Clinical Scorecard: Guidelines and Recommendations for Hematopoietic Stem Cell Transplantation in Autoimmune Disorders During the COVID-19 Pandemic: Insights from EBMT
At a Glance
Category
Detail
Condition
Severe autoimmune disorders requiring hematopoietic stem cell transplantation (HSCT)
Key Mechanisms
Immunosuppressive transplant regimens and immunomodulatory treatments increase vulnerability to SARS-CoV-2 complications
Target Population
Patients with severe autoimmune diseases such as multiple sclerosis and systemic sclerosis considered for autologous or allogeneic HSCT
Care Setting
Specialized HSCT centers with multidisciplinary teams, adhering to national and institutional COVID-19 policies
Key Highlights
HSCT activity for autoimmune disorders decreased by 52% during the COVID-19 pandemic compared to 2019, with MS and SSc comprising 80% of transplants.
Transplant regimens for autoimmune disorders are generally more immunosuppressive than for other indications, increasing COVID-19 risk.
Recommendations emphasize multidisciplinary team discussions, balancing HSCT benefits against COVID-19 risks, and adapting programs according to pandemic phases.
Guideline-Based Recommendations
Diagnosis
Careful patient selection through multidisciplinary team (MDT) discussions including HSCT and autoimmune disorder specialists.
Assessment of disease severity and alternative non-transplant treatment options prior to HSCT consideration.
Management
Follow established treatment protocols for autoimmune disorders when HSCT is indicated.
Implement SARS-CoV-2 minimization strategies during HSCT ‘restoration and recovery’ phases.
Prioritize HSCT delivery based on clinical urgency, virus prevalence, hospital capacity, and patient factors.
Provide clear written information to patients and caregivers on infection prevention and post-transplant care.
Ensure dedicated caregivers with low SARS-CoV-2 exposure risk during the first months post-HSCT.
Monitoring & Follow-up
Regularly update HSCT programs in response to evolving COVID-19 pandemic phases and local infection rates.
Maintain communication between MDTs at patient’s home and transplant centers, especially if treatment occurs abroad.
Risks
Increased risk of COVID-19 complications due to immunosuppressive HSCT regimens and prior immunomodulatory therapies.
Potential disruptions in HSCT program delivery due to pandemic-related healthcare infrastructure challenges.
Travel-related risks and care continuity issues for patients undergoing HSCT outside their home country.
Patient & Prescribing Data
Patients with severe autoimmune diseases undergoing autologous HSCT during the COVID-19 pandemic
Despite a significant reduction in transplant activity, HSCT remains integral and standard-of-care for MS and SSc; treatment decisions require balancing immunosuppression risks with disease control benefits amid pandemic constraints.
Clinical Best Practices
Engage multidisciplinary teams for individualized patient assessment and treatment planning.
Adhere strictly to local, national, and institutional COVID-19 policies and infection control measures.
Provide comprehensive patient and caregiver education on precautions and post-transplant care.
Adapt HSCT program operations dynamically in response to pandemic developments and resource availability.
Ensure clear communication and coordination between transplant centers and patients’ home care teams, especially for international patients.
by Raffaella Greco, Tobias Alexander, Joachim Burman, Nicoletta Del Papa, Jeska de Vries-Bouwstra, Dominique Farge, Jörg Henes, Majid Kazmi, Kirill Kirgizov, Paolo A. Muraro, Elena Ricart, Montserrat Rovira, Riccardo Saccardi, Basil Sharrack, Emilian Snarski, Barbara Withers, Helen Jessop, Claudia Boglione, Ellen Kramer, Manuela Badoglio, Myriam Labopin, Kim Orchard, Selim Corbacioglu, Per Ljungman, Malgorzata Mikulska, Rafael De la Camara, John A. Snowden
