The challenge of COVID-19 and hematopoietic cell transplantation; EBMT recommendations for management of hematopoietic cell transplant recipients, their donors, and patients undergoing CAR T-cell therapy

Abstract

The new coronavirus SARS-CoV-2 has rapidly spread over the world causing the disease by WHO called COVID-19. This pandemic poses unprecedented stress on the health care system including programs performing allogeneic and autologous hematopoietic cell transplantation (HCT) and cellular therapy such as with CAR T cells. Risk factors for severe disease include age and predisposing conditions such as cancer. The true impact on stem cell transplant and CAR T-cell recipients in unknown. The European Society for Blood and Marrow Transplantation (EBMT) has therefore developed recommendations for transplant programs and physicians caring for these patients. These guidelines were developed by experts from the Infectious Diseases Working Party and have been endorsed by EBMT's scientific council and board. This work intends to provide guidelines for transplant centers, management of transplant candidates and recipients, and donor issues until the COVID-19 pandemic has passed.

Impact of Covid19 on a tertiary care pediatric oncology and stem cell transplant unit in Riyadh, Saudi Arabia

“…5 With respect to severity of disease, we noticed a significant All elective stem cell transplants for benign hematological conditions were put on hold during the months of March to May 2020 and the transplant workload was limited to high-risk or relapsed hematological malignancies and autologous stem cell infusions for solid tumor patients, which was in line with international practice. 6,7 Difficulties in approaching unrelated donor registries because of donors' unavailability or travel bans led to transplanting only from matched related donors or haplo-identical family members. [6][7][8] The startling decrease in the number of outpatient clinic visits during the lockdown months did not affect chemotherapy administration for patients on active treatment and virtual clinics were introduced where practical.…”

“…6,7 Difficulties in approaching unrelated donor registries because of donors' unavailability or travel bans led to transplanting only from matched related donors or haplo-identical family members. [6][7][8] The startling decrease in the number of outpatient clinic visits during the lockdown months did not affect chemotherapy administration for patients on active treatment and virtual clinics were introduced where practical. This is something worth considering as a standard practice, even after the pandemic is over, for better utilization of outpatient clinic services.…”

Multiple Myeloma Management in COVID-19 Era

“…It is fully recommended to secure the stem cell produced by cryopreservation prior to conditioning. 21,27 Patients awaiting ASCT were recommended to do home isolation for 14 days before the beginning of conditioning, and hospital visit is avoided. They should be evaluated for COVID-19 infection and the results must be negative in spite of any influenza symptoms.…”

“…On the other hand, transplant should be postponed until the patient has fully recovered with no symptoms left and has been tested with two negative subsequent PCR test at least 1 week apart. 21,27,28…”

Evidence-based management of COVID-19 in cancer patients: Guideline by the Infectious Diseases Working Party (AGIHO) of the German Society for Haematology and Medical Oncology (DGHO)

“…For specific considerations regarding stem cell transplantation, we kindly refer to the current guidelines by the European Society for Blood and Marrow Transplantation. 22 …”