Hematopoietic stem cell transplantation for autoimmune diseases in the time of COVID-19: EBMT guidelines and recommendations

Abstract

Coronavirus disease-19 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), represents one of the biggest challenges of 21st century, threatening public health around the globe. Increasing age and presence of co-morbidities are reported risk factors for severe disease and mortality, along with autoimmune diseases (ADs) and immunosuppressive treatments such as haematopoietic stem cell transplantation (HSCT), which are also associated with adverse outcomes. We review the impact of the pandemic on specific groups of patients with neurological, rheumatological, and gastroenterological indications, along with the challenges delivering HSCT in adult and pediatric populations. Moving forward, we developed consensus-based guidelines and recommendations for best practice and quality of patient care in order to support clinicians, scientists, and their multidisciplinary teams, as well as patients and their carers. These guidelines aim to support national and international organizations related to autoimmune diseases and local clinical teams delivering HSCT. Areas of unmet need and future research questions are also highlighted. The waves of the COVID-19 pandemic are predicted to be followed by an "endemic" phase and therefore an ongoing risk within a "new normality". These recommendations reflect currently available evidence, coupled with expert opinion, and will be revised according to necessary modifications in practice.

Fig. 1. Autologous hematopoietic stem cell transplant (HSCT) for autoimmune diseases (ADs) 2019–2020, reflecting the impact of the COVID-19 pandemic in Europe.

a Numbers of autologous HSCT in January to December 2020 are compared with the numbers in January to December 2019; b 2019–2020 transplants are also represented according to disease indication (MS: deep blue; SSc: light blue; CD: green; other ADs: yellow). auto-HSCT autologous hematopoietic stem cell transplantation, AD autoimmune disease, MS multiple sclerosis, SSc systemic sclerosis, CD Crohn’s disease.