Clinical and pathologic information for patients with SARS-CoV-2–related AA and PRCA
| Variable . | Patients . | Summary* . | |||||
|---|---|---|---|---|---|---|---|
| 1 . | 2 . | 3 . | 4 . | 5 . | 6 . | ||
| Severity of aplasia | SAA | SAA | PRCA | SAA | SAA | SAA | 5 SAA, 1 PRCA |
| Age at diagnosis, y | 22 | 69 | 76 | 21 | 69 | 28 | 49 |
| Sex | Female | Female | Male | Male | Female | Female | 2 male subjects/4 female subjects |
| Interval between positive PCR and pancytopenia | 10 d | 2 d | 4 mo | 0 mo¶ | 5 mo | 3 mo | 7 wk |
| CBC, ×109/L WBC/ANC/ALC/PLT | 3.0/0.71/2.88/41 | 2.2/0.52/1.1/10 | 10.3/6.5/2.0/298 | 1.6/0.5/1.0/4 | 3.0/1.2/1.5/10 | 2.8/0.83/1.72/2 | 3.0/0.77/1.8/10 |
| Hgb/MCV, g/dL, fL | 7.4/86.5 | 8.0/97 | 5.9/92.5 | 3.5/92.5 | 11.2/94.9 | 3.3/77 | 6.7/92.5 |
| Absolute reticulocyte count, ×1012/L | 0.0107 (low) | 0.019 (low) | 0.008 (low) | 0.172 (low) | 0.0226 (low) | 0.04 (low) | 0.021 |
| RBC transfusion | Yes | Yes | Yes | Yes | No | Yes | 5 yes/1 no |
| Platelet transfusion | Yes | Yes | No | Yes | Yes | Yes | 5 yes/1 no |
| BMBx cellularity | 5% | 5%-10% | 20%-30%† | <5% | 5% | 20%-30% | |
| PNH clones | NA | – | – | 5.2% (granulocytes), 32.7% (monocytes) | 0.18% (granulocytes), 0.57% (monocytes), 0.02% (erythrocytes) | – | 2/5: subclinical PNH clones |
| T-cell rearrangement | NA | NA | – | – | – | NA | 3/3: – |
| NGS and CG | -(46,XX) | -(NA‡) | NA (46,XY) | NA (46,XY) | -(45,X-/46,XX)§ | -(46XX) | NGS 4/4: -CG 5/5: normal |
| Thrombotic events | – | – | – | – | – | – | 6/6: – |
| History of autoimmune disease | – | – | – | – | – | – | 6/6: – |
| Treatment | Sibling HSCT | CsA, h-ATG, EPAG | CsA→tacrolimus | CsA, h-ATG, EPAG | CsA, h-ATG, EPAG | CSA, h-ATG, EPAG | 1/5: HSCT; 4/5: IST |
| Conditioning | Cy + h-ATG | NA | NA | NA | NA | NA | |
| GVHD PPX | FK/LD-MTX | NA | NA | NA | NA | NA | |
| Follow-up, mo | 8 | 10 | 3 | 13 | 3 | 12 | 9 |
| Ongoing treatment | Tacrolimus | CsA, EPAG | Tacrolimus | CsA | CsA, EPAG | CsA | 6/6: Yes |
| Treatment response | CR | PR | CR | CR | NA | PR | 3/5: CR |
| SARS-CoV-2 PCR (at diagnosis) | + | + | + | + | NA | NA | 4/4: + |
| SARS-CoV-2 IgG | NA | + | NA | + | + | + | 4/4: + |
| SARS-CoV-2 BMBx-IHCǁ | − | − | NA | NA | NA | NA | 2/2: – |
| Variable . | Patients . | Summary* . | |||||
|---|---|---|---|---|---|---|---|
| 1 . | 2 . | 3 . | 4 . | 5 . | 6 . | ||
| Severity of aplasia | SAA | SAA | PRCA | SAA | SAA | SAA | 5 SAA, 1 PRCA |
| Age at diagnosis, y | 22 | 69 | 76 | 21 | 69 | 28 | 49 |
| Sex | Female | Female | Male | Male | Female | Female | 2 male subjects/4 female subjects |
| Interval between positive PCR and pancytopenia | 10 d | 2 d | 4 mo | 0 mo¶ | 5 mo | 3 mo | 7 wk |
| CBC, ×109/L WBC/ANC/ALC/PLT | 3.0/0.71/2.88/41 | 2.2/0.52/1.1/10 | 10.3/6.5/2.0/298 | 1.6/0.5/1.0/4 | 3.0/1.2/1.5/10 | 2.8/0.83/1.72/2 | 3.0/0.77/1.8/10 |
| Hgb/MCV, g/dL, fL | 7.4/86.5 | 8.0/97 | 5.9/92.5 | 3.5/92.5 | 11.2/94.9 | 3.3/77 | 6.7/92.5 |
