Malaria Screening and Treatment in Hematopoietic Cell Transplant Donors and Sickle Cell Disease Candidates/Recipients: A Case Series Using Malaria Polymerase Chain Reaction Testing and a Literature Review.

BACKGROUND

Malaria during hematopoietic stem cell transplant (HCT) poses serious risks. Historically, donors with potential exposure were deferred or treated empirically. Malaria PCR, the most sensitive diagnostic tool, is not routinely used. Patients with sickle cell disease (SCD) and their related donors may be disproportionately affected given endemic exposures and potential occult parasitemia.

METHODS

Performed a single-center retrospective review of malaria screening and outcomes in patients with SCD undergoing allogeneic HCT and their related donors. In addition, reviewed the literature on HCT-related malaria cases.

RESULTS

Among 57 HCT donors tested for malaria, three asymptomatic cases were identified. Two were identified prior to donation via blood smears and PCRs, while one-initially screened with smears alone-was diagnosed retrospectively after transmitting malaria to the recipient. Retrospective malaria PCR of the hematopoietic cell product was positive, suggesting the donor's pre-collection whole-blood malaria PCR may have been positive. Among 52 HCT recipients tested for malaria, two developed peri-HCT malaria-one diagnosed and treated pre-HCT, and another with donor-derived malaria. All cases diagnosed before collection and HCT proceeded successfully after treatment and negative PCR. Literature review identified 10 detailed malaria cases in HCT and two additional series lacking case specifics.

DISCUSSION: Asymptomatic HCT donors and candidates with potential exposure to malaria should undergo screening. Malaria PCR offers greater diagnostic sensitivity than conventional methods. PCR utilization may prevent unnecessary donor deferrals and avoided empiric malaria treatment. Moreover, PCR negativity post-treatment may help confirm donor and candidate eligibility. These observations warrant validation in larger studies.