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That's entirely normal as immuno-compromised patients are the perfect place for viruses to mutate as they are an active host for the viruses (the virus can't multiply on its own) and there's little/no immune system there to squish any of the virus.
Mutations are entirely normal, I think I read somewhere that the UK has sequenced more than 250,000 different variations of SARS-Cov-2 since the pandemic started.
Each time the virus replicates (and it does so billions of times inside an infected host) there's a small chance of a variation. It's just most variations are detrimental to the virus and don't survive.
In the long term variations that increase transmissibility generally tend to lower virulence (the ability to overcome the hosts defences), but that doesn't rule out a short term variant that is both more transmissible and more virulent.
I was trying to find the relevant post from someone on yacf who was able to explain it far better than I have but I'm failing to do so. I'll post a copy/summary if I find it.
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Greenbank
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Interesting doctor talking on radio 4 about how the virulent strains may be mutations that come from people with compromised immune systems. Replication of virus is impacted when you have something like HIV.
Could explain the South African variant too. It was interesting. I’ve done a terrible job of explaining it.