SARS‐CoV‐2 viral clearance during bone marrow aplasia after allogeneic hematopoietic stem cell transplantation—A case report

Abstract

Background Respiratory viral infections are known causes of mortality after allogeneic hematopoietic stem cell transplantation (HSCT). Here, we report a unique case of a child with viral pneumonia caused by coinfection with human metapneumovirus (MPV), respiratory syncytial virus (RSV), and SARS‐CoV‐2 after HSCT. Case report A 9‐year‐old girl with acute lymphoblastic leukemia underwent allogeneic HSCT from a matched, unrelated donor. During the posttransplant period, in profound leukopenia (below 10 leukocytes/µL), she was diagnosed with SARS‐CoV‐2, MPV and RSV pneumonia and was treated with ribavirin and chloroquine. Before leukocyte recovery, the girl became asymptomatic, and SARS‐CoV‐2 and RSV clearance was achieved. The shedding of SARS‐CoV‐2 stopped before immune system recovery, and one may hypothesize that the lack of an inflammatory response might have been a contributing factor to the mild clinical course. Conclusions Posttransplant care in HSCT recipients with COVID‐19 infection is feasible in regular transplant units, provided the patient does not present with respiratory failure. Early and repeated testing for SARS‐CoV‐2 in posttransplant patients with concomitant infection mitigation strategies should be considered in children after HSCT who develop fever, respiratory symptoms and perhaps gastrointestinal symptoms to control the spread of COVID‐19 both in patients and healthcare workers in hospital environments. Training of staff and the availability of personal protective equipment are crucial for containing SARS‐CoV‐2 infection.

Clinical presentations and outcomes of children with cancer and COVID‐19: A systematic review

“…After screening the full text of each of the studies, 23 studies were excluded, and 33 studies were included in the final analysis (Figure 1). 5,8–39 …”

“…In 29 studies ( n = 177 patients), 8,11–14,16–39 there was a mention of the type of test used to detect SARS‐CoV‐2. Among the 177 patients in these studies, PCR‐based tests were used to establish the diagnosis in 142 (one was also positive on CBNAAT) and antibody‐based tests in 23 (the type of test used was not mentioned for 12 patients in the study by Montoya et al 18 …”

“…In 196 patients (31 studies), 5,10–39 there was a mention about the type of malignancy, and 120 (53%) had hematological malignancies, and 76 (47%) had solid tumors. In studies that reported remission status (18 studies), 23 patients out of 47 were in remission from the underlying malignancy 10,11,14,20–26,29–37 (Table 1).…”

“…Among 24 studies including 102 patients 5,10,13–17,20–25,27–35,37 for whom information was available on the phase of chemotherapy/hematopoietic stem cell transplant (HSCT) status, 34 were on the intensive phase of chemotherapy, 13 were on low‐dose chemotherapy, six had completed treatment, and 17 post HSCT (Table 1).…”

“…Gastrointestinal symptoms were present in 17, and skin involvement was mentioned for three patients. In 30 studies ( n = 209 patients), 5,8,10–18,20–38 the severity of the symptoms was reported. Sixty‐three patients had no symptoms, 38 had mild symptoms, nine had moderate symptoms, and 20 (9.6%) had severe symptoms.…”