BACKGROUND: The outcome of COVID-19 in allogeneic hematopoietic stem cell transplantation (HSCT) recipients is almost uniformely considered poor. The aim of present study was to retrospectively analyse the outcome and risk factors for mortality in a large series of patients who developed COVID-19 infection after an allogeneic HSCT. METHODS: This multicenter retrospective study promoted by the European Hematology Association - Infections in Hematology Study Working Group, included 326 adult HSCT patients who had COVID-19 between January 2020 and March 2022. RESULTS: The median time from HSCT to the diagnosis of COVID-19 was 268 days (IQR 86-713; range 0-185 days). COVID-19 severity was mild in 21% of the patients, severe in 39% and critical in 16% of the patients. In multivariable analysis factors associated with a higher risk of mortality were, age above 50 years, presence of 3 or more comorbidities, active hematologic disease at time of COVID-19 infection, development of COVID-19 within 12 months of HSCT, and severe/critical infections. Overall mortality rate was 21% (n=68): COVID-19 was the main or secondary cause of death in 16% of the patients (n=53). CONCLUSIONS: Mortality in HSCT recipients who develop COVID-19 is high and largely dependent on age, comorbidities, active hematologic disease, timing from transplant and severity of the infection.

Amsterdam UMC Amsterdam Netherlands

Ankara University Ankara Türkiye

Aristotle University of Thessaloniki Thessaloniki Greece

ASST Grande Ospedale Metropolitano Niguarda Milan Italy

Azienda Ospedaliera Nazionale SS Antonio e Biagio e Cesare Arrigo Alessandria Italy

Azienda Ospedaliera San Gerardo Monza Monza Italy

Clinical Hematology Department ICO Hospital germans Trias i Pujol Josep Carreras Research Institute Badalona Spain

Clinical Microbiology and Infectious Diseases Department Hospital General Universitario Gregorio Marañón Madrid Spain

Clinical Microbiology Laboratory Medical School Attikon University General Hospital National and Kapodistrian University of Athens Athens Greece

Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain

Department of Hematology and Oncology Medical University of Innsbruck Innsbruck Austria

Department of Hematology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark

Department of Hematology University Hospital Virgen Macarena University Hospital Virgen del Rocío Instituto de Biomedicina de Sevilla Seville Spain

Department of Hematology UZ Leuven Leuven Belgium

Department of Hematology Vall d'Hebron Hospital Universitari Experimental Hematology Vall d'Hebron Institute of Oncology Vall d'Hebron Barcelona Hospital Barcelona Spain

Department of Infectious Diseases Karolinska University Hospital Stockholm Sweden

Department of Internal Medicine Hematology and Oncology Masaryk University Hospital Brno Brno Czechia

Department of Microbiology Immunology and Transplantation KULeuven Leuven Belgium

Department of Nephrology and Infectious diseases AZ Sint Jan Brugge Oostende AV Brugge Belgium

Department of Oncology Hematology and Bone Marrow Transplantation with Section of Pneumology University Medical Center Hamburg Eppendorf Hamburg Germany

Division of Infectious Diseases and Hospital Epidemiology and Department of Clinical Research University and University Hospital of Basel Basel Switzerland

Federal University of Rio de Janeiro Rio de Janeiro Brazil

Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy

Fundacion Jimenez Diaz University Hospital Health Research Institute IIS FJD Madrid Spain

Fundeni Clinical Institute University of Medicine and Pharmacy Carol Davila Bucharest Romania

General Hospital of Thessaloniki George Papanikolaou Thessaloniki Greece

German Centre for Infection Research Cologne Germany

Hematology and Stem Cell Transplant Unit IRCCS Regina Elena National Cancer Institute Rome Italy

Hematology and Stem Cell Transplant Unit Vito Fazzi Lecce

Hematology Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy

Hematology Unit Università Cattolica del Sacro Cuore Rome Italy

Hospital Universitario Puerta de Hierro Majadahonda Spain

Hospital University of Parma Hematology and Bone Marrow Unit Parma Italy

Infektiologie Universitätsklinikum Frankfurt am Main Frankfurt am Main Germany

Institute of Hematology and Blood Transfusion Prague Czechia

IRCCS Ospedale San Raffaele Milan Italy

King's College Hospital London United Kingdom

King's College London London United Kingdom

La Paz University Hospital Madrid Spain

Radboudumc Nijmegen Netherlands

San Luigi Gonzaga Hospital Orbassano Orbassano Italy

Stem Cell Transplant Center AOU Citta' della Salute e della Scienza Turin Italy

Università Milano Bicocca Milan Italy

University Hospital Hradec Králové Hradec Králové Czechia

University Medical Center Groningen Groningen Netherlands

University of Cologne Faculty of Medicine and University Hospital Cologne Center for Molecular Medicine Cologne Cologne Germany

University of Cologne Faculty of Medicine and University Hospital Cologne Clinical Trials Centre Cologne Cologne Germany

University of Cologne Faculty of Medicine and University Hospital Cologne Department 1 of Internal Medicine Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf Cologne Germany

University of Cologne Faculty of Medicine and University Hospital Cologne Translational Research Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases Cologne Germany

University of Kansas Medical Center Kansas KS United States

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