Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.
Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.
Blood Adv. 2023 Jun 27;7(12):2843-2854. doi: 10.1182/bloodadvances.2022009550.
There is limited information regarding COVID-19 in long-term blood or marrow transplant (BMT) survivors. We leveraged the BMT Survivor Study (BMTSS) to address this gap. BMTSS included patients who underwent BMT at 1 of 3 sites in the United States between 1974 and 2014 and survived ≥2 years after BMT. A sibling cohort serves as a non-BMT comparison group. Participants (2430 BMT survivors; 780 non-BMT participants) completed the BMTSS survey between October 2020 and November 2021 about COVID-19 testing, risk mitigation behaviors, morbidity, and health care use. Median age at BMT was 46 years (range, 0-78 years) and median follow-up since BMT was 14 years (6-46 years); 76% were non-Hispanic White, 54% had received allogeneic BMT. The risk of COVID-19 infection was comparable for BMT survivors vs non-BMT participants (15-month cumulative incidence, 6.5% vs 8.1%; adjusted odd ratio [aOR] = 0.93; 95% confidence interval [CI], 0.65-1.33; P = .68). Among survivors, being unemployed (aOR 1.90; 95% CI, 1.12-3.23; P = .02; reference: retired) increased the odds of infection; always wearing a mask in public was protective (aOR = 0.49; 95% CI, 0.31-0.77; P = .002; reference: not always masking). When compared with COVID-positive non-BMT participants, COVID-positive BMT survivors had higher odds of hospitalization (aOR = 2.23; 95% CI, 0.99-5.05; P = .05); however, the odds of emergency department visits were comparable (aOR = 1.60; 95% CI = 0.71-3.58; P = .25). COVID-19 infection status did not increase the odds of hospitalization among BMT survivors (aOR = 1.32; 95% CI = 0.89-1.95; P = .17) but did increase the odds of emergency department visits (aOR = 2.63; 95% CI, 1.74-3.98; P <.0001). These findings inform health care providers about the management of care for long-term BMT survivors during the ongoing pandemic.
关于 COVID-19 在长期血液或骨髓移植（BMT）幸存者中的信息有限。我们利用 BMT 幸存者研究（BMTSS）来解决这一差距。BMTSS 纳入了在美国 3 个地点之一于 1974 年至 2014 年间接受 BMT 且 BMT 后存活时间≥2 年的患者。同胞队列作为非 BMT 对照组。参与者（2430 名 BMT 幸存者；780 名非 BMT 参与者）于 2020 年 10 月至 2021 年 11 月期间完成了 BMTSS 调查，内容涉及 COVID-19 检测、风险缓解行为、发病率和医疗保健使用情况。BMT 时的中位年龄为 46 岁（范围，0-78 岁），BMT 后中位随访时间为 14 年（6-46 年）；76%为非西班牙裔白人，54%接受了同种异体 BMT。BMT 幸存者与非 BMT 参与者的 COVID-19 感染风险相当（15 个月累积发病率，6.5% vs 8.1%；调整后的优势比[aOR]0.93；95%置信区间[CI]，0.65-1.33；P=0.68）。在幸存者中，失业（aOR 1.90；95%CI，1.12-3.23；P=0.02；参考：退休）增加了感染的可能性；在公共场所始终戴口罩具有保护作用（aOR=0.49；95%CI，0.31-0.77；P=0.002；参考：不经常戴口罩）。与 COVID-19 阳性非 BMT 参与者相比，COVID-19 阳性 BMT 幸存者住院的可能性更高（aOR=2.23；95%CI，0.99-5.05；P=0.05）；然而，急诊就诊的可能性相似（aOR=1.60；95%CI=0.71-3.58；P=0.25）。COVID-19 感染状况并未增加 BMT 幸存者住院的可能性（aOR=1.32；95%CI=0.89-1.95；P=0.17），但确实增加了急诊就诊的可能性（aOR=2.63；95%CI，1.74-3.98；P<.0001）。这些发现为医疗保健提供者提供了有关在持续大流行期间管理长期 BMT 幸存者护理的信息。
