Omicron SARS-CoV-2 infection management and outcomes in patients with hematologic disease and recipients of cell therapy.

Fecha de publicación: 01/01/2024

Autores de IIS La Fe

• José Luis Piñana Sánchez

  Autor

• Pedro Miguel Aparicio Chorao

  Autor

• Manuel Nuno Direito De Morais Guerreiro

  Autor

• Carlos Solano Vercet

  Autor

Participantes ajenos a IIS La Fe

• Vazquez, Lourdes
• Heras, Inmaculada
• Aiello, Tommaso Francesco
• Lopez-Corral, Lucia
• Arroyo, Ignacio
• Soler-Espejo, Eva
• Garcia-Cadenas, Irene
• Garcia-Gutierrez, Valentin
• Aroca, Cristina
• Olave, Maria T
• Lopez-Jimenez, Javier
• Gomez, Marina Acera
• Arellano, Elena
• Cuesta-Casas, Marian
• Avendano-Pita, Alejandro
• Gonzalez-Santillana, Clara
• Hernandez-Rivas, Jose Angel
• Roldan-Perez, Alicia
• Mico-Cerda, Mireia
• Morell, Julia
• Rodriguez-Galvez, Paula
• Labrador, Jorge
• Campos, Diana
• Cedillo, Angel
• Vidal, Carolina Garcia
• Martino, Rodrigo

Grupos

• Hematología y Hemoterapia

  

  Investigador Principal

  Javier De La Rubia Comos

Abstract

Introduction Scarce real-life data exists for COVID-19 management in hematologic disease (HD) patients in the Omicron era.Purpose To assess the current clinical management and outcome of SARS-CoV-2 infection diagnosed, identify the risk factors for severe outcomes according to the HD characteristics and cell therapy procedures in a real-world setting.Methods A retrospective observational registry led by the Spanish Transplant Group (GETH-TC) with 692 consecutive patients with HD from December 2021 to May 2023 was analyzed.Results Nearly one-third of patients (31%) remained untreated and presented low COVID-19-related mortality (0.9%). Nirmatrelvir/ritonavir was used mainly in mild COVID-19 cases in the outpatient setting (32%) with a low mortality (1%), while treatment with remdesivir was preferentially administered in moderate-to-severe SARS-CoV-2 infection cases during hospitalization (35%) with a mortality rate of 8.6%. The hospital admission rate was 23%, while 18% developed pneumonia. COVID-19-related mortality in admitted patients was 14%. Older age, autologous hematopoietic stem cell transplantation (SCT), chimeric antigen receptor T-cell therapy, corticosteroids and incomplete vaccination were factors independently associated with COVID-19 severity and significantly related with higher rates of hospital admission and pneumonia. Incomplete vaccination status, treatment with prior anti-CD20 monoclonal antibodies, and comorbid cardiomyopathy were identified as independent risk factors for COVID-19 mortality.Conclusions The results support that, albeit to a lower extent, COVID-19 in the Omicron era remains a significant problem in HD patients. Complete vaccination (3 doses) should be prioritized in these immunocompromised patients. The identified risk factors may help to improve COVID-19 management to decrease the rate of severe disease, ICU admissions and mortality.

Keywords

• SARS-CoV-2; hematologic disease; immunocompromised; risk factors; COVID-19