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Martinez-Rivera N, Franco D, Acosta-Maldonado BL, Alatorre-Fernandez P, Islas-Muñoz B, Perez-Jimenez C, Martin-Onraet A. Severe acute respiratory syndrome coronavirus 2 infection in hematopoietic stem cell transplant recipients in Mexico City. Transpl Infect Dis 2024:e14274. [PMID: 38576133 DOI: 10.1111/tid.14274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/12/2024] [Accepted: 03/18/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Hematopoietic stem cell transplant (HSCT) recipients are among patients with highest risk of adverse coronavirus disease 2019 (COVID-19) outcomes. OBJECTIVE We compared clinical outcomes in post-HSCT patients with COVID-19 before and during the Omicron period. STUDY DESIGN This was a retrospective study including patients post-HSCT with severe acute respiratory syndrome coronavirus 2 infection from April 2020 to March 2023 at Instituto Nacional de Cancerología, Mexico City. We describe their clinical characteristics and report the variables associated with severe clinical disease, hospitalization, and death. RESULTS Fifty-three patients were included; 31 (58.5%) from the pre-Omicron period and 22 (41.5%) from the Omicron period. Median age was 42-years old (interquartile range 26-53), and 31 patients (59%) were men. Only four patients (16%) had received a vaccine prior to COVID-19 diagnosis in the pre-Omicron period versus 20 (91%) in the Omicron period (p < 0.001). COVID-19 severe cases were more common before Omicron: seven patients (23%) versus two patients (9%). Only one patient (3%) received an antiviral in the pre-Omicron period compared to 11 patients (50%) during the Omicron period (p < 0.01). COVID-19-associated mortality was almost double in the pre-Omicron period (16% vs. 9%, p = 0.6). CONCLUSIONS This study reports patients with a high proportion of severe outcomes during the first 2 years of the pandemic. Outcomes improved during Omicron with better access to vaccines and antivirals and no in-hospital cases. Variables associated with worse outcomes were similar to other reports. Strengthening infection control measures in the hospital and better access to preventive strategies and therapeutic options are mandatory in these high-risk patients.
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Affiliation(s)
- Nancy Martinez-Rivera
- Infectious Diseases Department, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - Daniel Franco
- Hematology Department, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | | | - Beda Islas-Muñoz
- Infectious Diseases Department, Instituto Nacional de Cancerologia, Mexico City, Mexico
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Olivares-Gazca JC, Gale RP, Sánchez-Bonilla D, Gallardo-Pérez MM, Soto-Olvera S, Ruiz-Delgado GJ, Ruiz-Argüelles GJ. SARS-CoV-2-infection in the setting of autotransplants for multiple sclerosis. HEMATOLOGY (AMSTERDAM, NETHERLANDS) 2023; 28:2164443. [PMID: 36625336 DOI: 10.1080/16078454.2022.2164443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The severe adult respiratory syndrome virus type 2 (SARS-CoV-2) related acute respiratory distress syndrome (ARDS) has a strong immunological and inflammatory component; accordingly investigators are employing monoclonal antibodies to ameliorate the virus-induced cytokine storm such as antibodies against interleukin 6 (IL-6), tumor necrosis factors alpha (TNF-alpha) and CC chemokine receptor 5 (CCR5) (1). Cyclophosphamide (Cy) has proven its role in various settings including autoimmune diseases, and in the post-haploidentical stem cell transplant setting; Cy depletes cytotoxic and effector T cell populations while relatively sparing the regulatory T cells (Tregs) and could tip the balance away from the overtly pro-inflammatory setting (1). We present here the cases of three persons who were infected by the SARS-CoV-2 virus during the Cy-induced pancytopenia of an autologous hematopoietic stem cell transplantation (HSCT), aimed to down-regulate the immune response in multiple sclerosis (MS) (2). The surprisingly benign course of the COVID-19 in the three cases suggest that the Cy could have had a role in abrogating the inflammatory response in these persons.
