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

Acta Haematol. 2021;144(5):500-507. doi: 10.1159/000513036. Epub 2021 Mar 9.

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.

Keywords: Coronavirus infectious disease 2019; Donor; Hematopoietic cell transplant; Severe acute respiratory syndrome coronavirus-2.

Publication types

  • Review

MeSH terms

  • COVID-19 / epidemiology*
  • COVID-19 / pathology
  • COVID-19 / virology
  • COVID-19 Nucleic Acid Testing
  • Hematologic Diseases / diagnosis
  • Hematologic Diseases / epidemiology
  • Hematopoietic Stem Cell Transplantation* / psychology
  • Humans
  • Lung / diagnostic imaging
  • Pandemics
  • SARS-CoV-2 / isolation & purification
  • Tissue Donors / psychology