Comparison of Fresh and Frozen Grafts for Allogeneic Stem Cell Transplantation: Insights and Practices during the COVID-19 Pandemic from EBMT Infectious Diseases Working Party and Cellular Therapy & Immunobiology Working Party
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 allo-SCT depends on several factors, including the quality of the graft used. Traditionally, fresh grafts have been preferred due to their perceived higher viability and lower risk of complications. However, the COVID-19 pandemic has posed unique challenges to the transplantation community, leading to a reevaluation of graft selection strategies. This article aims to provide insights into the comparison of fresh and frozen grafts for allo-SCT during the COVID-19 pandemic, based on the recommendations from the EBMT Infectious Diseases Working Party and Cellular Therapy & Immunobiology Working Party.
Fresh Grafts:
Fresh grafts are harvested from the donor shortly before transplantation. They offer several advantages, including higher cell viability, reduced risk of graft failure, and lower rates of infections. Fresh grafts also allow for immediate transplantation, minimizing the time between collection and infusion. However, the COVID-19 pandemic has raised concerns regarding the safety of fresh grafts due to potential viral transmission from asymptomatic or pre-symptomatic donors. This has led to a shift towards considering frozen grafts as an alternative.
Frozen Grafts:
Frozen grafts involve the cryopreservation of stem cells after collection, allowing for long-term storage. They offer several advantages, including increased flexibility in scheduling transplantation, reduced risk of viral transmission, and improved availability of grafts from unrelated donors. Cryopreservation techniques have significantly improved over the years, resulting in high cell recovery rates and comparable clinical outcomes to fresh grafts. However, frozen grafts may have slightly lower cell viability and increased risk of graft failure compared to fresh grafts.
Insights and Practices during the COVID-19 Pandemic:
The EBMT Infectious Diseases Working Party and Cellular Therapy & Immunobiology Working Party have provided recommendations for graft selection during the COVID-19 pandemic. These recommendations aim to balance the need for timely transplantation with the safety of patients and healthcare providers. Key insights and practices include:
1. Donor Screening: Donors should undergo thorough screening for COVID-19 symptoms and exposure history. This includes a detailed medical history, physical examination, and laboratory testing, including PCR-based testing for SARS-CoV-2.
2. Fresh Grafts: Fresh grafts remain the preferred option whenever feasible, especially for urgent transplantations or when the risk of graft failure is high. Donors should be tested for COVID-19 as close to the time of graft collection as possible, preferably within 72 hours.
3. Frozen Grafts: Frozen grafts should be considered when there are concerns about potential viral transmission or logistical challenges in obtaining fresh grafts. Cryopreserved grafts should be tested for SARS-CoV-2 before transplantation.
4. Viral Inactivation: In cases where fresh grafts are used, additional measures can be taken to minimize the risk of viral transmission. These include using pathogen reduction technologies or performing plasma exchange on the graft before infusion.
5. Patient Isolation: Patients undergoing allo-SCT should be isolated and monitored closely for COVID-19 symptoms before and after transplantation. Strict infection control measures should be implemented to minimize the risk of viral transmission.
Conclusion:
The COVID-19 pandemic has necessitated a reevaluation of graft selection strategies for allo-SCT. While fresh grafts remain the preferred option whenever feasible, frozen grafts offer a safe alternative in certain situations. The recommendations from the EBMT Infectious Diseases Working Party and Cellular Therapy & Immunobiology Working Party provide valuable insights and practices to guide clinicians in making informed decisions during these challenging times. Continued research and collaboration are essential to further optimize graft selection strategies and improve patient outcomes in the era of COVID-19.
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