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EBMT 2021 Annual Meeting - The Impact of COVID-19 in HSCT and Cellular Therapy

by
Infectious Diseases Working Party (IDWP)

Special Session SS06: The Impact of COVID-19 in HSCT and Cellular Therapy: a year from the start of the pandemic

Wednesday, March 17, 16:15 - 17:30, Auditorium 4

This four-part special session on the final day of this year’s congress will discuss multiple issues around the effect of the COVID-19 pandemic on cellular therapy, including updates from Germany, France and the Netherlands.

Per Ljungman (Professor Emeritus of Hematology at the Karolinska Institutet and based at Karolinska University Hospital, Stockholm, Sweden) will open the session with an overview of the various recommendations that have been published giving guidance to transplant centres on how to deal with COVID-19, including prevention policies and procedures, how to deal with patients waiting for transplantation (candidates), donor considerations (following WMDA recommendations) and how to manage visitors/family members.

He will also discuss data from the EBMT COVID-19 Registry, which includes 382 patients from 22 countries (236 allogenic, 146 autologous). A total of 107 patients died, of which 95 had COVID-19 listed as the principal cause of death. 

Professor Ljungman concludes that COVID-19, like other respiratory viruses, causes severe disease in HCT recipients. Increased age and poor performance status are the most important risk factors for poor outcome, and patients soon after their SCT seem to do worse. The outcome seems better in the second wave, however analyses are preliminary and the registry study is continuing in 2021.

An overview of the situation in Germany will then be given by Professor Lutz Müller and Dr Judith Schaffrath of University Hospital Halle on behalf of the German Working Group for Stem Cell Transplantation and Cellular Therapies (DAG-HSZT).

The SARS-CoV-2 pandemic in Germany was generally marked by low infection rates during spring but a significant increase in disease burden by the end of 2020. Specific guidelines on COVID-related care for cancer patients had been implemented early on.

“According to our surveys via the DAG-HSZT more than 80% of German transplant centers felt the impact of the pandemic during the last 12 months,” explains Dr Schaffrath.  “Interestingly, preliminary numbers by the German Registry for Stem Cell Transplantation show that the number of allogeneic and autologous SCTs remained approximately the same in 2020. Many centres delayed planned transplants and cryopreserved their allogeneic products, especially during the first wave. During the second wave, the number of postponements and cryopreservations decreased considerably.”

“Many centres reported infections with SARS-CoV-2 after SCT with similar death rates between autologous and allogeneic SCT and high rates of ICU requirement,” says Professor Müller.

“And looking at vaccinations, DAG-HSZT has issued a recommendation on vaccination of patients after cell therapies and almost all centres participating in our survey recommend vaccination against COVID-19 to their patients.”

An update on the situation in France will be given by Dr Aliénor Xhaard, a physician in the allogeneic HSCT unit of Saint Louis Hospital in Paris, France. She will explain that despite the concerns around COVID-19, there was no significant difference in total alloHSCT performed per year in the year 2020 compared with the mean 2016-2019.

Some 85% of alloHSCT activity in France during the first wave was performed, although postponed – with a range of delay from 3 days to 10 months. In some cases, the problems were similar to those that routinely occurred before the COVID-19 pandemic – but the pandemic did cause various other problems including preventing family donors coming to France due to border closures, and a COVID-19 diagnosis in one donor.

Dr Xhaard will also discuss COVID-19 diagnoses in alloHSCT recipients, with 54 patients diagnosed in 14 centres between March and May 2020. COVID-19 disease sadly progressed in 21 (39%) of these patients, resulting in ICU admission or death.

In the final talk of this session, Professor Mette Hazenberg of the Sanquin Research Department of Hematopoiesis, UMC Amsterdam, will update delegates on the problems caused by the COVID-19 pandemic in the Netherlands, and give a detailed overview of the vaccination program as it relates to patients undergoing stem cell transplants.