Coronavirus infection after blood stem cell transplantation

Abstract

Background. In March 2020, oncohematologists faced the problem of severe COVID-19 coronavirus infection in patients after a high-dose chemotherapy and autologous or allogeneic bone marrow transplantation. This required a review of issues related to the selection of patients for blood stem cell transplantation (HSCT), the development of new preventive and therapeutic tactics aimed at treating infectious and immunological complications in patients of this category, depending on the nature and status of the underlying disease and the timing of treatment.Aim. To assess the severity, most typical complications and course of COVID-19 in patients during early and late posttransplant periods.Materials and methods. We analyzed the data of patients after HSCT with active coronavirus infection hospitalized in the hematology department from 2020 to 2021. A total of 25 patients were hospitalized: 4 after allogeneic transplantation, 21 after autologous transplantation. According to the timing of HSCT, patients were divided into 2 groups: early period (ETP) (2-90 days after HSCT) - 14 patients, late period (LTP) (3-24 months after HSCT) - 11 patients.Results. Severe coronavirus infection (grades III-IV according to computed tomography) was more often observed in patients in the ETP group (65 %) than in the LTP group (18 %). The incidence of respiratory failure was 70 and 36 % in the ETP and LTP groups, respectively. In the ETP group, agranulocytosis and the development of severe infectious complications (bacterial, fungal and viral) were observed significantly more often than in the LTP group, which required the appointment of reserve groups antibacterial therapy and antifungal therapy. Mortality in the ETP group was 35 %, while no deaths were recorded in the LTP group. The median duration of hospitalization for patients in the ETP and LTP groups was 20 and 13 days, respectively.Conclusion. Patients early after HSCT are at higher risk of developing lower respiratory tract infections, are more likely to require hospitalization in the intensive care unit, and have a greater risk of death from COVID-19. Therapy with genetically engineered biological drugs is not contraindicated in the case of leukopenia and agranulocytosis in this group of patients.