk factors for increased risk of death among allogeneic HCT recipients. 13/

Among autologous HCT recipients, patients who received an #HCT for lymphomas were more likely to succumb to #COVID19 than those who underwent HCT for plasma cell disorders/myeloma. 14/

Lymphopenia (ALC <300/uL) at the time of #COVID19 was also associated with a high risk of death in #HCT survivors. 15/

We could not assess the impact of any therapeutic strategies or effectiveness of drugs used to treat #COVID19 in this study. But hopefully, future analyses will provide more information. 16/

I hope this #tweetorial (my first!😊) was helpful. h/t @jyoti_nangalia whose excellent tweetorial on genetic origins on #MPNsm was the inspiration to this creation. Read her full tweetorial here

https://twitter.com/jyoti_nangalia/status/1326523224558071813

17/

Congratulations and a huge shout out to @nbhattmd @BilalAbidMD @Dr_AmerZeidan @cdandoy1 @drjgauthier @DrMiguelPerales @GunjanLShah and all other co-authors not on Twitter (please support my campaign to have them all join #MedTwitter) @CIBMTR @ASTCT 18/

I will be presenting our data during the #BestAbstracts session of #TCTM21 on Friday, February 12, 2021 at 12:30 PM CST. I look forward to discussing our findings in detail then. @ASTCT /fin