Coronavirus positive six-year transplant successful


A 6-year-old boy suffering from acute lymphoblastic leukemia underwent a bone marrow transplant after a plasma treatment obtained from a subject recovered from the viral infection. The boy tested positive in Sars-Cov-2 in March with the whole family (mom and dad). To facilitate the elimination of the virus, he had been hospitalized at the Covid Center in Palidoro and had been subjected to the treatment with plasma obtained by a subject recovered from the viral infection. Once negative, the expected transplantation with hematopoietic stem cells was possible taken from his father, who in the meantime also recovered from the virus. Now the baby is fine, has had no complications and will undergo normal post-transplantation checks.

From London to Rome to treat leukemia

The family arrived in Italy from London, where they reside, in October 2019 to treat the Child Jesus a recurrence of the disease from which the child is affected, the acute lymphoblastic leukemia. A bone marrow transplant is required and the team of the Department of Oncohematology and Cellular and Gene Therapy starts the preparatory therapy program: the child undergoes chemo and immunotherapy to lower the “load” of the disease up to the threshold that allows the transplant to have the best chance of success, that is, to definitively recover from leukemia. Over the months, during which home care and hospital treatments alternate, the treatments produce the desired effect and the time of transplant is approaching. Not having found a compatible donor, it was decided to proceed with the transplantation of hematopoietic stem cells as a parent.

And then comes the Coronavirus

In March 2020, in the midst of a pandemic, the child’s parents are undergoing the necessary investigations to determine who will be the candidate for bone marrow donation. The series of exams also includes screening for COVID-19. Child and parents are positive on the test: dad and son are asymptomatic, the mother with mild symptoms (pauci-symptomatic). To proceed with the transplant, however, you must wait until everyone is negative, especially the small patient who has immune defenses already compromised by leukemia. At the same time, it is necessary to respect the intervention program to avoid a new recurrence of the tumor.

Plasma treatment

To give the child extra “weapons” to eliminate viruses and to reduce the risk of complications induced by viral infection, by circulating a charge of “strong” antibodies, we opt for the infusion of hyperimmune plasma from people recovered from Covid. Obtained the authorization for compassionate use from the Ethical Committee of the Child Jesus and the clearance from the Regional Blood Center, the treatment is carried out on May 9 in the Covid Center of Palidoro (where the child had been hospitalized as a precaution). The treatment was made possible thanks to the collaboration developed with Inmi Spallanzani (for the recruitment of the plasma donor with the best neutralizing antibody titre, i.e. able to prevent protein binding spike of SARS-CoV-2 to its receptor present on human cells) and the San Camillo Hospital (for the collection of plasma by apheresis, inactivation – procedure by which any pathogens present are blocked – and freezing). In the meantime, even the father of the child, the chosen bone marrow donor, is finally negative on the swab and everything is ready to proceed with the last checks before the transplant.

Bone marrow transplant from dad

On May 29, the baby is infused at the site of the Infant Jesus of the Janiculum stamina cells of the father, specially manipulated to eliminate T alpha / beta + lymphocytes, cells dangerous for the recipient’s organism. This is the technique developed by the team of Professor Franco Locatelli, director of the Department of Onco-hematology and Cellular and Gene Therapy and developed in the Holy See Pediatric Hospital with the largest case studies in the world (about 700 parent transplants carried out to date) on children suffering from leukemias and blood cancers. The baby is now in excellent general condition, has had no post-transplant complications, dad’s cells are multiplying and he is moving towards complete recovery. With the cell manipulation methods currently available, the percentage of healing with bone marrow transplantation by one of the 2 parents is comparable to that obtained using a perfectly suitable donor.

A collaboration between excellences

“This case is the demonstrationcomments prof. Franco Locatelli, who is also a professor of Pediatrics at the Sapienza University of Romehow the collaboration between centers of excellence in the Lazio region, based on scruple respect for correct clinical and scientific procedures, allows to obtain the most effective answers for patients even in times of pandemic. I want to personally thank the colleagues from the Spallanzani Hospital, especially Professor Giuseppe Ippolito, and colleagues from the San Camillo Hospital, with whom we are pleased to share this positive result. “

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