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One Man’s Experience With AML, COVID-19, and Allo-HSCT

By: Celeste L. Dixon
Posted: Friday, September 3, 2021

Michael Medinger, MD, of University Hospital Basel in Basel, Switzerland, and colleagues added to the knowledge base of SARS–CoV-2 by detailing a case documenting SARS–CoV-2 reactivation in a patient with acute myeloid leukemia (AML) who was receiving immunosuppressant agents. According to the authors, this case “raises questions about reactivation risks among recipients of stem cell transplants and other immunocompromised patients.”

Published in SN Comprehensive Clinical Medicine, the case study involved a 61-year-old man who was undergoing a conditioning regimen with fludarabine, cyclophosphamide, and 2-Gy of total-body irradiation in preparation for a haploidentical allogeneic hematopoietic stem cell transplantation (allo-HSCT). At 6 weeks before transplantation, he received his first dose of the BioNTech/Pfizer COVID-19 mRNA vaccine.

However, 2 weeks after that, a polymerase chain reaction test yielded a positive result for SARS–CoV-2, and the patient was successfully treated for COVID-19 pneumonia. Twice—7 and 10 days after diagnosis—nasal swabs for SARS–CoV-2 returned negative results; his SARS–CoV-2 IgG antibodies were positive as well, so it was decided to forgo the second vaccine dose.

“Due to the good general condition of the patient and the molecular leukemia persistence, we decided to proceed to allo-HSCT without any delay,” wrote Dr. Medinger and his team. However, “later during his stay, the patient showed undetectable SARS–CoV-2 load four times,” although he was asymptomatic.

“We interpreted the re-positive tests most likely as an asymptomatic flare-up. [It was] possibly caused by a prolonged or intermittent shedding and favored by immunosuppression because of the AML and chemotherapy conditioning,” the doctors speculated.

Notably, the patient still had antibodies at the time of these positive tests, despite his AML and lymphopenia. He underwent allo-HSCT and, as of 2 months later, continued in complete AML remission. It remains to be seen, though, the team said, whether the patient will ultimately lose his anti–SARS–CoV-2 antibodies due to the allo-HSCT.

Disclosure: The study authors reported no conflicts of interest.



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