How Do We Manage Hematopoietic Cell Transplant during the SARS-CoV-2 Pandemic?

Abstract

Patients receiving a hematopoietic cell transplant are thought to be at increased risk of infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and coronavirus infectious disease 2019. Transplant activities at our center continue, and notably, no patient has been infected with SARS-CoV-2. Indeed, social distancing, masking, and education for patients and donors are major pillars of prevention. We recommend potential transplant recipients and donors to be tested for SARS-CoV-2 with qRT-PCR, serum antibody detection, and a lung CT scan pretransplant. If possible, stem cells from HLA-matched unrelated donors by local processing laboratories should be cryopreserved and shipped before initiating pretransplant conditioning. An alternative HLA-haplotype-matched related donor should be identified and evaluated as a backup. The interval immediately after discharge is the time of greatest risk for SARS-CoV-2 infection because of travel and exposure to infected persons. We recommend self-isolation and minimal contact with family members. Nonessential clinic visits should be deferred or substituted with telemedicine consultations if possible. These recommendations are based on our experience at a major transplant center in China. Although some recommendations are evidence based, other recommendations are not and warrant validation in controlled trials.

Changes in the medical-seeking pattern and daily behavior of hematopoietic stem-cell transplant recipients during the COVID-19 epidemic: An online survey in Hubei Province, China

“…They reported that patients received HSCT are at increased risk of infection with SARS-CoV-2 and COVID-19 ( 18 ). A major transplant center in China recommended that self-isolation and minimal contact with family members, and nonessential clinic visits should be deferred or substituted with telemedicine consultations if possible ( 11 ).…”

“…Prior to this survey, there has only been a small amounts of published articles describing how to manage hematopoietic cell transplant during the SARS-CoV-2 pandemic (11,(15)(16)(17)(18)(19). They reported that patients received HSCT are at increased risk of infection with SARS-CoV-2 and COVID-19 (18).…”

“…The EBMT and the ASTCT recommend that transplant-related procedures be delayed 14–21 days from the last contact and potential recipients be monitored for SARS-CoV-2 infection in patients if they had come in close contact to persons infected with SARS-CoV-2 ( 9 , 10 ). A major transplant center in China suggested that social distancing, mask wearing, and education for patients and donors are essential preventative measures in these patients ( 11 ). They also recommend potential transplant recipients and donors to finish SARS-CoV-2 with qRT-PCR, serum antibody detection, and a lung CT scan pretransplant ( 11 ).…”

“…A major transplant center in China suggested that social distancing, mask wearing, and education for patients and donors are essential preventative measures in these patients ( 11 ). They also recommend potential transplant recipients and donors to finish SARS-CoV-2 with qRT-PCR, serum antibody detection, and a lung CT scan pretransplant ( 11 ).…”

The new world: hematopoietic stem cell transplant during a pandemic

“…Early in the pandemic, several groups recommended the delay of nonurgent transplants, such as noncurative transplants for plasma cell dyscrasias or potentially curative HCT in patients with nonmalignant disorders [1 ▪▪ –3 ▪▪ ,4,5]. However, as the pandemic persisted, individual centers reconsidered these recommendations because of concerns that ongoing therapy may limit subsequent stem cell mobilization or result in prolonged neutropenia increasing the risk of infectious complications [6].…”