Reduction in Transplantation Activity without Impairment in Outcomes in the Covid-19 Era- Data from the Sarah Cannon Blood Cancer Network (SCBCN)

Background

The Covid-19 pandemic has profoundly disrupted healthcare operations for vulnerable transplant and cell therapy patients. The Sarah Cannon Blood Cancer Network (SCBCN) comprises six Healthcare Corporation of America hospitals that have been certified based upon defined metrics of infrastructure, staffing, processes and volume. The SCBCN actively coordinated a response by integrating information from the framework of federal, state, network, hospital and individual transplant programs. Dynamic standards were developed taking into account operational aspects (such as PPE conservation, staffing, isolation policy, etc.), external regulations, and input from professional societies in order to balance the needs for life-saving therapy while reducing the likelihood of adverse consequences. In this study, we describe the impact of the Covid-19 across our network on transplant and cell therapy activity as well as the outcomes of the patients who were treated.

Methods

Data was integrated from electronic health records and a center survey questionnaire. The period of observation (defined as Covid era) was from March 15, 2020 to June 15^th, 2020 to allow sufficient time for analysis of early outcomes. Transplant and cell therapy data from the prior 12 months was used as a comparator.

Results:

Within the SCBCN there was a decrease in overall transplant and cell therapy activity in the Covid era. Autologous transplantation was mainly diminished, particularly in the first 2 months. There was no significant impact on allogeneic or CAR-T therapy volumes. For allogeneic transplantation, there was a modest reduction in marrow grafts (11% to 8%) and a significant increase in cryopreservation (16% to 79%, P<0.001). The time to neutrophil and platelet engraftment in the Covid era were similar to those in the prior year. Day +30 survival in the Covid era for allogeneic, autologous, and CAR-T therapy were 95%, 99% and 100%, respectively. Including historically transplanted patients, centers reported a total of 22 patients who contracted proven Covid19, at a median duration of 4 years (range 3-2634 days) post infusion. There were 9-auto, 12-allo, and 1-CAR-T recipients, and two died. Of the two deaths, one 70-year old recipient died from Covid19 after first testing positive at day+3 after autologous transplantation, and another 68-year old recipient tested positive at day+464 after autologous transplantation but died with refractory lymphoma.

Conclusions:

We describe a deliberate and coordinated reduction in transplant and cell therapy activity across our network compared to the prior year. For those patients who were selectively transplanted during the Covid19 pandemic, outcomes were not impaired. Our analysis will be updated at the time of presentation with data covering the Covid era from July-Oct '20.

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