Changes in Stem Cell Transplant activity and procedures during SARS-CoV2 pandemic in Italy: an Italian Bone Marrow Transplant Group (GITMO) nationwide analysis (TransCOVID-19 Survey)

Abstract

The Transplant Centers belonging to Gruppo Italiano per il Trapianto di Midollo Osseo (GITMO) conducted a survey with the aim of evaluating the effect of SARS-CoV2 pandemic on the allogeneic transplant activity in Italy. The pandemic period from 1/3/2020 to 31/7/2020 was compared with the same period in 2019. Overall, in 2020 there was a 2.4% reduction in the number of allo-HCT cases compared to 2019. Interestingly, this deflection did not affect the acute leukemia cases (+5.7% in 2020). The use of peripheral blood-derived stem cells (+10.7%) and cryopreservation (97.4% of the centers) was highly adopted in 2020. Despite the sanitary emergency, almost all of the surveyed centers declared no impact of SARS-CoV2 pandemic on the transplant timing and outcomes, and the sanitary policy was positively evaluated by the majority of centers. The emergency measures ensured that only a minority of the allo-HCT patients had been infected by SARS-CoV2; however, a mortality of 42.1% among the allo-HCT patients hospitalized for COVID-19 was recorded. This survey gives us the information that the GITMO Group reacted positively to the pandemic. Thanks to the emergency strategies, the Italian allo-HCT activity continued safely, showing only a minor deflection and offering the same probability of cure to the transplanted patients.

Impact of COVID-19 pandemic on global unrelated stem cell donations in 2020—Report from World Marrow Donor Association

“…The noticeable decrease in BM collections and intercontinental/cross-border shipments can be explained by logistically complex processes, and increased risk to the donor of being exposed to COVID-19 during an operative procedure. These observations are in line with published data in the early stages of the pandemic [ 6 , 7 ]. Use of CBUs as a stem cell source was expected to increase given that the product is already available for shipping.…”

COVID-19 and HSCT (Hematopoietic stem cell transplant)

“…Early in the pandemic, several groups and societies advised that nonurgent transplants be delayed and that conditioning regimens or stem cell source be modified in some instances [ [2] , [3] , [4] ] to decrease risk for severe COVID-19 disease in patients receiving intensive immunosuppression for hematopoietic stem cell transplantation (HSCT) and in donors, and to preserve hospital capacity. In this context, centers reported a decrease in HSCT volume, both for non-malignant and malignant disorders, along with a shift in stem cell source distribution and in patient-level protocols [ 5 , 6 ]. A study from the World Marrow Donor Association examining global trends during the COVID-19 pandemic found that donations from unrelated donors decreased by 3.5% from 2019 to 2020, compared to an average annual growth rate of 3.9% from 2015 to 2019 [ 7 ].…”

“…ǂ variable definition of severe disease, *variable follow-up time. Author, site(s) Diagnosis period # HSCT recipients: auto/allo/CAR-T Age, years – median (range) Time since HSCT or CAR-T – median (range) % asymptomatic % hospitalized % required supplemental O2 % required ICU care % require mechanical ventilation % severe COVID ǂ % COVID-specific mortality* % overall mortality* % mortality (by time from diagnosis) Altuntas, Republic of Turkey (Ministry of Health database) 3/11/20–5/29/20 32: 20/12/0 56.5 [ [17] , [18] , [19] ] 100 22 16 22 16 Coll, Spain (national)*not all lab confirmed on or before 7/13/20 113: 42/71/0 Auto:60 [ [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] ] 18 months [ [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] ...…”

Secondary Impact of the Coronavirus Disease 19 Pandemic on Patients and the Cellular Therapy Healthcare Ecosystem

“…Conversely, the Italian experience has been markedly different, with the literature reporting only mild decreases in the number of auto-HSCT procedures (-15% reduction) and a minimal reduction in the number of allo-HSCT procedures (only a 2.4% reduction) 22 .…”

“…Because international flight restrictions and other COVID-19-related transport issues may hamper timely delivery of fresh allogeneic stem cell products, on March 30, 2020, the National Marrow Donor Program (NMDP) required that all unrelated donor cell products be cryopreserved before the initiation of the recipients’ preparative regimen. Understandably, centers reported decreased numbers of hematopoietic progenitor cell (HPC) collection and processing procedures during the initial year of the pandemic, along with a dramatic increase in the cryopreservation of HPC products even from related donors 14 , 21 , 22 , 23 , 24 .…”