Risk of Mortality in Bone Marrow Transplant Patients During SARS-CoV-2 Infection: A Systematic Review

Recipients of bone marrow transplant with COVID-19 are at high risk of mortality and morbidity from their underlying immunocompromised state. Graft-versus-host disease and other comorbidities lead to poor COVID-19 outcomes in these patients. Understanding the outcomes and clinical characteristics of bone marrow transplant recipients with COVID-19 is needed to devise potential life-saving therapies for patients with hematologic malignancies. Reviewing large data sets from different ethnic groups and regions can lead to better understanding. We conducted a systematic review ofreal-world data from prospective and retrospective observational cohort studies that reported the clinical outcomes of COVID- 19 in bone marrow transplant patients.

We used electronic databases (PubMed, ScienceDirect, Google Scholar), with a cut off date of May 31, 2022, to conduct our search. After screening 349 articles, we selected 33 original reports for screening. After screening these articles for eligibility criteria, we selected 12 studies for final data extraction. We extracted data per the preferred reporting items followed for systematic reviews. Quality evaluation was done with a Cochrane risk-of bias tool for nonrandomized studies (ROBINS-1).

Bone marrow transplant recipients with COVID-19 experienced poor disease outcomes and high mortality rates. Patient age, immunosuppressant intensity, and presence of graft-versus-host disease or other underlying comorbidities directly affected mortality rates of bone marrow transplant recipients with COVID-19. Other factors, like type of malignancy, type of transplant, and time between transplant and COVID-19 diagnosis, did not affect mortality or poor outcomes of COVID-19.

Bone marrow transplant recipients have a higher risk of mortality and poor disease outcomes from COVID-19. Because curative therapies for COVID- 19 are not available, the only option available is its prevention. Transplant centers worldwide, as pertheir capacities, should develop and adhere to strict standard operating procedures based on international or national guidelines related to transplant recipients with COVID-19.