The study, published in The Lancet eClinicalMedicine, aims to improve clinical care, disease surveillance, and resource allocation for the most vulnerable patient groups.
The DESTINIES Study brought together 64 leading experts in immunology, virology and infectious disease from across 16 countries and four continents. Their goal: to resolve long-standing disagreements over which medical procedures and diagnoses would confer immunosuppression and which of these would carry the greatest risk of severe illness from COVID-19.
The result is the DESTINIES Phenotype - a clinically grounded, COVID-specific classification system that groups individuals with immunosuppression into high, moderate or low risk bands based on their underlying diagnoses. Designed to work within electronic medical records, this new system categorises patients into ten risk categories and aims to improve disease surveillance and public health decision-making by giving a clearer picture of who is most at risk.
The study reached several important conclusions:
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Patients with solid organ or bone marrow transplants, blood cancers and primary immunodeficiencies were consistently rated as high risk for severe COVID-19.
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Drug-managed HIV and cancer in remission were removed from immunosuppression classifications - a landmark change that recognises the effectiveness of modern treatments. However, experts noted exceptions, including cancers treated with bone marrow transplants and the long-lasting effects of certain therapies like rituximab, where immunosuppression may persist despite remission.
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The phenotype received overwhelming support from both the expert panel (94%) and a newly formed DESTINIES Patient Panel (89%).