Key Takeaways & Executive Findings
- •• HPC(A) product collected during acute, minimally symptomatic SARS-CoV-2 infection tested negative for viral RNA by RT-PCR, suggesting low risk of product viremia. • Autologous stem cell transplant using this product was successful, with engraftment and recovery, indicating that transplantation may be feasible in such scenarios. • Donor screening questionnaires may miss minimally symptomatic Covid-19 cases, highlighting the need for objective testing and careful risk assessment. • This case provides evidence that HPC(A) collection during acute Covid-19 infection may be safe, but larger studies are needed to confirm outcomes.
Abstract
Collection of hematopoietic progenitor cell products [HPC(A)] is deferred if the donor is symptomatic and tests positive for Covid-19. However, donor questionnaires are subjective and may miss minimally symptomatic donors. Alternatively, myalgia associated with Covid-19 infection can be falsely dismissed as an adverse effect of granulocyte stimulating factor (Filgrastim) administered prior to product collection. The likelihood of donors with an underlying acute but minimally symptomatic infection undergoing successful product collection is significant. In these circumstances, it is less known whether Covid-19 infection results in product viremia or alters the clinical outcome of transplant. We aimed to evaluate the above question by studying a donor whose product was collected during acute Covid-19 infection. Aliquots of the product tested negative for SARS-CoV-2 RNA by reverse-transcriptase polymerase chain reaction assay (RT-PCR). Importantly, the donor received an autologous stem cell transplant using the product collected at the time of infection, and their case will be described in this report. We describe one of the very few reports of successful transplant of HPC(A) product collected during acute Covid-19 infection.
1. Introduction
Collection of hematopoietic progenitor cell products [HPC(A)] is deferred if the donor is symptomatic and tests positive for Covid-19. However, donor questionnaires are subjective and may miss minimally symptomatic donors. Alternatively, myalgia associated with Covid-19 infection can be falsely dismissed as an adverse effect of granulocyte stimulating factor (Filgrastim) administered prior to product collection. The likelihood of donors with an underlying acute but minimally symptomatic infection undergoing successful product collection is significant.
In these circumstances, it is less known whether Covid-19 infection results in product viremia or alters the clinical outcome of transplant. We aimed to evaluate the above question by studying a donor whose product was collected during acute Covid-19 infection. Aliquots of the product tested negative for SARS-CoV-2 RNA by reverse-transcriptase polymerase chain reaction assay (RT-PCR). Importantly, the donor received an autologous stem cell transplant using the product collected at the time of infection, and their case will be described in this report.
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Pranav S. Renavikar, Phyllis I. Warkentin, Shelly M. Williams, Krishna Gundabolu, Charles Branson, Scott A. Koepsell (2026). Characteristics of HPC(A) product obtained from a donor with SARS-CoV-2 infection and outcome of autologous transplant. Stem Cell Research & Therapy. https://doi.org/10.1186/s13287-024-03872-4
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Frequently Asked Questions
Can HPC(A) products be collected from donors with acute Covid-19 infection?
This case report demonstrates that HPC(A) collection was performed in a donor with acute, minimally symptomatic Covid-19 infection. The product tested negative for SARS-CoV-2 RNA, and the subsequent autologous transplant was successful, suggesting that collection may be feasible in select cases.
What are the risks of using HPC(A) products from Covid-19 positive donors?
The primary concern is potential product viremia and transmission of the virus to the recipient. In this case, RT-PCR testing of the product did not detect SARS-CoV-2 RNA, and the transplant proceeded without complications. However, larger studies are needed to fully assess risks.
How was the HPC(A) product tested for SARS-CoV-2?
The product aliquot was thawed, total nucleic acid was extracted, and RT-PCR was performed using primers for the SARS-CoV-2 E gene and the internal control RNase P gene. The RNase P gene amplified with a cycle threshold of 18.7, but no Covid-19 RNA was detected after 40 cycles.
What was the outcome of the autologous transplant using the Covid-19 positive donor's product?
The patient received the autologous stem cell transplant after a 45-day delay. The transplant was successful, with engraftment and recovery, despite the product being collected during acute Covid-19 infection.
Why is this case significant?
This is one of the few reports of successful autologous transplant using HPC(A) product collected during acute Covid-19 infection. It highlights the need for objective testing and careful risk assessment in donors who may be minimally symptomatic, and suggests that transplantation may be possible in such scenarios.
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