COVID-19 and Hematopoietic Cell Transplant Center-specific survival analysis: Can we adjust for the impact of the pandemic? Recommendations of the COVID-19 Taskforce of the 2020 CIBMTR Center Outcomes Forum.

COVID-19 has significantly impacted the practice of hematopoietic cell transplantation (HCT) and likely affected outcomes of HCT recipients. Early reports document substantially higher case fatality rates for HCT recipients than faced by the general population. The threat to individual patients is real, but at present, we do not have a clear picture of how much of this threat is present within the first year after HCT, as the majority of cases in early reports occurred after the first year. Still unknown is how infection rates and outcomes vary with time after HCT. This is important because center-specific survival estimates for reporting purposes focus on 1-year post-HCT mortality. Transplant centers have dramatically changed practices due to the pandemic. For many centers, quality assurance processes and procedures were disrupted, and these changes likely affected team performance. Centers have been affected unevenly by the pandemic, by time, location, and COVID-19 burden. Assessment of center-specific survival depends on the ability to adjust for risk factors such as COVID-19 that are outside center control using consistent methods so that team performance based on controllable risk factors can be ascertained. The Center of International Blood and Marrow Transplantation Research (CIBMTR) convened a working group for the 2020 Center Outcomes Forum (COF) to assess the impact of COVID-19 on both patient-specific risks and center-specific performance. This committee reviewed the factors at play and developed recommendations for a process to determine if adjustments in the methodology to assess center-specific performance are needed.