Introduction: Onco-hematological patients, specifically those treated with hematopoietic stem cell transplantation (HSCT) [2], are particularly at risk of severe acute respiratory syndrome due to Coronavirus-2 (SARS-CoV-2). Conversely, evidences regarding Coronavirus Disease 2019 (COVID-19) in aggressive multiple sclerosis (MS) treated with autologous HSCT (aHSCT) are not available. At pandemic start, and in the absence of data, European Society for Blood and Marrow transplantation/Autoimmune Disease Working Party (EBMT/ADWP) suggested delaying not life-sparing HSCT. Aim: To describe cases of COVID-19 in a population of aggressive MS treated with aHSCT. Materials and Methods: Data were collected from 4 centers (march-2020 to april-2021). Patients’ health-status was periodically monitored by phonecall. Patients transplanted within a 12-month period were asked to maintain a strict home-isolation. Those transplanted from longer than 12 months were asked to keep safe behaviour, as recommended by EBMT/ADWP. Results: We recorded 5 cases out of 70 patients. At COVID-19 time, mean (standard deviation) disease duration (dd) was 12.0 (±4.9) years and median expanded disability status scale (EDSS) was 4.5 (range 3.0-7.5). Mean time from aHSCT was 24.7 (±9.8) months (range 12.9-37.0). All patients presented normal lymphocyte values besides one with grade-two lymphopenia (617.0 cc/mm^3) 2 months before COVID-19 diagnosis. One patient (SPMS, dd 7 years, EDSS 7.5, normal lymphocyte-count, no therapy after aHSCT) required low molecular weight heparin, steroid and oxigen within hospedalization and completely recovered from disease. All the other patients presented mild SARS-CoV2 infection, including the one that developed infection at 13th month after transplantation. Two out of 3 patients tested resulted positive for IgG anti-SARS-CoV2 after 65 and 128 days from onset. One patient, currently in therapy with rituximab, resulted negative after 61 days. Conclusions: The cases of COVID-19 in patients with MS treated with aHSCT described here developed mostly a mild infection with complete recovery.
COVID-19 in patients with aggressive MS treated with aHSCT: a multi-center study / E. Sbragia, A. Mariottini, M. Capobianco, S. Martire, L. Moiola, M.P. Amato, L. Massacesi, G. Mancardi, G. Boffa, M. Inglese. - In: MULTIPLE SCLEROSIS. - ISSN 1352-4585. - ELETTRONICO. - 27:(2021), pp. 0-0.
COVID-19 in patients with aggressive MS treated with aHSCT: a multi-center study
A. Mariottini;M. P. Amato;L. Massacesi;
2021
Abstract
Introduction: Onco-hematological patients, specifically those treated with hematopoietic stem cell transplantation (HSCT) [2], are particularly at risk of severe acute respiratory syndrome due to Coronavirus-2 (SARS-CoV-2). Conversely, evidences regarding Coronavirus Disease 2019 (COVID-19) in aggressive multiple sclerosis (MS) treated with autologous HSCT (aHSCT) are not available. At pandemic start, and in the absence of data, European Society for Blood and Marrow transplantation/Autoimmune Disease Working Party (EBMT/ADWP) suggested delaying not life-sparing HSCT. Aim: To describe cases of COVID-19 in a population of aggressive MS treated with aHSCT. Materials and Methods: Data were collected from 4 centers (march-2020 to april-2021). Patients’ health-status was periodically monitored by phonecall. Patients transplanted within a 12-month period were asked to maintain a strict home-isolation. Those transplanted from longer than 12 months were asked to keep safe behaviour, as recommended by EBMT/ADWP. Results: We recorded 5 cases out of 70 patients. At COVID-19 time, mean (standard deviation) disease duration (dd) was 12.0 (±4.9) years and median expanded disability status scale (EDSS) was 4.5 (range 3.0-7.5). Mean time from aHSCT was 24.7 (±9.8) months (range 12.9-37.0). All patients presented normal lymphocyte values besides one with grade-two lymphopenia (617.0 cc/mm^3) 2 months before COVID-19 diagnosis. One patient (SPMS, dd 7 years, EDSS 7.5, normal lymphocyte-count, no therapy after aHSCT) required low molecular weight heparin, steroid and oxigen within hospedalization and completely recovered from disease. All the other patients presented mild SARS-CoV2 infection, including the one that developed infection at 13th month after transplantation. Two out of 3 patients tested resulted positive for IgG anti-SARS-CoV2 after 65 and 128 days from onset. One patient, currently in therapy with rituximab, resulted negative after 61 days. Conclusions: The cases of COVID-19 in patients with MS treated with aHSCT described here developed mostly a mild infection with complete recovery.
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