key: cord-0974085-yo9w8673
authors: Gupta, Aditya Kumar; Ramachandran, Mohanraj; Meena, Jagdish Prasad; Dwivedi, Tanima; Singh, Urvashi; Gupta, Ritu; Seth, Rachna
title: Robust and sustained antibody response to SARS‐CoV‐2 in a child pre and post autologous hematopoietic stem cell transplant
date: 2020-12-22
journal: Pediatr Blood Cancer
DOI: 10.1002/pbc.28848
sha: 9b8bb9a19354ef670b18f450c916ef99912925a7
doc_id: 974085
cord_uid: yo9w8673

nan

To the Editor:

The coronavirus disease (COVID)-19 pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been evolving rapidly, and till date has resulted in over a million deaths worldwide. Previous reports have suggested that the severity of the disease is mild and self-limiting upper respiratory tract infection in most children. 1 The European blood and marrow transplant (EBMT) society guidelines state that if a transplant candidate is diagnosed with COVID-19, a deferral of HSCT by at least 3 months is advisable. 3 Here, we report the case of a child who was able to mount a good antibody response to the novel coronavirus despite being on chemotherapy in the recent past, and the response was sustained during and after his successful autologous HSCT. Before admission for HSCT, the child underwent a mandatory screening test for the SARS-CoV-2 and was found to be positive by the cartridge-based nucleic acid amplification test (CBNAAT). After 2 weeks of home isolation, during which time the child remained asymptomatic, the child tested negative by CBNAAT, on the 17th day.

His total serum SARS-CoV-2 antibody titers (IgG and IgM), estimated using chemiluminescent immunoassay, were reactive with an index of >10 (>1 taken as reactive).

The child was started (6 days after testing negative) on his HSCTconditioning regimen consisting of busulfan at a dose of 1 mg/kg intravenously every 6 h for 4 days (day −6 to day −3) and melphalan at a dose of 140 mg/m 2 intravenously on day −2.

He was infused his prestored stem cells on day 0, and the CD34+ cell dose given was 1 × 10 6 /kg. Post his stem cell infusion, the child developed complications of mucositis, febrile neutropenia, and Clostridium difficile colitis, which were managed with supportive care and appropriate antibiotics. The child also developed rapid respiration, low-grade fever, and facial puffiness on day +16, which was attributed to engraftment syndrome. He received 3 days of low-dose oral steroids for the same. Neutrophil engraftment was achieved on day +18, and platelet engraftment occurred on day +24. His SARS-CoV-2 antibody titers that were repeated on day 0 and day +22 (ie, on the 37th and 55th day from initial positivity) were reactive, with titer indices being greater In our report, we demonstrate that this child on chemotherapy for a high-risk malignancy was able to mount a robust immune response against the SARS-CoV-2 virus and cleared the virus during his period of home isolation. Further, humoral immunity, reflected by the total immunoglobulin levels against the virus, was achieved and sustained at good levels during and after the HSCT.

Few pediatric patients post chemotherapy may be capable of mounting a good antibody response to the SARS-CoV-2 virus after infection. The antibody response helps in clearance of the virus, and facilitates the child in proceeding for HSCT and intensive chemotherapy. As seen in our patient, in some children this response could be sus-tained at good levels even after potentially immunosuppressive HSCT.

Estimation of antibody levels and its correlation with viral clearance in a prospective manner may further help us formulate guidelines that may be more generalizable.

The authors declare that there is no conflict of interest. 

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