Balancing benefits and risks in treating aggressive MS within COVID-19 pandemic: A single-center experience

ABSTRACT

Background and aims: Severe acute respiratory syndrome due to Coronavirus 2 (SARS-CoV-2) pandemic forced deferrals on most of autologous hematopoietic stem-cell transplantation (aHSCT), specifically for autoimmune diseases, in line with European Society for Blood and Marrow transplantation/Autoimmune Disease Working Party indications. Though concerns on the possible repercussions of the infection in transplanted autoimmune patients required higher monitoring, the impending activity that characterizes some forms of Multiple Sclerosis (MS) demanded a special evaluation on the benefit-risk balance. We aim to describe our experience in treating MS-patients with aHSCT along SARS-CoV-2-pandemic. Methods: Patients candidated to aHSCT were collegially discussed with our haematological and infectious-diseases expertise. two consecutive SARS-CoV-2 negative swabs, a two-weeks-long home-isolation and a five-days intradepartment observation were required for treatment start. Patients recently transplanted were all asked to keep safe behaviour and periodically monitored for possible Coronavirus Disease 2019 (COVID-19) symptoms;in particular, those treated in the previous 12-month were asked to maintain a strict home-isolation. Results: None of the three patients transplanted during pandemic (July, November and December 2020) developed COVID-19. Of the six transplanted in 2019 and that reached one-year from procedure within the outbreak, One developed pauci-symptomatic COVID-19 at the 13th month, confirmed by SARS-CoV-2 swab;white-bloodcells, lymphocyte (totals, CD4+, CD8+ and CD19+) and gamma-globulins levels were normal. two of the remaining 17 patients transplanted from 2015 developed slight COVID-19 symptoms at 30th and 57th month respectively. Conclusion: Three patients with highly-active MS were treated with aHSCT during pandemic without complications;three minor cases of COVID-19 were recorded in our cohort.