COVID-19: ASTCT interim guidelines for HSCT and cellular therapy

  • ASCTC
  • 09.03.2020

  • von Pavankumar Kamat
  • Studien – kurz & knapp
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Takeaway

  • The American Society for Transplantation and Cellular Therapy (ASTCT) has issued interim guidelines for patients receiving hematopoietic stem cell transplantation (HSCT) and cellular therapy in view of the COVID-19 pandemic.

Key recommendations

  • Diagnostic considerations
    • In patients with upper (URT) or lower respiratory tract (LRT) symptoms, conduct PCR testing for SARS-CoV-2 in addition to other respiratory viruses from any respiratory sample obtained.
    • If SARS-CoV-2 is detected in the URT but patients have LRT symptoms, consider chest imaging to evaluate for LRT infections.
    • Bronchoalveolar lavage (BAL) is not recommended unless chest imaging is abnormal and if clinically indicated (e.g., invasive ventilation).
  • General treatment principles
    • SARS-CoV-2 detected in URT:
      • If chest imaging normal and asymptomatic: no therapy.
      • If imaging normal and mild URT symptoms: no therapy unless symptoms worsen; consult with infectious diseases (ID).
      • If imaging abnormal and LRT symptoms: consider therapy with ID consultation.
    • SARS-CoV-2 detected in BAL:
      • Consider therapy with ID consultation; priority for participation in clinical trials.
  • Pretransplant evaluation
    • Transplant candidates:
      • With symptoms of an acute respiratory tract infection, test for respiratory viruses, preferably using PCR, including for SARS-CoV-2, if available.
      • If SARS-CoV-2 is detected in a respiratory specimen, defer procedures until asymptomatic with 2 consecutive negative PCR tests each 1 week apart (minimum total, 14 days).
      • If candidates are in close contact with SARS-CoV-2-positive individuals, monitor candidates for infection and defer procedures until 2 consecutive PCR tests are negative.
      • Candidates should avoid nonessential travel to high-risk areas.
      • If candidates have traveled to a high-risk area or had close contact with a person with such travel history, defer procedures for at least 14 days and preferably 21 days from the day of the last contact.
      • If high community prevalence of COVID-19 is suspected:
        • Screen all candidates for SARS-CoV-2 at initial evaluation and 2 days before conditioning/lymphodepletion, regardless of the presence of symptoms.
        • Consider interim treatment and/or longer deferral of definite therapy when feasible.
    • HSCT donors:
      • If SARS-CoV-2 is detected in a respiratory sample, donors are ineligible.
      • If donors are in close contact with SARS-CoV-2-positive individuals, exclude them from donation for at least 28 days.
      • If donors have a history of travel to high-risk areas for COVID-19 or had close contact with a person with such history, exclude them from donation for at least 28 days.
      • Ensure the availability of an alternative stem cell source.
      • Donors should practice good hygiene and social distancing for 28 days prior to donation.