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Excellent Outcomes of Patients of Middle Eastern Ethnic Origin with Autologous Haemopoietic Stem Cell Transplantation and COVID-19: Does a Dampened Immune System Protect Against Severe COVID-19?
Introduction Outcomes of patients with hematological cancers and coronavirus disease 2019 (COVID-19) have been reported to be poor with high rates of hospitalization, mechanical ventilation with high case fatality rates, mortality being around 10% or higher. The mortality had been particularly highe...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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American Society of Hematology
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8330261/ http://dx.doi.org/10.1182/blood-2020-140682 |
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author | Tailor, Imran K Altaf, Syed Y Alshehry, Nawal F Alser, Alaa M Marei, Mohammed Alfayez, Mansour Motabi, Ibraheem Zaidi, Syed Ziauddin A |
author_facet | Tailor, Imran K Altaf, Syed Y Alshehry, Nawal F Alser, Alaa M Marei, Mohammed Alfayez, Mansour Motabi, Ibraheem Zaidi, Syed Ziauddin A |
author_sort | Tailor, Imran K |
collection | PubMed |
description | Introduction Outcomes of patients with hematological cancers and coronavirus disease 2019 (COVID-19) have been reported to be poor with high rates of hospitalization, mechanical ventilation with high case fatality rates, mortality being around 10% or higher. The mortality had been particularly higher among blacks and ethnic minority individuals. There is paucity of data on the outcomes of patients with autologous stem cell transplant and concurrent COVID-19 infections, especially from eastern mediterranean region, no similar studies have been reported so far. Methods Here we describe outcomes of five consecutive patients of middle eastern ethnic origin who had a history of autologous stem cell transplant and developed COVID-19 infection, who were admitted at our tertiary care center between April and June 2020 with a minimum of 10 days follow-up. Results A total of five patients were identified who had undergone autologous stem cell transplantation and had developed COVID-19 infection. There were 3 males and 2 females and the median age was 43 years (range 18-59). Indications for transplant were myeloma (n=3), relapsed Hodgkin lymphoma (n=1), and relapsed diffuse large b cell lymphoma (n=1). Three of five patients had other comorbidities. Median time from transplant was 9 months (range 3-33 months). Four of five patients were on active treatment or maintenance at the time of infection. One patient was on brentuximab, and three were on lenalidomide based therapy. Only one of the five patients had active disease at the time of infection while the rest were in remission. None of the patients had severe disease and four were discharged to home isolation and made full recovery, and one needed admission requiring minimal oxygen and eventually made full recovery. At a median follow up of 70 days (range 12-90) all patients were doing well with no sequelae. Conclusion Our study, albeit small, shows excellent outcomes among patients of middle eastern ethnic origin with hematological cancers who had undergone autologous stem cell transplantation and had developed COVID-19 infection, unlike other studies that have shown high mortality among patients with hematological cancers. However, our cohort is relatively younger, most of them were in remission at the time of infection which may have had a protective effect. At the same time, the majority had transplant within the last nine months and four-fifths of the patients were on some sort of immunosuppressive therapy whilst developing COVID-19 infection. It is possible that a dampened immune system due to transplant and recent therapy might have had a protective effect against cytokine storm or severe COVID-19, in our view. More studies are needed to examine this aspect further, however, these results are encouraging. DISCLOSURES: No relevant conflicts of interest to declare. |
format | Online Article Text |
id | pubmed-8330261 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | American Society of Hematology |
record_format | MEDLINE/PubMed |
