Guidelines for Hematopoietic Stem Cell Transplantation in Autoimmune Disorders During COVID-19

Overview

The COVID-19 pandemic caused a 52% reduction in autologous HSCT activity for autoimmune disorders in 2020 compared to 2019, with multiple sclerosis and systemic sclerosis remaining the predominant indications. Updated EBMT guidelines emphasize careful patient selection, multidisciplinary discussion, and adaptation of HSCT programs to evolving pandemic conditions to balance risks and benefits.

Background

Hematopoietic stem cell transplantation (HSCT) is a treatment option for severe autoimmune disorders (ADs) after weighing benefits against risks and alternative therapies. The COVID-19 pandemic disrupted HSCT delivery due to infrastructure challenges and increased infection risks in immunocompromised patients. Immunosuppressive regimens used in HSCT for ADs may heighten vulnerability to SARS-CoV-2, necessitating updated guidelines to safely resume transplantation. The European Society for Blood and Marrow Transplantation (EBMT) developed recommendations integrating pandemic-related risks with clinical priorities and evidence-based indications.

Data Highlights

Transplant activity decreased by 52% during the pandemic period. Multiple sclerosis and systemic sclerosis accounted for 80% of HSCT indications in 2020.

Key Findings

• Autologous HSCT activity for autoimmune disorders dropped by 52% during March–December 2020 compared to the same period in 2019.
• Multiple sclerosis and systemic sclerosis comprised 80% of HSCT indications, consistent with their established role in treatment algorithms.
• HSCT regimens for autoimmune diseases are generally more immunosuppressive, increasing vulnerability to COVID-19 complications.
• EBMT guidelines recommend multidisciplinary team (MDT) discussions including HSCT and autoimmune disease specialists to assess risks and benefits before proceeding.
• HSCT programs must remain flexible to adapt to fluctuating COVID-19 alert levels and prioritize cases based on clinical urgency.
• Patient education on infection prevention and coordination between transplant centers and patients’ home care teams are critical, especially when treatment occurs abroad.

Clinical Implications

Clinicians should carefully evaluate autoimmune disease patients for HSCT during the ongoing COVID-19 pandemic, balancing immunosuppressive risks against disease severity and alternative treatments. Multidisciplinary collaboration and adherence to evolving EBMT and local guidelines are essential to safely restart and maintain HSCT programs. Patient counseling on infection control and post-transplant care coordination is vital to minimize SARS-CoV-2 exposure and complications.

Conclusion

The COVID-19 pandemic significantly impacted HSCT activity for autoimmune disorders, necessitating updated, evidence-based guidelines to safely resume transplantation. Ongoing adaptation to pandemic dynamics and multidisciplinary decision-making remain key to optimizing patient outcomes.

References

1. EBMT Guidelines and Recommendations 2021 -- Hematopoietic Stem Cell Transplantation in Autoimmune Disorders During COVID-19