COVID-19 in hematopoietic stem-cell transplant recipients: A systematic review and meta-analysis of clinical characteristics and outcomes

Bruno Azevedo Randi; Hermes Ryoiti Higashino; Vinícius Ponzio da Silva; Erick Menezes Xavier; Vanderson Rocha; Silvia Figueiredo Costa

doi:10.1002/rmv.2483

COVID-19 in hematopoietic stem-cell transplant recipients: A systematic review and meta-analysis of clinical characteristics and outcomes

Rev Med Virol. 2023 Nov;33(6):e2483. doi: 10.1002/rmv.2483. Epub 2023 Oct 4.

Authors

Bruno Azevedo Randi¹, Hermes Ryoiti Higashino¹, Vinícius Ponzio da Silva², Erick Menezes Xavier³, Vanderson Rocha³, Silvia Figueiredo Costa^{1

4}

Affiliations

¹ Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
² Médico do grupo de infecção em imunodeprimidos da Unifesp/ Escola Paulista de Medicina, São Paulo, Brazil.
³ Departamento de Hematologia, Hemoterapia e Terapia Celular, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
⁴ Laboratório de Investigação Médica em Protozoologia, Bacteriologia e Resistência Antimicrobiana - LIM/49, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil.

PMID: 37794598
DOI: 10.1002/rmv.2483

Abstract

Patients who undergo hematopoietic stem-cell transplantation (HSCT) are more susceptible to developing severe forms of COVID-19 with an increased risk of mortality. The aim of this study was to analyze, by performing a systematic review and meta-analysis, all studies that evaluated COVID-19 in HSCT adult recipients and present clinical characteristics and outcomes. Studies were eligible for inclusion if they: (I) described the clinical characteristics of COVID-19 in adult (aged 18 years old or above) HSCT recipients; (II) described outcomes of COVID-19 in this population, mainly lethality; (III) were full-text articles. We searched MedLine, Embase, SCOPUS, LILACS and Web of Science for full-text studies that evaluated COVID-19 in adult HSCT patients until 26 Apr 2023. Two independent reviewers screened the articles and extracted the data. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Studies Reporting Prevalence Data was used to assess quality of the included studies. Meta-analysis was performed and the pooled prevalence of severe/critical disease and of death with a 95% CI was calculated with the random-effects model. Sixteen studies were included; seven (43.7%) were multicenter. Most of the studies were from Europe (37.5%). All of them had a low risk of bias using the JBI Checklist. A total of 1186 patients were included. Allogeneic HSCT patients were the majority in most studies, with a total of 861 patients (72.5%). The symptomatic rate was 79.4%. The pooled prevalence of severe/critical COVID-19 was 24.0% (95% CI 0.13-0.36; I² = 94%; n = 334/990). The pooled prevalence of death for the entire population was 17% (95% CI 0.13-0.22; I² = 76%; n = 221/1117), 17% (95% CI 0.12-0.23; I² = 67%; n = 152/822) for allogeneic-HSCT and 14% (95% CI 0.08-0.22; I⁴ = 65%; n = 48/293) for autologous-HSCT. In conclusion, frequently the infection of SARS-CoV-2 in HSCT was symptomatic and lethality is higher than in general population. Thus, it is essential to focus on the implementation of measures to mitigate the risk of SARS-CoV-2 infection in this population, as well as to carefully assess HSCT recipients who develop COVID-19.

Keywords: COVID-19; SARS-CoV-2; hematopoietic stem cell transplantation.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Adolescent
Adult
COVID-19* / therapy
Europe
Hematopoietic Stem Cell Transplantation* / adverse effects
Humans
Multicenter Studies as Topic
SARS-CoV-2
Transplant Recipients