Abstract:Coronavirus disease-19 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), represents one of the biggest challenges of 21st century, threatening public health around the globe. Increasing age and presence of co-morbidities are reported risk factors for severe disease and mortality, along with autoimmune diseases (ADs) and immunosuppressive treatments such as haematopoietic stem cell transplantation (HSCT), which are also associated with adverse outcomes. We review the impact of … Show more
“…The main decrease was seen in the numbers of HCT for multiple sclerosis (49% of all AID), from 442 to 226. This decrease, most likely related to the SARS-CoV-2 pandemic within the predominant countries of activity in this field, also reflected EBMT guidelines [ 28 ]. Fig.…”
Section: Resultsmentioning
confidence: 96%
“…The analysis of the survey data since 1990 has illustrated a continued and constant increase in the annual numbers of HCT and transplant rates for both allogeneic and autologous HCT [ 14 ]. This 2020 survey data report, showed for the first time in 31 years a drop in activity possibly related to the SARS-CoV-2 pandemic [ 28 – 32 ].…”
In 2020, 45,364 HCT in 41,016 patients, 18,796 (41%) allogeneic and 26,568 (59%) autologous in 690 centers were reported. Changes observed were as follows: total number of HCT −6.5%, allogeneic HCT −5.1%, autologous HCT −7.5%, and were more pronounced in non-malignant disorders for allogeneic HCT and in autoimmune disease for autologous HCT. Main indications were myeloid malignancies 10,441 (25%), lymphoid malignancies 26,120 (64%) and non-malignant disorders 2532 (6%). A continued growth in CAR-T cellular therapies to 1874 (+65%) patients in 2020 was observed. In allogeneic HCT, the use of haploidentical donors increased while use of unrelated and sibling donors decreased. Cord blood HCT increased by 11.7% for the first time since 2012. There was a significant increase in the use of non-myeloablative but a drop in myeloablative conditioning and in use of marrow as stem cell source. We interpreted these changes as being due to the SARS-CoV-2 pandemic starting early in 2020 in Europe and provided additional data reflecting the varying impact of the pandemic across selected countries and larger cities. The transplant community confronted with the pandemic challenge, continued in providing patients access to treatment. This annual report of the EBMT reflects current activities useful for health care planning.
“…The main decrease was seen in the numbers of HCT for multiple sclerosis (49% of all AID), from 442 to 226. This decrease, most likely related to the SARS-CoV-2 pandemic within the predominant countries of activity in this field, also reflected EBMT guidelines [ 28 ]. Fig.…”
Section: Resultsmentioning
confidence: 96%
“…The analysis of the survey data since 1990 has illustrated a continued and constant increase in the annual numbers of HCT and transplant rates for both allogeneic and autologous HCT [ 14 ]. This 2020 survey data report, showed for the first time in 31 years a drop in activity possibly related to the SARS-CoV-2 pandemic [ 28 – 32 ].…”
In 2020, 45,364 HCT in 41,016 patients, 18,796 (41%) allogeneic and 26,568 (59%) autologous in 690 centers were reported. Changes observed were as follows: total number of HCT −6.5%, allogeneic HCT −5.1%, autologous HCT −7.5%, and were more pronounced in non-malignant disorders for allogeneic HCT and in autoimmune disease for autologous HCT. Main indications were myeloid malignancies 10,441 (25%), lymphoid malignancies 26,120 (64%) and non-malignant disorders 2532 (6%). A continued growth in CAR-T cellular therapies to 1874 (+65%) patients in 2020 was observed. In allogeneic HCT, the use of haploidentical donors increased while use of unrelated and sibling donors decreased. Cord blood HCT increased by 11.7% for the first time since 2012. There was a significant increase in the use of non-myeloablative but a drop in myeloablative conditioning and in use of marrow as stem cell source. We interpreted these changes as being due to the SARS-CoV-2 pandemic starting early in 2020 in Europe and provided additional data reflecting the varying impact of the pandemic across selected countries and larger cities. The transplant community confronted with the pandemic challenge, continued in providing patients access to treatment. This annual report of the EBMT reflects current activities useful for health care planning.
“…1 2 The COVID-19 pandemic has challenged experts regarding decisions on AHSCT in these high-risk patients. 3 Increased risk for severe COVID-19 infection in SSc is related to lung and heart involvement 4 and is enhanced by high-dose immunosuppressive drugs and antithymocyte globulins used for conditioning to eliminate autoreactive cells before AHSCT and to allow reset of tolerance during the immune reconstitution period, lasting around 12 months after transplant. 1 3 Several centres have stopped AHSCT activity for SSc during the pandemic for safety considerations.…”
Section: Sars-cov-2 Vaccination After Stem Cell Transplantation For Sclerodermamentioning
“…The majority of such patients have chronic diseases, which impact on quality-of-life and can shorten life expectancy but are rarely life-threatening in the short-term. Autologous and allogeneic HSCT are performed in this population after a careful balance of benefits and risks, and consideration of alternative treatment options [ 2 , 3 ], with the aim to ablate the aberrant immune system and reconstitute one more tolerant to self-antigens, inducing a complete and stable remission from disease activity [ 4 ].…”
Autoimmune diseases (ADs) represent a heterogenous group of complex diseases with increasing incidence in Western countries and are a major cause of morbidity. Hematopoietic stem cell transplantation (HSCT) has evolved over the last 25 years as a specific treatment for patients with severe ADs, through eradication of the pathogenic immunologic memory and profound immune renewal. HSCT for ADs is recently facing a unique developmental phase across transplant centers. This review provides a comprehensive overview of the recent evidence and developments in the area, including fundamentals of preclinical research, clinical studies in neurologic, rheumatologic and gastroenterologic diseases, which represent major indications at present, along with evidence of HSCT for rarer indications. Moreover, we describe the interwoven challenges of delivering more advanced cellular therapies, exploiting mesenchymal stem cells, regulatory T cells and potentially CAR-T cell therapies, in patients affected by ADs. Overall, we discuss past and current indications, efficacy, associated risks and benefits, and future directions of HSCT and advanced cellular therapies in the treatment of severe/refractory ADs, integrating the available literature with European Society for Blood and Marrow Transplantation (EBMT) registry data.
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