Utjecaj pandemije COVID-19 na prikupljanje alogeničnih krvotvornih matičnih stanica

Ivona Horvat, Ines Bojanić, Sanja Mazić, Nadira Duraković, Radovan Vrhovac, Branka Golubić Ćepulić

Uvod: Pandemija COVID-19 dovela je do izazova u liječenju bolesnika kojima je potrebna transplantacija krvotvornih matičnih stanica (KMS). Porastom broja oboljelih širom svijeta smanjila se dostupnost KMS-a zbog infekcije darivatelja i ograničenja u međunarodnom prometu. Sukladno tomu, uveden je niz mjera u cilju zaštite bolesnika i darivatelja te osiguravanja dostupnosti transplantata tijekom pandemije. Cilj rada bio je prikazati utjecaj pandemije COVID-19 na prikupljanje alogeničnih KMS-a u KBC-u Zagreb. Metode: Provedena je retrospektivna analiza podataka za razdoblje od 1. ožujka 2020. do 30. lipnja 2021. Podatci su prikupljeni iz bolničkoga informacijskog sustava te zapisnika sa sastanaka Povjerenstva za liječenje transplantacijom KMS-a KBC-a Zagreb. Rezultati: U navedenom razdoblju prvenstveno su korištene KMS iz periferne krvi, osim u slučaju snažne indikacije za primjenu koštane srži (KS). Pripravci alogeničnih KMS-a su prije početka kondicioniranja krioprezervirani kako bi se osigurala raspoloživost prema planu liječenja. Kod 13 bolesnika se odustalo od prikupljanja KMS-a jer su dobili COVID-19. Alogenične KMS su prikupljene od srodnih i nesrodnih darivatelja iz Hrvatskog registra dobrovoljnih darivatelja KMS-a i Svjetskog udruženja darivatelja koštane srži za ukupno 135 bolesnika. Koštana srž je prikupljena za 12,5% bolesnika i svi pripravci su transplantirani. Šesnaest bolesnika je transplantirano s perifernim KMS umjesto KS. Transplantirano je 94,1% pripravaka perifernih KMS-a, od kojih je 17 transplantirano s odgodom zbog infekcije darivatelja i/ili bolesnika bolešću COVID-19 prije ili nakon prikupljanja KMS-a. Od ukupno 118 transplantata perifernih KMS-a, 100 (84,7%) ih je krioprezervirano u 540 vrećica. Sedam (5,9%) krioprezerviranih transplantata perifernih KMS-a nisu infundirani zbog progresije bolesti (5), infekcije primatelja bolešću COVID-19 (1) i loše vijabilnosti stanica (1). Zaključak: Pandemija COVID-19 nepovoljno je utjecala na prikupljanje i transplantaciju KMS-a uz brojne organizacijske i logističke izazove. Krioprezervacija alogeničnih KMS-a omogućila je uspješno odvijanje transplantacijskog liječenja, iako je nažalost praćena rizikom da neki od tih pripravaka kasnije ne budu infundirani, što izlaže darivatelje riziku nepotrebnog prikupljanja i povećava troškove liječenja.

Introduction: COVID-19 pandemic brought challenges in the organization of hematopoietic stem cell (HSC) transplantation. Availability of HSCs was decreased due to donor infection and transport limitations. Accordingly, a series of measures was introduced to ensure the protection of patients and donors and availability of transplants during the pandemic. The goal of this study was to show the impact of COVID-19 pandemic on the collection of allogeneic HSCs in University Hospital Centre (UHC) Zagreb. Methods: We conducted a retrospective analysis for the period from March 1, 2020, to June 30, 2021. The data were collected from hospital computer
database and meeting reports of the HSC Transplantation Committee of UHC Zagreb. Results: In the reported period peripheral blood stem cells (PBSC) were preferred, except when bone marrow (BM) transplantation was strongly indicated. Allogeneic HSC grafts were cryopreserved before conditioning to ensure availability on the day of transplantation. Thirteen patients were excluded from the program due to COVID-19 infection. HSCs were collected from related and unrelated donors from the Croatian HSC Donor Registry and World Marrow Donor Assocciation for the total of 135 patients. All 17 (12.5%) harvested BM grafts were transplanted. Sixteen patients were transplanted with PBSC instead of BM. Out of the collected PBSC 94.1% were transplanted but in 17 patients transplantations were delayed due to COVID-19 infection of the donor and/or the patient. Of the total 118 PBSC transplants 100 (84.7%) were cryopreserved in 540 cryo bags. Seven (5.9%) cryopreserved grafts have not been infused because of the progression of the main disease (5), COVID-19 infection of the patient (1) and poor product viability (1). Conclusion: COVID-19 pandemic adversely impacted HSC collection and transplantation with many organizational and logistical challenges. Cryopreservation of allogeneic grafts enabled efficient management of the transplantation programs but was accompanied with the risk of not infusing some grafts, which exposed donors to unnecessary risks and increased the cost of treatment.