Hematopoietic Cell Transplantation is Feasible in Patients with Prior COVID-19 Infection.

ABSTRACT Background There are limited data on outcomes of patients with prior Coronavirus disease 2019 (COVID-19) who proceeded to autologous or allogeneic hematopoietic cell transplantation (HCT). It is unknown whether these patients are more susceptible to poor outcomes and recurrence of COVID-19. Objective We report a retrospective analysis of outcomes of 15 consecutive patients with hematologic malignancies who experienced COVID-19 and subsequently underwent autologous (n=8) or allogeneic (n=7) HCT between 6/17/20 and 2/17/21. The reported cohort included patients with asymptomatic past infections or symptomatic COVID-19 disease. Methods Data were obtained from chart review. Descriptive statistics were used to summarize patient characteristics. Results Among eight patients who underwent autologous HCT, four had a diagnosis of multiple myeloma while the rest had a diagnosis of non-Hodgkin's lymphoma. Four of the eight patients did not test positive for anti-SARS- CoV-2 IgG antibody at any point during their course. The remaining four patients had detectable anti-SARS-CoV-2 IgG antibodies prior to autologous HCT but only two of these patients remained anti-SARS-CoV-2 IgG antibody-positive at their last follow-up. One patient died from progression of disease. Seven patients with prior COVID-19 underwent allogeneic HCT for acute lymphoblastic leukemia (n=3); acute myeloid leukemia (n=1); chronic myeloid leukemia in lymphoid blast crisis (n=1); myelodysplastic syndrome (n=1); and myelofibrosis (n=1). Three of the seven patients tested positive for anti-SARS- CoV-2 IgG antibodies following the initial COVID-19 diagnosis; however, only one of these patients retained anti-SARS- CoV-2 IgG antibody following allogeneic stem cell transplantation. One patient died of infections (fungal and Pneumocystis jirovecii pneumonia) occurring in the context of ongoing treatment for GVHD. None of the 15 patients developed recurrence of COVID-19 infection. Conclusions Based on our experience, autologous and allogeneic HCT can be safely performed in select patients with previous COVID-19 infection.