ABSTRACT
Background. There is significant global concern that the COVID-19 pandemic may negatively impact tuberculosis (TB) control. This is a descriptive analysis of TB evaluations and diagnosis during 2019 (pre COVID-19 period) and 2020 (COVID-19 period) at the largest safety net hospital in Los Angeles County (LAC+USC Medical Center). Methods. The medical records of patients diagnosed with pulmonary TB from January 1, 2019 to December 31, 2020 were identified through laboratory and electronic medical records. We included all patients with ≥ 1 sputum positive result for Mycobacterium tuberculosis (MTB) culture and reviewed their Xpert MTB/RIF MTB PCR. Results. Table 1 shows summary of results. During the COVID-19 period, the number of patients evaluated for pulmonary TB decreased by 64% compared to the previous year (Figure 1). The proportion of patients with culture-confirmed TB disease however, was nearly identical (P=0.913) (Table 1). Sputum acid-fast bacilli (AFB) smear positivity increased 52% to 64% during COVID-19 (P=0.324) and disease severity as measured by chest radiograph, was significantly higher during the COVID-19 period (P = 0.031) (Figure 2). Trend of sputum AFB smear and culture samples collected from January 1, 2019 to December 31, 2020. Summary of results of patients diagnosed with pulmonary TB from January 1, 2019 to December 31, 2020 at LAC+USC Medical Center. Results of two-sample test for proportions of 2019 vs 2020 for cavitary lesions, extent of disease, and sputum positive AFB smear microscopy. Conclusion. These preliminary results suggest that when compared to the previous year, the number of pulmonary TB evaluations decreased by 64% during the COVID period. Whereas the proportion of patients diagnosed with TB disease was similar, TB patients during the COVID-19 period had more advanced disease at diagnosis, as measured by sputum smear AFB microscopy and disease severity on chest radiograph (P=0.031). These data suggest potentially consequential interruptions and delays in pulmonary TB diagnosis during the COVID-19 period.
ABSTRACT
Intro: Hematopoietic stem-cell transplant (HSCT) recipients are considered to be at high risk for poor outcomes following COVID-19 infection given their co-morbidities and immunosuppression. Sharma et al published the CIBMTR observational report data that showed that recipients of allogeneic HSCT who contract COVID-19 have poor overall survival with a 30-day mortality of 32%. That being said, there have been relatively few studies that look into the effect of COVID-19 on HSCT recipients in the setting of in vivo T cell depletion protocols. With the increased use of post-transplant cyclophosphamide (PTCy) based GVHD prophylaxis regimens for our match related and match unrelated HSCT recipients since 2018 at our institution, we are interested to see if our COVID-19 outcomes differ from those published in the CIBMTR report. Methods: This is a single institution retrospective analysis evaluating outcomes of HSCT recipients who were diagnosed with COVID-19 between March 2020 and April 2021. Patients 18 years or older who underwent HSCT and subsequently contracted COVID-19 were included in the data collection. Demographic data including age, type of hematologic malignancy, conditioning regimen, GVHD prophylaxis, date of COVID-19 infection, with pre- and post-COVID-19 infection labs were obtained. Our primary endpoint in this retrospective analysis was non-relapse mortality within 30 days of COVID-19 diagnosis. Results: There were 21 patients at our institution who had undergone HSCT and subsequently contracted COVID-19. The most common primary disease types were acute lymphoblastic leukemia (33.3%), acute myeloid leukemia (23.8%), and myelodysplastic syndrome (19.0%). The median age of our patient population was 53 years (range, 24-66). 6 of the patients received match related allografts. 7 received cells from match unrelated donors. 7 received cells from haploidentical donors. 1 patient had received an autologous stem cell transplant. Of the remaining 20 allo-HSCT recipients, 14 of them (70.0%) received myeloablative conditioning regimens, whereas 6 (30.0%) received reduced intensity or non-myeloablative regimens. Our GVHD prophylaxis regimens were PTCy/Tacro/MMF (12 pts, 60.0%) and Tacro/MTX (8 pts, 40.0%). Patient demographics and outcomes are found on Tables 1 and 2. Our patients were diagnosed with COVID-19 a median 469 days post-transplant, with 8 patients (38.1%) diagnosed with COVID-19 within 1 year of transplant. 11 of the patients (52.4%) received steroids following their diagnosis with COVID-19. Of the 20 allo-HSCT recipients with confirmed COVID-19 infection, 1 passed away 20 days after the diagnosis was made. This gives us a 5.0% case fatality rate attributable to COVID-19 in our population in our allo-HSCT population. 16 of the 20 patients were symptomatic at the time of diagnosis (80.0%). 7 of the 20 patients (35.0%) were hospitalized for a median of 7 days (range, 5-17 days), with 2 requiring ICU level of care. The one patient who passed away tested positive for COVID-19 177 days post-transplant and was hospitalized approximately 7 days after diagnosis, where he was intubated on hospital day 4 and ultimately passed away on hospital day 13. The patient had received Tacro/MTX for GVHD prophylaxis. Discussion: Although this is a small sample size, our data suggests that our allo-HSCT recipients who contracted COVID-19 have had generally good short-term outcomes. Our study is limited by the small number of patients who got infected with COVID-19, particularly those within 1-year post-transplant. Furthermore, we acknowledge it is difficult to claim that the PTCy based GVHD prophylaxis regimens for our HSCT recipients were solely responsible for their improved outcomes since 40% of allo-HSCT recipients did not get PTCy for GVHD prophylaxis. However, we believe it would be valuable to evaluate in a prospective analysis. We are currently evaluating if a COVID-19 diagnosis has any effect on long term transplant related complications and outcomes in this population. [Formula presented] Disclosures: Chaudhary: Angel s Therapeutics: Current holder of individual stocks in a privately-held company, Current holder of stock options in a privately-held company, Membership on an entity's Board of Directors or advisory committees, Other: Founder, Patents & Royalties: Cell therapy;Celldex: Current equity holder in publicly-traded company;Moderna: Current equity holder in publicly-traded company;Pancella: Consultancy;Oncotartis: Consultancy;Athelas: Consultancy, Current holder of stock options in a privately-held company;TCR2: Current equity holder in publicly-traded company;Allogene: Current equity holder in publicly-traded company. Yaghmour: Novartis: Consultancy, Speakers Bureau;BMS: Speakers Bureau;Alexion: Speakers Bureau;Astellas: Speakers Bureau;Takeda: Consultancy, Speakers Bureau;Jazz: Speakers Bureau;Agios: Consultancy, Speakers Bureau.