A new study suggests that autologous or allogeneic hematopoietic stem cell transplant (HSCT) after SARS-CoV-2 infection is safe, but many patients do not maintain anti-SARS-CoV-2 antibodies.
The retrospective study was published in Transplantation and Cellular Therapy.
Researchers evaluated the medical charts of 15 consecutive patients with hematologic malignancies who had developed asymptomatic or symptomatic COVID-19.
All patients underwent HSCT, all had tested negative for SARS-CoV-2 on admission, and none had received a COVID-19 vaccine.
There were 8 patients who underwent autologous HSCT — 4 to treat non-Hodgkin lymphoma, 3 for multiple myeloma, and 1 for polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes.
All 8 patients achieved engraftment, with a median of 10 days (range, 9-12 days) to neutrophil engraftment and 12 days (range, 10-15 days) to platelet engraftment. Two patients developed engraftment syndrome and were treated with dexamethasone.
None of the patients were reinfected with SARS-CoV-2 or developed complications associated with COVID-19.
There were 4 patients in whom anti-SARS-CoV-2 immunoglobulin G (IgG) antibodies were not detected at any point. The remaining 4 patients had detectable antibodies prior to HSCT, and 2 of these patients were still antibody-positive after HSCT.
One patient in this cohort died from myeloma progression.
There were 7 patients who underwent allogeneic HSCT — 3 for acute lymphoblastic leukemia, 1 for acute myeloid leukemia, 1 for myelodysplastic syndrome, 1 for myelofibrosis, and 1 for chronic myeloid leukemia.
Patients had human leukocyte antigen (HLA)-identical related donors (n=2), HLA-matched unrelated donors (n=2), HLA-haploidentical related donors (n=2), and an HLA-mismatched unrelated donor (n=1). All 7 patients received peripheral blood stem cells.
All 7 patients achieved engraftment. The median time to neutrophil engraftment was
12 days (range, 10-26 days), and the median time to platelet engraftment was 12 days (range, 11-34 days).
There were 3 patients in whom anti-SARS-CoV-2 IgG antibodies were detected after diagnosis, but only 1 of these patients still had antibodies after HSCT.
None of the patients in this group were reinfected with SARS-CoV-2 or developed complications associated with COVID-19.
Two patients developed grade 2 acute graft-vs-host disease (GVHD), and 1 had grade 3 acute GVHD. One patient died from Pneumocystis jirovecii/fungal pneumonia during GVHD treatment.
Based on these results, the researchers concluded that HSCT can be safe for patients with a history of COVID-19. However, the fact that most patients “did not maintain durable antibody response is an important consideration in the post-transplant care and vaccination approaches in this vulnerable patient population.”
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Shah N, Dahi PB, Ponce DM, et al. Hematopoietic cell transplantation is feasible in patients with prior COVID-19 infection. Transplant Cell Ther. 2021; S2666-6367(21)01296-3. doi:10.1016/j.jtct.2021.10.004