| Absolute reticulocyte count, ×1012/L | 0.0107 (low) | 0.019 (low) | 0.008 (low) | 0.172 (low) | 0.0226 (low) | 0.04 (low) | 0.021 |
| RBC transfusion | Yes | Yes | Yes | Yes | No | Yes | 5 yes/1 no |
| Platelet transfusion | Yes | Yes | No | Yes | Yes | Yes | 5 yes/1 no |
| BMBx cellularity | 5% | 5%-10% | 20%-30%† | <5% | 5% | 20%-30% | |
| PNH clones | NA | – | – | 5.2% (granulocytes), 32.7% (monocytes) | 0.18% (granulocytes), 0.57% (monocytes), 0.02% (erythrocytes) | – | 2/5: subclinical PNH clones |
| T-cell rearrangement | NA | NA | – | – | – | NA | 3/3: – |
| NGS and CG | -(46,XX) | -(NA‡) | NA (46,XY) | NA (46,XY) | -(45,X-/46,XX)§ | -(46XX) | NGS 4/4: -CG 5/5: normal |
| Thrombotic events | – | – | – | – | – | – | 6/6: – |
| History of autoimmune disease | – | – | – | – | – | – | 6/6: – |
| Treatment | Sibling HSCT | CsA, h-ATG, EPAG | CsA→tacrolimus | CsA, h-ATG, EPAG | CsA, h-ATG, EPAG | CSA, h-ATG, EPAG | 1/5: HSCT; 4/5: IST |
| Conditioning | Cy + h-ATG | NA | NA | NA | NA | NA | |
| GVHD PPX | FK/LD-MTX | NA | NA | NA | NA | NA | |
| Follow-up, mo | 8 | 10 | 3 | 13 | 3 | 12 | 9 |
| Ongoing treatment | Tacrolimus | CsA, EPAG | Tacrolimus | CsA | CsA, EPAG | CsA | 6/6: Yes |
| Treatment response | CR | PR | CR | CR | NA | PR | 3/5: CR |
| SARS-CoV-2 PCR (at diagnosis) | + | + | + | + | NA | NA | 4/4: + |
| SARS-CoV-2 IgG | NA | + | NA | + | + | + | 4/4: + |
| SARS-CoV-2 BMBx-IHCǁ | − | − | NA | NA | NA | NA | 2/2: – |
VSAA was defined as an ANC < 200/μL. PR was defined as blood counts no longer meeting the standard Camitta criteria: ANC ≥ 500/μL, PLT ≥ 20 000/μL, and absolute reticulocyte count ≥60 000/μL. CR was defined as absolute ANC > 1000/μL, PLT ≥ 100 000/μL, and Hgb ≥ 10 g/L.
ALC, absolute lymphocyte count; ANC, absolute neutrophil count; CBC, peripheral blood cell count; CG, cytogenetics; CsA, cyclosporine; Cy, cyclophosphamide; EPAG, eltrombopag; FK, Tacrolimus; GVHD PPX, graft-versus-host disease prophylaxis; Hgb, hemoglobin; HSCT, hematopoietic stem cell transplant; IgG, immunoglobulin G; IST, immune suppressive therapy; LD-MTX, low-dose methotrexate; MCV, mean corpuscular volume; NA, not applicable; NGS, next-generation sequencing a large panel of genes in hematolymphoid neoplasms; PLT, platelet count; PR, partial response; SAA, severe AA; VSAA, very severe AA; WBC, white cell count.
Quantitative data presented as median.
Marked erythroid hypoplasia.
No dividing cells found; could not evaluate karyotype.
-X likely representing age-related changes.
Bone marrow biopsy by immunohistochemistry (BMBx-IHC) used mouse monoclonal antibody against SARS-CoV/SARS-CoV-2 nucleocapsid protein (Sino Biological; 40143-MM05).
Although these patients had a short duration between positive PCR test results and observation of pancytopenia, their initial infections may be weeks to months before developing pancytopenia.