key: cord-0776667-bcq5nbgh authors: Gupta, Aditya Kumar; Ramachandran, Mohanaraj; Gupta, Aditya; Meena, Jagdish Prasad; Dwivedi, Tanima; Bala, Kiran; Kanga, Uma; Singh, Urvashi; Gupta, Ritu; Seth, Rachna title: Allogeneic hematopoietic stem cell transplant after COVID‐19 infection and its effect on the antibody titers to SARS‐CoV‐2 date: 2021-10-20 journal: Pediatr Transplant DOI: 10.1111/petr.14175 sha: 473fd48ae2a80892d3c1c8d13dda59dc0dd2d494 doc_id: 776667 cord_uid: bcq5nbgh nan To the editor, The pediatric guidelines for managing a prospective hematopoi- Here, we report a 12-year-old male child, with relapsed acute lymphoblastic leukemia, who was found to be positive on routine mandatory screening before HSCT, for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by the TrueNat test (Molbio Diagnostics). Subsequently, after clearance of the infection, he underwent the allogeneic HSCT procedure, with his 6/6 HLAmatched sister as the donor using peripheral blood stem cells as the product. On the detection of the infection, he had been admitted to a dedicated COVID-19 isolation facility. He did not have any symptoms or signs of COVID infection and was discharged after 14 days. His total serum anti-SARS-CoV-2 antibody titers (IgG and IgM), estimated using chemiluminescent immunoassay (ADVIA Centaur COV2G assay by Siemens), were reactive, with an index of >10 (>1 taken as reactive). (The assay detects antibodies to spike protein receptor binding domain.) He was subsequently admitted for HSCT, after taking an informed consent. The donor tested negative before her harvest, and her antibody titers were non-reactive. The patient received a TBI + Etoposide-based conditioning with a CD34+ stem cell dose of 2.86 million/kg. The child received methotrexate and cyclosporine for graft-versus-host disease prophylaxis. Post-HSCT, he had mucositis and febrile neutropenia, which were managed appropriately. The engraftment of neutrophils (on day +16) and platelets (on day +19) occurred successfully. The child was discharged on day +31. The chimerism analysis done on day +29 revealed 100% donor cells (XX). We tested the anti-SARS-CoV-2 antibody levels in the patient during the transplant and post-transplant period, and these were maintained above levels considered to be reactive (index range: 4.7 to >10; index >1 was considered as reactive; Table 1 ). The infections. 5 We found evidence of sustained antibody production postallogeneic HSCT in our patient even after myeloablative conditioning and post-replacement by the donor-derived hematopoietic system. The antibody response was sustained and detectable preand post-HSCT. All the authors declare no conflict of interest. AKG, MR, and AG contributed to the conception of the manuscript. All the authors contributed to the drafting of the manuscript and provided critical inputs, and approved the version of the manuscript to be published. Data sharing is not applicable to this article as no new data were created or analyzed in this study. Coronavirus disease covid-19: EBMT recommendations. Version 14 Robust and sustained antibody response to SARS-CoV-2 in a child pre and post autologous hematopoietic stem cell transplant B cell reconstitution and influencing factors after hematopoietic stem cell transplantation in children VH1 family immunoglobulin repertoire sequencing after allogeneic hematopoietic stem cell transplantation Antibody responses to viral infections: a structural perspective across three different enveloped viruses How to cite this article: Gupta