ABSTRACT
BACKGROUND: The SARS-CoV-2 pandemic brought challenges to all areas of medicine. In pediatric bone marrow transplant (BMT), one of the biggest challenges was determining how and when to transplant patients infected with SARS-CoV-2 while mitigating the risks of COVID-related complications. METHODS: Our joint adult and pediatric BMT program developed protocols for performing BMT during the pandemic, including guidelines for screening and isolation. For patients who tested positive for SARS-CoV-2, the general recommendation was to delay BMT for at least 14 days from the start of infection and until symptoms improved and the patient twice tested negative by polymerase chain reaction (PCR). However, delaying BMT in patients with malignancy increases the risk of relapse. RESULTS: We opted to transplant two SARS-CoV-2 persistently PCR positive patients with leukemia at high risk of relapse. One patient passed away early post-BMT of a transplant-related complication. The other patient is currently in remission and doing well. CONCLUSION: These cases demonstrate that when the risk associated with delaying BMT is high, it may be reasonable to proceed to transplant in pediatric leukemia patients infected with SARS-CoV-2.
Subject(s)
COVID-19/complications , Hematopoietic Stem Cell Transplantation/methods , Leukemia, B-Cell/therapy , Leukemia, Myeloid, Acute/therapy , Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/therapy , Adolescent , COVID-19/diagnosis , Fatal Outcome , Female , Humans , Infant , Leukemia, B-Cell/complications , Leukemia, Myeloid, Acute/complications , Male , Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/complications , Time-to-TreatmentSubject(s)
Betacoronavirus , Coronavirus Infections/complications , Pneumonia, Viral/complications , Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/complications , Respiratory Distress Syndrome/etiology , Adolescent , Allopurinol/therapeutic use , Anemia, Hemolytic, Autoimmune/etiology , Anti-Bacterial Agents/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , COVID-19 , Combined Modality Therapy , Coronavirus Infections/diagnostic imaging , Cytokine Release Syndrome/etiology , Daunorubicin/administration & dosage , Fluid Therapy , Humans , Male , Methylprednisolone/therapeutic use , Nitriles , Pandemics , Pneumonia, Viral/diagnostic imaging , Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/diagnosis , Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Pyrazoles/therapeutic use , Pyrimidines , Respiration, Artificial , Respiratory Distress Syndrome/diagnostic imaging , Respiratory Distress Syndrome/drug therapy , Respiratory Distress Syndrome/therapy , SARS-CoV-2 , Vincristine/administration & dosageABSTRACT
Relapse of infection due to SARS-CoV-2 has been rarely described and there is little guidance regarding the management of such cases in immunocompromised hosts. We present a case of an adolescent female with B-cell acute lymphoblastic leukemia hospitalized multiple times for symptomatic SARS-CoV-2 infection who was safely treated with 2 courses of remdesivir (RDV) and has had no additional readmissions to date. Though additional studies are needed to confirm the safety and efficacy of an additional course of RDV in the setting of relapsed or prolonged severe COVID-19, our observations suggest that a second course of RDV may be considered.