spelling | pubmed-83302612021-08-03 Excellent Outcomes of Patients of Middle Eastern Ethnic Origin with Autologous Haemopoietic Stem Cell Transplantation and COVID-19: Does a Dampened Immune System Protect Against Severe COVID-19? Tailor, Imran K Altaf, Syed Y Alshehry, Nawal F Alser, Alaa M Marei, Mohammed Alfayez, Mansour Motabi, Ibraheem Zaidi, Syed Ziauddin A Blood 731.Clinical Autologous Transplantation: Results Introduction Outcomes of patients with hematological cancers and coronavirus disease 2019 (COVID-19) have been reported to be poor with high rates of hospitalization, mechanical ventilation with high case fatality rates, mortality being around 10% or higher. The mortality had been particularly higher among blacks and ethnic minority individuals. There is paucity of data on the outcomes of patients with autologous stem cell transplant and concurrent COVID-19 infections, especially from eastern mediterranean region, no similar studies have been reported so far. Methods Here we describe outcomes of five consecutive patients of middle eastern ethnic origin who had a history of autologous stem cell transplant and developed COVID-19 infection, who were admitted at our tertiary care center between April and June 2020 with a minimum of 10 days follow-up. Results A total of five patients were identified who had undergone autologous stem cell transplantation and had developed COVID-19 infection. There were 3 males and 2 females and the median age was 43 years (range 18-59). Indications for transplant were myeloma (n=3), relapsed Hodgkin lymphoma (n=1), and relapsed diffuse large b cell lymphoma (n=1). Three of five patients had other comorbidities. Median time from transplant was 9 months (range 3-33 months). Four of five patients were on active treatment or maintenance at the time of infection. One patient was on brentuximab, and three were on lenalidomide based therapy. Only one of the five patients had active disease at the time of infection while the rest were in remission. None of the patients had severe disease and four were discharged to home isolation and made full recovery, and one needed admission requiring minimal oxygen and eventually made full recovery. At a median follow up of 70 days (range 12-90) all patients were doing well with no sequelae. Conclusion Our study, albeit small, shows excellent outcomes among patients of middle eastern ethnic origin with hematological cancers who had undergone autologous stem cell transplantation and had developed COVID-19 infection, unlike other studies that have shown high mortality among patients with hematological cancers. However, our cohort is relatively younger, most of them were in remission at the time of infection which may have had a protective effect. At the same time, the majority had transplant within the last nine months and four-fifths of the patients were on some sort of immunosuppressive therapy whilst developing COVID-19 infection. It is possible that a dampened immune system due to transplant and recent therapy might have had a protective effect against cytokine storm or severe COVID-19, in our view. More studies are needed to examine this aspect further, however, these results are encouraging. DISCLOSURES: No relevant conflicts of interest to declare. American Society of Hematology 2020-11-05 2021-08-03 /pmc/articles/PMC8330261/ http://dx.doi.org/10.1182/blood-2020-140682 Text en Copyright © 2020 American Society of Hematology. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
spellingShingle | 731.Clinical Autologous Transplantation: Results Tailor, Imran K Altaf, Syed Y Alshehry, Nawal F Alser, Alaa M Marei, Mohammed Alfayez, Mansour Motabi, Ibraheem Zaidi, Syed Ziauddin A Excellent Outcomes of Patients of Middle Eastern Ethnic Origin with Autologous Haemopoietic Stem Cell Transplantation and COVID-19: Does a Dampened Immune System Protect Against Severe COVID-19? |
title | Excellent Outcomes of Patients of Middle Eastern Ethnic Origin with Autologous Haemopoietic Stem Cell Transplantation and COVID-19: Does a Dampened Immune System Protect Against Severe COVID-19? |
title_full | Excellent Outcomes of Patients of Middle Eastern Ethnic Origin with Autologous Haemopoietic Stem Cell Transplantation and COVID-19: Does a Dampened Immune System Protect Against Severe COVID-19? |
title_fullStr | Excellent Outcomes of Patients of Middle Eastern Ethnic Origin with Autologous Haemopoietic Stem Cell Transplantation and COVID-19: Does a Dampened Immune System Protect Against Severe COVID-19? |
title_full_unstemmed | Excellent Outcomes of Patients of Middle Eastern Ethnic Origin with Autologous Haemopoietic Stem Cell Transplantation and COVID-19: Does a Dampened Immune System Protect Against Severe COVID-19? |
title_short | Excellent Outcomes of Patients of Middle Eastern Ethnic Origin with Autologous Haemopoietic Stem Cell Transplantation and COVID-19: Does a Dampened Immune System Protect Against Severe COVID-19? |
title_sort | excellent outcomes of patients of middle eastern ethnic origin with autologous haemopoietic stem cell transplantation and covid-19: does a dampened immune system protect against severe covid-19? |
topic | 731.Clinical Autologous Transplantation: Results |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8330261/ http://dx.doi.org/10.1182/blood-2020-140682 |
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