Title: Comparison of Fresh and Frozen Grafts for Allogeneic Stem Cell Transplantation: Insights and Practices during the COVID-19 Pandemic
Introduction:
Allogeneic stem cell transplantation (allo-SCT) is a life-saving treatment option for patients with various hematological malignancies and non-malignant disorders. The success of this procedure relies on the availability of suitable grafts, which can be obtained either as fresh or frozen products. However, the ongoing COVID-19 pandemic has posed unique challenges to the transplantation community, leading to a reevaluation of graft selection strategies. In this article, we will explore the insights and practices recommended by the EBMT Infectious Diseases Working Party (IDWP) and Cellular Therapy & Immunobiology Working Party (CTIWP) in Bone Marrow Transplantation regarding the comparison of fresh and frozen grafts during the COVID-19 pandemic.
Fresh Grafts:
Fresh grafts refer to stem cell products that are collected from donors shortly before transplantation. These grafts offer several advantages, including higher cell viability, reduced risk of contamination, and potentially better immune reconstitution. However, the collection process requires close coordination between the donor and recipient, which may be challenging during a pandemic due to travel restrictions and infection control measures. Additionally, fresh grafts are time-sensitive and need to be processed and infused promptly, which can be logistically challenging during a crisis situation.
Frozen Grafts:
Frozen grafts, on the other hand, involve the cryopreservation of stem cells after collection, allowing for long-term storage and flexibility in transplantation scheduling. This method offers advantages such as increased availability, reduced logistical constraints, and improved patient safety by minimizing the risk of viral transmission. Cryopreservation techniques have significantly improved over the years, ensuring high cell viability and functional recovery post-thaw. However, concerns have been raised regarding potential adverse effects on immune reconstitution and graft-versus-leukemia (GVL) effects compared to fresh grafts.
Insights and Practices during the COVID-19 Pandemic:
The EBMT IDWP and CTIWP have provided valuable insights and recommendations to guide clinicians in selecting the most appropriate graft type during the COVID-19 pandemic. These include:
1. Risk Assessment: Consider the local epidemiology, prevalence of COVID-19, and availability of resources when deciding between fresh and frozen grafts.
2. Donor Selection: Evaluate the donor’s health status, potential exposure to COVID-19, and travel history. Preferentially select local donors to minimize travel-related risks.
3. Logistics: Assess the feasibility of timely collection, processing, and infusion of fresh grafts, considering potential disruptions in transportation and healthcare services.
4. Infection Control: Implement strict infection control measures during graft collection, processing, and transplantation to minimize the risk of COVID-19 transmission.
5. Patient Safety: Weigh the benefits of fresh grafts against the potential risks of delayed transplantation or compromised immune reconstitution associated with frozen grafts.
6. Communication: Maintain open and transparent communication with patients, donors, and healthcare providers to address concerns, manage expectations, and ensure informed decision-making.
Conclusion:
The COVID-19 pandemic has necessitated a reevaluation of graft selection strategies for allo-SCT. While fresh grafts offer certain advantages, logistical challenges and infection control considerations during a pandemic may favor the use of frozen grafts. The decision should be based on a comprehensive risk assessment, considering local epidemiology, donor health status, logistical feasibility, and patient safety. Close collaboration between transplant centers and adherence to recommended practices by the EBMT IDWP and CTIWP will help optimize outcomes for patients undergoing allo-SCT during these challenging times.
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- Source Link: https://platohealth.ai/fresh-or-frozen-grafts-for-allogeneic-stem-cell-transplantation-conceptual-considerations-and-a-survey-on-the-practice-during-the-covid-19-pandemic-from-the-ebmt-infectious-diseases-working-party-id/