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Affiliation(s)
- Juan Carlos Olivares-Gazca
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, México.,Universidad Popular Autónoma del Estado de Puebla, Puebla, México
| | - Robert Peter Gale
- Haematology Research Centre, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Daniela Sánchez-Bonilla
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, México.,Universidad Popular Autónoma del Estado de Puebla, Puebla, México
| | - Moisés Manuel Gallardo-Pérez
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, México.,Universidad Popular Autónoma del Estado de Puebla, Puebla, México
| | - Silvia Soto-Olvera
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México.,Laboratorios Ruiz, Clínica Ruiz, Puebla, México
| | - Guillermo J Ruiz-Delgado
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, México.,Universidad Popular Autónoma del Estado de Puebla, Puebla, México.,Laboratorios Ruiz, Clínica Ruiz, Puebla, México
| | - Guillermo José Ruiz-Argüelles
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, México.,Universidad Popular Autónoma del Estado de Puebla, Puebla, México
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3
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León AGD, Gil-Flores L, Colunga-Pedraza P, Bourlon C, Vargas-Serafín C, del Campo-Martínez MDLÁ, Olaya-Vargas A, Pérez-García M, González-Leal XJ, Herrera Rojas MA, Lozano-Rodríguez S, Solano-Genesta M, Rodríguez-Zúñiga AC, Sánchez-Arteaga A, Ruiz-Argüelles GJ, Gómez-Almaguer D. Hematopoietic stem cell transplantation activity in Mexico during the COVID19 pandemic: on the way to recovery. Hematology 2022; 27:1294-1300. [DOI: 10.1080/16078454.2022.2156737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Andrés Gómez-De León
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - Lourdes Gil-Flores
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - Perla Colunga-Pedraza
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - Christianne Bourlon
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - César Vargas-Serafín
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | - Xitlaly J. González-Leal
- Instituto Tecnológico de Estudios Superiores de Monterrey. Monterrey Nuevo León.S, Monterrey, Mexico
- Clínica Gómez-Almaguer, Monterrey
| | | | - Sergio Lozano-Rodríguez
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | | | - Anna Cecilia Rodríguez-Zúñiga
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - Alexia Sánchez-Arteaga
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | | | - David Gómez-Almaguer
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
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Gómez-Almaguer D, Gómez-De León A, Colunga-Pedraza PR, Cantú-Rodríguez OG, Gutierrez-Aguirre CH, Ruíz-Arguelles G. Outpatient allogeneic hematopoietic stem-cell transplantation: a review. Ther Adv Hematol 2022; 13:20406207221080739. [PMID: 35237396 PMCID: PMC8882949 DOI: 10.1177/20406207221080739] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/31/2022] [Indexed: 11/16/2022] Open
Abstract
Hematopoietic stem-cell transplantation (HSCT) is usually performed in
well-equipped units inside a hospital. The cost of this in-hospital transplant
is usually very high; therefore, this procedure is more difficult to perform in
low- and middle-income countries. Autologous outpatient HSCT is now a common
procedure; however, outpatient allogeneic transplants are more complicated. Only
a few centers in the world have incorporated outpatient HSCT. This transplant
requires special adaptation, like a day hospital, careful selection of patients,
oral medications, and the patient must live relatively close to the hospital.
The results until now suggest that this outpatient transplant is factible and
similar to inpatient HSCT. The objective was to review and describe the
different methods and results following an outpatient allogeneic-HSCT
strategy.
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Affiliation(s)
- David Gómez-Almaguer
- Hematology Service, Facultad de Medicina y Hospital Universitario ‘Dr. Jose Eleuterio Gonzalez’, Universidad Autónoma de Nuevo León, Francisco I. Madero Ave., Mitras Centro, Monterrey 64460, Nuevo León, México
| | - Andrés Gómez-De León
- Hematology Service, Hospital Universitario ‘Dr. José Eleuterio González’, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Perla R. Colunga-Pedraza
- Hematology Service, Hospital Universitario ‘Dr. José Eleuterio González’, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Olga G. Cantú-Rodríguez
- Hematology Service, Hospital Universitario ‘Dr. José Eleuterio González’, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - César Homero Gutierrez-Aguirre
- Hematology Service, Hospital Universitario ‘Dr. José Eleuterio González’, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
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