Outcome of haploidentical hematopoietic stem cell transplantation with a donor and recipient with sars-cov2 infection
Authors: G. Ali, M. Altareb, N. Chaudhri
Journal: HemaSphere (2021)

Background: COVID-19 disease is an infectious disease caused by the most recently discovered SARS Coronavirus 2 (SARS- CoV-2). This new virus and disease were unknown before the outbreak began in Wuhan, China, in December 2019. The WHO classified COVID-19 a pandemic on March 11.[3] Although elderly and people with comorbidities patients are the most affected by the severe manifestations of the disease, patients undergoing hematopoietic stem cell transplantation (HCT) are a group of patients with special immunocompromised situation and could have potentially devastating outcome if they infected with SARS-CoV-2. Although the majority of infected patients have mild disease, critical illness occurs in about 6.1% of affected patients.[4] People at risk of severe outcome and death include those older than 60 years and those with comorbid disease states such as hypertension (HTN), chronic respiratory disease, chronic kidney disease (CKD), cardiovascular disease, diabetes mellitus (DM), cancer and immunosuppressed patients [5]. Data emerging about cancer patients show that these patients have an increased risk of complications and intensive care unit (ICU) admissions.[6] Hematopoietic cell transplant (HCT) patients are severely immune-compromised and their course with COVID-19 disease is expected to be complicated. The patient that is reported here developed SARS-CoV-2 post HCT who received stem cells from donor diagnosed with SARS-CoV2 by Nasopharyngeal swab on the day of the HCT. It is possible that this might be one of the rarest cases during the pandemic. Aims: case report Methods: case report Results: case report Summary/Conclusion: During this COVID-19 pandemic era, any patient for whom an allogeneic transplant is planned should be tested with nasopharyngeal swab for SARS-CoV-2 infection especially prior to hospital admission.If the result for SARS-CoV-2 infection proves negative, the transplant procedure should be pursued as planned. Donors with SARS-CoV-2 detected in a respiratory sample are considered ineligible to donate. However, an ineligible donor may be collected in certain situations where delay is not possible or unavoidable. Post-transplant care in HCT recipients with COVID-19 infection is feasible in regular transplant units, provided the patient does not present with respiratory symptoms or failure. Early and repeated testing for SARS-CoV-2 in post-transplant patients with concomitant infection mitigation strategies should be considered in patients who develop fever, respiratory symptoms and/or gastrointestinal symptoms to control the spread of COVID-19 both in patients and healthcare workers in hospital environments. Clinical decision making and team work is crucial for patient survival in the COVID-19 pandemic era. This case of an asymptomatic SARS-CoV-2 positive recipient, stem cell transplantation was pursued as planned from an asymptomatic SARSCoV- 2 positive stem cell donor with no significant adverse CRS or infection- related outcome in the recipient.