Surveillance and Outcomes of Pediatric Hematopoietic Stem Cell Transplantation Recipients During the Recent COVID-19 Outbreak in China

Abstract

Background

The COVID-19 pandemic presents challenges for healthcare systems globally, especially in vulnerable populations such as pediatric hematopoietic stem cell transplant (HSCT) recipients. This study examines the clinical characteristics and outcomes of COVID-19 infection in pediatric HSCT recipients within one year post-HSCT.

Methods

Retrospective analysis was conducted on data from 247 pediatric patients. None of them had received SARS-CoV-2 vaccination or had prior infection. SARS-CoV-2 infection was confirmed using RT-PCR testing. COVID-19 disease severity was categorized according to established guidelines. Demographic, clinical, laboratory, imaging and treatment data were collected.

Results

The median age of the cohort was 7±3.7 years, with thalassemia major as the predominant underlying disease. Allogeneic HSCT was performed in the majority of cases, with haploidentical donors being the most common source of grafts. Nearly half of the patients developed COVID-19, with significantly higher infection rates observed in recipients over 100 days compared to recipients within 100 days post-HSCT (40.1% vs 21.7%, p<0.05, Fisher’s Exact test). Fever (n=107, 43.2%) and cough (n=88, 35.6%) were the most common symptoms. While most patients had mild disease and did not require specific anti-viral treatment, a significant proportion required hospitalization (n=34, 13.8%). Various treatments were employed hospitalized patients, including Paxlovid (n=19, 55.9%), methylprednisolone (n=7, 20.6%), IL-6 antibody (n=2, 5.9%), mesenchymal stem cells (n=3, 8.8%), and exosomes nebulization therapy (n=2, 5.9%). Despite multidisciplinary approaches, one patient died from severe respiratory failure. However, overall survival of all patients remained high (99.53%; CI 96.72–99.93%), indicating favorable outcomes in pediatric HSCT recipients with COVID-19.

Conclusion

This study provides insights into clinical features, therapeutic measures, and outcomes of pediatric HSCT recipients following COVID-19 infection in a large HSCT center in China. These findings contribute to our understanding of COVID-19 in this population and inform strategies to mitigate the impact the pandemic’s impact on their care.

Keywords:

• COVID-19
• SARS-CoV2
• hematopoietic stem cell transplantation
• pediatrics

Ethical Approval

This study was approved by the Ethics Committee of Shenzhen Children’s Hospital (approval number 2021102).

Consent for Publication

Written consent was obtained from the parents of the patient for the participation of this study.

Acknowledgments

Xiaodong Wang and Uet Yu are co-first authors for this study. Sixi Liu and Feiqiu Wen are co-correspondence authors for this study. We thank the patients and families for participation in this study. We thank Dr. Kongpeng Lyu from Shenzhen Archean Biotechnology for the manufacturing and providing exosomes for the patients.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare no conflicts of interest in this work.

Additional information

Funding

Shenzhen Science and Technology Innovation Commission (RCBS20200714114858018), Shenzhen Key Medical Discipline Construction Fund (SZXK034), Shenzhen Fund for Guangdong Provincial High-level Clinical Key Specialties (SZGSP012), Shenzhen Children’s Hospital Research fund (ynkt2021-zz26, ynkt2020-zz01), and Guangdong and Shenzhen High-level Hospital Construction Fund.