INTRODUCTION: COVID-19 has been associated with high morbidity and mortality in allogeneic hematopoietic stem cell transplant (allo-HCT) recipients. METHODS: This study reports on 986 patients reported to the EBMT registry during the first 29 months of the pandemic. RESULTS: The median age was 50.3 years (min - max; 1.0 - 80.7). The median time from most recent HCT to diagnosis of COVID-19 was 20 months (min - max; 0.0 - 383.9). The median time was 19.3 (0.0 - 287.6) months during 2020, 21.2 (0.1 - 324.5) months during 2021, and 19.7 (0.1 - 383.9) months during 2022 (p = NS). 145/986 (14.7%) patients died; 124 (12.6%) due to COVID-19 and 21 of other causes. Only 2/204 (1%) fully vaccinated patients died from COVID-19. There was a successive improvement in overall survival over time. In multivariate analysis, increasing age (p<.0001), worse performance status (p<.0001), contracting COVID-19 within the first 30 days (p<.0001) or 30 - 100 days after HCT (p=.003), ongoing immunosuppression (p=.004), pre-existing lung disease (p=.003), and recipient CMV seropositivity (p=.004) had negative impact on overall survival while patients contracting COVID-19 in 2020 (p<.0001) or 2021 (p=.027) had worse overall survival than patients with COVID-19 diagnosed in 2022. DISCUSSION: Although the outcome of COVID-19 has improved, patients having risk factors were still at risk for severe COVID-19 including death.

Assistance Publique Hôpitaux de Paris Henri Mondor Hospital Department of Hematology Créteil France

Blood and Bone Marrow Transplantation Department University of Cardiff Cardiff United Kingdom

Bone Marrow Transplantation Unit Azienda Sociosanitaria Territoriale Papa Giovanni XXIII Bergamo Italy

Clinical Haematology Department Manchester Royal Infirmary Manchester United Kingdom

Department of Cellular Therapy and Allogeneic Stem Cell Transplantation Karolinska Comprehensive Cancer Center Karolinska University Hospital Huddinge Stockholm Sweden

Department of Clinical Haematology Institut Catala d'Oncologia Hospital Universitari Germans Trias i Pujol Badalona Spain

Department of Haematology Inst Portugues Oncologia Lisbon Portugal

Department of Haematology Leeds Teaching Hospitals NHS Trust Leeds United Kingdom

Department of Haematology Nottingham University Hospital Nottingham United Kingdom

Department of Hematology Ankara University Faculty of Medicine Ankara Türkiye

Department of Hematology Copenhagen University Hospital Copenhagen Denmark

Department of Hematology Gazi University Faculty of Medicine Ankara Türkiye

Department of Hematology Hospital Universitario de la Princesa Madrid Spain

Department of Hematology Hospital Universitario Morales Meseguer Instituto Murciano de Investigación Biosanitaria Arrixaca Universidad de Murcia Murcia Spain

Department of Hematology Sahlgrenska University Hospital Gothenburg Sweden

Department of Hematology Skåne's University Hospital Lund Sweden

Department of Hematology University Hospital Gasthuisberg Leuven Belgium

Department of Hematology Uppsala University Hospital Uppsala Sweden

Department of Internal Medicine Hematology and Oncology Masaryk University Brno Czechia

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

Department of Internal Medicine Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden

Department of Laboratory Medicine Karolinska Institutet Stockholm Sweden

Department of Pediatric Hematology and Oncology Collegium Medicum Nicolaus Copernicus University Torun Bydgoszcz Poland

Department of Pediatric Hematology and Oncology National Institute of Children's Diseases Comenius University Bratislava Slovakia

Department of Stem cell Transplantation University Hospital Eppendorf Hamburg Germany

Dipartimento di Diagnostica per Immagini Radioterapia Oncologica e Ematologia Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico Rome Italy

Division of Hematology Department of Medicine Huddinge Karolinska Institutet Stockholm Sweden

Division of Infectious Diseases University of Genoa and Ospedale Policlinico San Martino Genova Italy

European Society for Blood and Marrow Transplantation Data Office Department of Medical Statistics and Bioinformatics Leiden Netherlands

European Society for Blood and Marrow Transplantation Data Office Leiden Netherlands

Fundación Investigación del Hospital Clínico de la Comunidad Valenciana Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia Valencia Spain

Haematology oncology Unit Royal Marsden Hospital London United Kingdom

Hematology Department Hospital Clínico Universitario de Valencia Valencia Spain

Hematology Transplantation Unit Department of Hematology Hôpital St Louis Paris France

Istanbul Medical Faculty Adult Hematopoietic Stem Cell Transplant Center Istanbul University Istanbul Türkiye

Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele University Vita Salute San Raffaele Milan Italy

Marrow Transplant Department Inst Português de Oncologia do Porto Porto Portugal

Pediatric Hematology Oncology Azienda Ospedaliera Universitaria Integrata Verona Italy

Pediatric Infectious Diseases Unit Hadassah Medical Center and Faculty of Medicine Hebrew University of Jerusalem Jerusalem Israel

Raisa Memorial Gorbacheva Research Institute Pavlov University St Petersburg Russia

Service d'Hématologie Hôpital Lyon Sud Lyon France

St Anna Children's Hospital Department of Pediatrics and Adolescent Medicine Medical University of Vienna Vienna Austria

Translational and Clinical Research Institute and The National Institute for Health and Care Research Newcastle Biomedical Research Centre Newcastle United Kingdom

University Hospitals Bristol and Weston National Health Service Foundation Trust Bristol United Kingdom

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