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\begin{document}

\title{COVID-19 disease in children and adolescents following hematopoietic
stem cell transplantation: A report from the Turkish Pediatric Bone
Marrow Transplantation Study Group}



\author[1]{CEYHUN BOZKURT}%
\author[2]{Volkan Hazar}%
\author[3]{Baris Malbora}%
\author[4]{Alphan Küpesiz}%
\author[5]{Utku Aygüneş}%
\author[6]{Tunc Fısgın}%
\author[7]{Musa Karakükçü}%
\author[8]{Baris Kuskonmaz}%
\author[9]{Suar Çakı Kilic}%
\author[3]{Derya Bayırlı}%
\author[10]{Özlem Arman Bilir}%
\author[11]{Koray Yalcin}%
\author[12]{Salih Gözmen}%
\author[11]{Vedat Uygun}%
\author[13]{Murat Elli}%
\author[3]{Hakan Sarbay}%
\author[4]{Funda  Küpesiz}%
\author[5]{Hatice İlgen Şaşmaz}%
\author[6]{Basak Aksoy}%
\author[7]{Ebru Yılmaz}%
\author[8]{Fatma Okur}%
\author[9]{Funda Tekkeşin}%
\author[5]{Fatma Demir Yenigürbüz}%
\author[14]{Gülcihan Ozek}%
\author[3]{Avni Atay}%
\author[10]{İkbal Ok Bozkaya}%
\author[11]{Suna Çelen}%
\author[11]{Seda Ozturkmen}%
\author[15]{Adalet Gunes}%
\author[16]{Orhan Gursel}%
\author[4]{Elif Guler}%
\author[7]{Alper Özcan}%
\author[8]{Duygu Uçkan}%
\author[9]{Selime Aydogdu}%
\author[10]{Namık Yaşar Özbek}%
\author[11]{Gulsun Karasu}%
\author[17]{Gulay Sezgin}%
\author[18]{Omer Dogru}%
\author[11]{Davut Albayrak}%
\author[5]{Gülyüz Öztürk}%
\author[14]{Serap Aksoylar }%
\author[11]{Hayriye Daloglu}%
\author[13]{Işık Odaman Al}%
\author[15]{Melike Sezgin Evim}%
\author[19]{Sinan Akbayram}%
\author[20]{Yurday Öncül}%
\author[21]{Emine Zengin}%
\author[22]{Canan  Albayrak}%
\author[23]{Timur Cetin}%
\author[24]{Yeter Düzenli Kar}%
\author[25]{Hasan Fatih Çakmaklı}%
\author[26]{Özlem Tüfekçi}%
\author[27]{Ersin Toret}%
\author[5]{Bulent Antmen}%
\affil[1]{Istinye University School of Medicine}%
\affil[2]{Memorial Health Group}%
\affil[3]{Yeni Yüzyıl University School of Medicine}%
\affil[4]{Akdeniz University School of Medicine}%
\affil[5]{Acibadem Saglik Grubu}%
\affil[6]{Altınbaş University School of Medicine}%
\affil[7]{Erciyes University School of Medicine}%
\affil[8]{Hacettepe University School of Medicine}%
\affil[9]{Umraniye Egitim Ve Arastirma Hastanesi}%
\affil[10]{Ankara Sehir Hastanesi}%
\affil[11]{Medical Park Hospitals Group}%
\affil[12]{SBU Dr Behcet Uz Cocuk Hastaliklari Ve Cerrahisi Egitim Ve Arastirma Hastanesi}%
\affil[13]{Medipol University School of Medicine}%
\affil[14]{Ege University School of Medicine}%
\affil[15]{Uludağ University School of Medicine}%
\affil[16]{Ankara Gulhane Egitim ve Arastirma Hastanesi}%
\affil[17]{Çukurova University School of Medicine}%
\affil[18]{Marmara University School of Medicine}%
\affil[19]{Gaziantep University School of Medicine}%
\affil[20]{Inönü University School of Medicine}%
\affil[21]{Kocaeli University School of Medicine}%
\affil[22]{Ondokuz Mayıs University School of Medicine}%
\affil[23]{Yeditepe University Hospital}%
\affil[24]{Afyon Health Sciences University School of Medicine}%
\affil[25]{Ankara University School of Medicine}%
\affil[26]{Dokuz Eylül University School of Medicine}%
\affil[27]{Osmangazi University School of Medicine}%


\vspace{-1em}



  
  \date{May 23, 2024}


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\selectlanguage{english}
\begin{abstract}
\textbf{Background:} Data on the outcome and risk factors of pediatric
patients with SARS-CoV-2 infection (COVID-19) following hematopoietic
stem cell transplantation (HSCT) are limited. \textbf{Objectives:} We
aimed to describe risk factors for a severe course and mortality.
\textbf{Method:} In this nationwide study, data were collected
retrospectively from 28 transplant centers. \textbf{Results:} One
hundred ninety-six children {[}(63.8\% male; median age 8.75 (IQR,
4.86-14.30){]} who received allogeneic (n: 184, 93.9\%) or autologous
(n: 12, 6.1\%) HSCT were included. The median time from HSCT to
SARS-CoV-2 infection was 207.5 days (IQR, 110.2-207.5). The most common
clinical manifestation was fever (58.2\%), followed by cough (33.7\%);
43 cases (21.9\%) were asymptomatic. Lower respiratory tract disease
(LRTD) and multisystem inflammatory syndrome in children (MIS-C)
developed in 58 (29.6\%) and 8 (4.1\%) patients, respectively.
Twenty-six patients (13.3\%) required ICU admission. Nine patients died
at a median of 17 days (min-max 1-33) after COVID-19 diagnosis, 6 of
whom died due to the disease, with a COVID-19 lethality rate of 3.1\%.
The 6-week overall survival was 95.4\% (95\% CI 92.5-98.3). Multivariate
analysis found that HSCT with a mismatched donor (OR, 8.98, p: 0.039)
and LRTD (OR, 61.55, p: 0.001) were independent risk factors for ICU
admission; MIS-C (OR, 9.55, p: 0.044) and lymphopenia (OR, 4.01, p:
0.030) at diagnosis were risk factors for mortality.
\textbf{Conclusion:} Overall mortality was lower in children than in
adult counterparts, and HSCT with a mismatched donor, lymphopenia, LRTD,
MIS-C and ICU admission were important risk factors for adverse
outcomes.%
\end{abstract}%



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