Objective: To assess the feasibility of using donors with novel coronavirus disease 2019 (COVID-19) for allogeneic hematopoietic stem cell transplantation (allo-HSCT) when there are no other available donors and allo-HSCT cannot be delayed or discontinued. Methods: Seventy-one patients with malignant hematological diseases undergoing allo-HSCT between December 8, 2022, and January 10, 2023, were included. Of these, 16 received grafts from donors with mild COVID-19 (D-COVID(+) group) and 55 received grafts from donors without COVID-19 (D-COVID(-) group). The graft compositions were compared between the two groups. Engraftment, acute graft-versus-host disease (aGVHD), overall survival (OS), and relapse were also evaluated. Results: There were no serious side effects or adverse events in the D-COVID(+) group. The mononuclear cell dose and CD34(+) cell dose were comparable between the two groups, and no additional apheresis was required. There were no significant differences in the lymphocyte, monocyte, and T-cell subset doses between the two groups. The median natural killer cell dose in the D-COVID(+) group was significantly higher than that in the D-COVID(-) group (0.69×10(8)/kg vs. 0.53×10(8)/kg, P=0.031). The median follow-up time was 72 (33-104) days. All patients achieved primary engraftment. The 60-day platelet engraftment rates in the D-COVID(+) and D-COVID(-) groups were 100% and (96.4±0.2) %, respectively (P=0.568). There were no significant differences in neutrophil (P=0.309) and platelet (P=0.544) engraftment times. The cumulative incidence of grade 2-4 aGVHD was (37.5±1.6) % vs. (16.4±0.3) % (P=0.062), and of grade 3-4 aGVHD was 25.0% ±1.3% vs. 9.1% ±0.2% (P=0.095) in the D-COVID(+) and D-COVID(-) groups, respectively. The probabilities of 60-day OS were 100% and 98.1% ±1.8% (P=0.522) in the D-COVID(+) and D-COVID(-) groups, respectively. There was no relapse of primary disease during the study period. Conclusion: When allo-HSCT cannot be delayed or discontinued and no other donor is available, a donor with mild COVID-19 should be considered if tolerable. Larger sample sizes and longer follow-up periods are required to validate these results.
目的： 评估供者发生新型冠状病毒感染（COVID-19）时，在没有其他可用供者且异基因造血干细胞移植（allo-HSCT）无法推迟或中止的情况下，使用原计划供者进行allo-HSCT的可行性。 方法： 纳入71例在2022年12月8日至2023年1月10日接受allo-HSCT的恶性血液病患者，其中16例接受轻症新冠病毒感染供者移植物（D-COVID(+)组），55例接受未感染新冠病毒感染供者移植物（D-COVID(－)组）。比较D-COVID(+)组和D-COVID(－)组供者采集物组分，观察两组早期植入、急性移植物抗宿主病（aGVHD）、总生存和复发等结局。 结果： D-COVID(+)组供者未发生严重不良事件。与D-COVID(－)组相比，D-COVID(+)组移植物的单个核细胞（MNC）和CD34(+)细胞计数相当，且无需更多的采集次数。两组淋巴细胞、单核细胞、T细胞亚群分布差异无统计学意义，而D-COVID(+)组移植物中位NK细胞含量高于D-COVID(－)组（0.69×10(8)/kg对0.53×10(8)/kg，P＝0.031）。中位随访时间为72（33~104）d。所有患者均获得粒细胞植入。D-COVID(+)组、D-COVID(－)组移植后60 d血小板植入率分别为100%、（96.4±0.2）%（P＝0.568），并且粒细胞植入、血小板植入时间差异均无统计学意义（P＝0.309，P＝0.544）。D-COVID(+)组、D-COVID(－)组Ⅱ~Ⅳ度aGVHD累积发生率分别为（37.5±1.6）%、（16.4±0.3）%（P＝0.062），Ⅲ/Ⅳ度aGVHD累积发生率分别为（25.0±1.3）%、（9.1±0.2）%（P＝0.095），移植后60 d总生存率分别为100%、（98.1 ± 1.8）%（P＝0.522）。随访期间未发生原发病复发。 结论： 在无替代供者且allo-HSCT无法推迟或中止时，如供者可耐受，可考虑使用轻型新型冠状病毒感染供者按原计划进行移植。.
Keywords: Allogeneic hematopoietic stem cell transplantation; COVID-19; Donor; Malignant hematological disease.