Patient Q&A#2: Are autoimmune or stem cell transplant patients at higher risk from COVID-19?

COVID-19 stem cells autoimmune disease HSCT
Image from Florida Dept. of Public Health.
COVID-19 stem cells autoimmune disease HSCT
Image from Florida Dept. of Public Health.

I’m continuing my stem cell patient Q&A series and today’s Q&A#2 post is focused on whether autoimmune patients generally or specifically those who have received chemo and hematopoietic stem cell transplants (HSCT) are at higher risk from COVID-19? Multiple patients have asked me this. It’s a great question and obviously urgent right now during the outbreak.

BTW, You can read patient Q&A#1 from this Q&A series on the potential for stem cell clinics to put patients at risk of graft-vs-host disease via stem cell injections.

Now back to today’s question.

While there is growing interest in the idea of clinical trials of certain kinds of stem cells to treat COVID-19 patients, mostly in China, what about the flip side?

For the many thousands of people who have already received chemo and HSCT for blood cancers and increasingly for autoimmune diseases in clinical trials, should they be extra cautious about COVID-19 and taking more steps to avoid infection with SARS-CoV-2?

What about autoimmune patients more generally including those taking immunosuppressive drugs– should they take extra precautions too?

The short answer is “Yes” to both.

The extra steps would involve things such as more substantial social distancing. However, there are many variables here and for some people social distancing may have more of a psychological toll. Talk to your physician before making any big changes of any kind.

According to this new piece by Multiple Sclerosis News Today, there could be reason to somewhat change the standard drug regimen for MS or other autoimmune diseases in some very specific cases during the novel coronavirus pandemic, but again you’ll want to first discuss that idea with your physician.

Note that the general CDC advice on COVID-19 can be found here.

While in theory those patients who have received a successful HSCT whether for cancer or autoimmune disease should have a substantially “rebooted” immune system, that may not always be the case. Also, the HSCT regimen for autoimmune diseases is still experimental so less known about the state of the immune systems of those who participated in the clinical trials so far, especially over years post-transplant. Patients with underlying medical conditions seem generally at much higher risk from COVID-19 too.

In addition, some organizations are proposing that patients now considering getting HSCT for autoimmune diseases delay that going forward for a while. For patients with serious blood cancers, such transplant delays may not be possible though. The MS Society of the UK had this to say on a helpful general information page for autoimmune patients in regard to COVID-19.

“Haematopoietic stem cell transplantation (HSCT)

HSCT is an intense chemotherapy treatment for MS. It aims to stop the damage MS causes by wiping out and then regrowing your immune system, using your stem cells. This treatment greatly hampers your immune system for a period of time. You and your neurologist or healthcare professional should consider delaying this treatment.”

Treatments for MS and other autoimmune diseases having nothing to do with stem cells also often involve immunosuppressive drugs as well, which likely leave patients more vulnerable to both getting infected with the coronavirus in the first place and having more severe symptoms. So whether you received HSCT or are taking other drugs for your autoimmune disease, now is the time if you haven’t already for detailed discussions and planning with your healthcare team related to social distancing and more.

Again, those patients who already received some form of chemo and successful HSCT have likely had their immune systems bounce back somewhat over time, but it’s just not possible to be sure for any given patient (without additional testing of your immune system) so taking extra caution makes the most sense to me.  Keep in mind too that the COVID-19 disease-causing virus SARS-CoV-2 is different from other viruses so I’d expect that it’s harder for doctors to predict for any given patient how they’ll do if infected, even if you have your blood count or other tests done, for example.

Disclaimer: I’m not a physician and this post is not intended as medical advice. Patients should talk to their own personal physicians about their risks, plans during the coronavirus outbreak, etc.

4 Comments

    • It’s difficult to say if patients who have received stem cell injections from unproven clinics could be at higher risk for COVID-19. The clinics are so heterogeneous these days that it also likely depends on the clinic. I wouldn’t expect that autologous minimally manipulated bone marrow injections such as into joints would pose any particularly high risk. The potential impact of IV adipose injections like SVF are harder to predict. If they suppress the immune system then that could be bad. If they accumulate in the lungs (as has been reported) and cause some inflammation there then that could also be a problem. Birth-related allogeneic injections at clinics may not always even be of living cells, but if they are of a substantial number of living cells such as from cord blood then there could be some risks. It’s all kind of uncharted territory, but in a general sense avoiding getting unproven stem cell clinic injections during the pandemic is probably wise. Talk to your primary care doctor.

      The other issue is just going to the clinic could expose you to the virus from medical personnel there and other patients.

  1. I’m an HSCT transplant patient, 5 yrs out, but still on a modest dose of prograf (generic name: tacrolimus) due to mild, bu persistent, GVHD. A couple of years ago, when contemplating international travel, I asked my hematologist what my reaction would be to getting exposed to measles (the guidelines for my condition do not permit live vaccines) i.e. would I have a “cytokine storm” i.e. unpleasant to fatal immune inflammation or would I get the disease, she essentially said “Yes”. I imagine the answer is the same for Covid-19 or any eventual live vaccine for it. That is, any medico who tells you one specific thing or another would just be guessing. Better safe than sorry (or worse).

  2. Physicians and other medics performing bone marrow stem cell (BMSC) transplants seem to be ignorant of the underlying science. For one, BMSC transplantation increases p16INK4a expression, a biomarker of T-cell aging (Wood et al, 2016). BMSC transplants can induce a pro-inflammatory state, and many other dangerous phenotypes given the bone marrow is a site of recirculated cells, including cancer cells. Indeed cancer cells have been found to be transplanted from donor to recipient, even under the strict conditions of a hospital-based allogeneic transplant. Much of the same is true for the molecules and exosomes released by BMSCs. Exosome of BMSCs also have MHC Class II Proteins that may induce untoward effects in the adaptive immune system during a time of infection. I review much of this in my recent paper (Maguire, 2019)

    Araf S et al (2019) Transmission of diffuse large B-cell lymphoma by an allogeneic stem-cell transplant. Haematologica. 104(4): e174–e177.

    Maguire G (2019) The Safe and Efficacious Use of Secretome From Fibroblasts and Adipose-derived (but not Bone Marrow-derived) Mesenchymal Stem Cells for Skin Therapeutics. J Clin Aesthet Dermatol. 2019 Aug;12(8):E57-E69.

    Wood WA, Krishnamurthy J, Mitin N et al. Chemotherapy and stem cell transplantation increase p16INK4a expression, a biomarker of T-cell aging. EBioMedicine. 2016;11:227–238.

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