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COVID-19 prior to hematopoietic stem cell transplantation increases the risk of acute graft-versus-host disease but does not affect overall mortality

Bone Marrow Transplantation volume 60, pages 715–717 (2025)Cite this article

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Hematopoietic stem cell transplant (HSCT) recipients infected with SARS-CoV-2 are at higher risk of worse outcomes [1]. Furthermore, respiratory virus infections can warrant delaying HSCT, depending on the virus and the presence of lower respiratory involvement [2]. It is also uncertain whether SARS-CoV-2 increases the risk of acute graft-versus-host disease (aGVHD) [3]. Data regarding safety of performing HSCT in patients recovered from COVID-19 remain limited, coming primarily from small case series [4,5,6,7,8]. Thus, the objective of this study was to evaluate whether COVID-19 prior to HSCT is associated with an increased risk of post-transplant mortality and aGVHD.

We conducted a retrospective observational study in two hospitals in the city of São Paulo, Brazil. The included centers were Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP) and Hospital 9 de Julho. The former is a major public hospital in Latin America and the latter is a private facility.

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Fig. 1: Kaplan-Meier survival curves and cumulative incidence of aGVHD (grades II-IV) by D+100 in HSCT patients.

Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil

    Bruno Azevedo Randi, Hermes Ryoiti Higashino, Edson Abdala & Silvia Figueiredo Costa

  2. Dasa, Hospital 9 de Julho, São Paulo, Brazil

    Hermes Ryoiti Higashino, Vinícius Ponzio, Edson Abdala, Fabiana Vasques & Celso Arrais Rodrigues da Silva

  3. Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil

    Vinícius Ponzio & Celso Arrais Rodrigues da Silva

  4. Departamento de Controle de Infecção Hospitalar do Hospital das Clínicas HC-FMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil

    Thaís Guimarães

  5. Departamento de Hematologia, Hemoterapia e Terapia Celular, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil

    Thales Dalessandro Meneguin Pereira, Bruno Garcia Pires & Vanderson Rocha

  6. Laboratório de Investigação Médica em Protozoologia, Bacteriologia e Resistência Antimicrobiana - LIM/49, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil

    Silvia Figueiredo Costa

Authors
  1. Bruno Azevedo Randi
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  2. Hermes Ryoiti Higashino
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  3. Vinícius Ponzio
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  4. Edson Abdala
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  5. Thaís Guimarães
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  6. Fabiana Vasques
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  7. Celso Arrais Rodrigues da Silva
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  8. Thales Dalessandro Meneguin Pereira
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  9. Bruno Garcia Pires
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  10. Vanderson Rocha
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  11. Silvia Figueiredo Costa
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Contributions

BAR, HRH, VP, EA, FV, TG, CARS, and BGP were responsible for collecting data in the participating institutions. BAR and TDMP performed the statistical analysis. SFC was responsible for the organization and coordination of this work. SFC and VR actively participated in the manuscript preparation. All authors contributed to the writing of the final manuscript.

Corresponding author

Correspondence to Bruno Azevedo Randi.

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The authors declare no competing interests.

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Randi, B.A., Higashino, H.R., Ponzio, V. et al. COVID-19 prior to hematopoietic stem cell transplantation increases the risk of acute graft-versus-host disease but does not affect overall mortality. Bone Marrow Transplant 60, 715–717 (2025). https://doi.org/10.1038/s41409-025-02536-y

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