ABSTRACT
Introduction: In winter, mortality in the elderly general population is increased. Among other causes, this is due to infections from seasonal respiratory viruses and pneumonia. Patients afer hematopoietic stem cell transplantation (HSCT) frequently experience such infections. We therefore hypothesized that HSCT recipients experience excess mortality during winter. Method(s): This is a retrospective cohort study using the SBST database to assess the proportion of HSCT-patients who died during winter defned as from October to March as compared to the summer half of the year. Histograms depict distribution of dates of death. Univariate analyses for death afer allogeneic and autologous HSCT of factors potentially associated with higher risks of winter deaths such as patient age, disease, disease stage, presence of GvHD and treatment center were done by chi-squared tests. Multivariable logistic regression was done separately for all patients and those surviving less and more than 100 days and more than one year to separately evaluate early and late deaths. Result(s): Between 1997 and 2019 12'412 patients received HSCT (8107 auto, 4305 allo). 4904 patients died (3218 auto, 1686 allo). Overall, 2517 patients (51.3%) of those died in the winter season, 2387 (48.7%) in summer (fgure 1). The proportion of patients with deaths in winter did not difer by type of HSCT, age, disease or disease stage at the time of transplant. Excluding patients dying in the first 100 days and in the first year afer transplant or those dying without relapsed disease did not change these results. Only deaths in the first 100 days afer autologous HSCT had a higher number of events in winter but this did not reach statistical signifcance (p=0.17). Of particular interest, in patients afer allogeneic HSCT the proportion of deaths occurring in winter was 48%, 49%, 52% and 51% in patients with a transplant age less than 20, 20-40, 40-65 and >65 (p=0.61). Conclusion(s): Contrary to our assumption, no higher mortality in winter was found in HSCT patients pointing to no increased death rate due to respiratory viruses. Additional data will be analyzed once the Covid-19 pandemic is over. [Figure Presented].
ABSTRACT
BACKGROUND: The COVID-19 pandemic has created enormous challenges for the clinical management of patients with hematological malignancies (HMs), raising questions about the optimal care of this patient group. METHODS: This consensus manuscript aims at discussing clinical evidence and providing expert advice on statements related to the management of HMs in the COVID-19 pandemic. For this purpose, an international consortium was established including a steering committee, which prepared six working packages addressing significant clinical questions from the COVID-19 diagnosis, treatment, and mitigation strategies to specific HMs management in the pandemic. During a virtual consensus meeting, including global experts and lead by the European Society for Medical Oncology and the European Hematology Association, statements were discussed and voted upon. When a consensus could not be reached, the panel revised statements to develop consensual clinical guidance. RESULTS AND CONCLUSION: The expert panel agreed on 33 statements, reflecting a consensus, which will guide clinical decision making for patients with hematological neoplasms during the COVID-19 pandemic.
Subject(s)
COVID-19 , Hematologic Neoplasms , COVID-19 Testing , Consensus , Hematologic Neoplasms/epidemiology , Hematologic Neoplasms/therapy , Humans , PandemicsABSTRACT
Introduction: Patients after allogeneic stem cell transplantation are at high risk for infection-related complications and vaccination efficacy might be impaired depending on the immune reconstitution. In this study we evaluate the response of 182 patients to mRNA vaccines against SARS-CoV2. Methods: During routine follow up visits, patients were asked about their vaccination status and if they had a previous infection with SARS-CoV2. In fully vaccinated patients, the antibody titer was measured using the Roche Elecsys Anti-SARS-CoV2 S test. A titer of <1 U/l was considered as negative, titers of >250 U/ml as a high antibody titer and a titer of 50-249 U/ml as a low antibody titer. Patient characteristics were evaluated by chart review to identify risk factors for poor vaccination response. Results: The majority of patients developed a high antibody titer (138 out 182 patients, 75.8%). Risk factors for a low antibody titer were im-munosuppressive therapy, a lymphocyte count <0.9 G/l, ongoing treatment for the underlying malignancy and active GvHD. The vaccine (Moderna vs Pfizer), donor type, underlying disease, a previous SARS-CoV2 infection and sex did not significantly influence the response to the vaccination. Discussion: While patients undergoing allogeneic stem cell transplantation have been excluded from the initial registration trials, our large patient cohort confirms the data of previous smaller studies, showing that most patients do have a good response to mRNA vaccines against SARS-CoV2. Nevertheless, a significant proportion of patients shows an inadequate vaccination response and thus qualifies for a third vaccination.