CML-005: Outcome of Haploidentical Hematopoietic Stem Cell Transplantation with a Donor and Recipient with SARS-CoV-2 Infection

Abstract

We report a rare case of a 21 year old male patient known to have chronic myeloid leukemia (CML) with progression to T-cell lymphoblastic lymphoma (T-cell LBL) as extra-medullary blast crisis of CML. Patient was treated by pediatric chemotherapy regimen and then underwent haploidentical stem cell transplantation. Post transplantation, on day+7 he developed SARS-CoV-2 after receiving stem cell graft from a donor who was diagnosed with SARS-CoV-2 on the day of stem cells harvesting. The case elaborates complications and outcome of a patient receiving stem cell transplant from a donor with SARS-CoV-2 infection.Introduction: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. Patients undergoing hematopoietic stem cell transplantation (HCT) are a group of patients with special immunocompromised situation and could have potentially devastating outcome if they are infected with SARS-CoV-2. Hematopoietic stem cell transplant (HSCT) recipients are at increased risk of respiratory viral infections and their associated complications, and their course with COVID-19 disease is expected to be complicated. The patient 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.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. Clinical decision making and teamwork 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 SARS-CoV-2 positive stem cell donor with no significant adverse CRS or infection-related outcome in the recipient.