Successful re-infusion of hepatitis E contaminated stem cells during autologous stem cell transplantation with ribavirin prophylaxis

Background: Hepatitis E virus (HEV) infection is a common and usually asymptomatic infection but can be fatal in the context of prolonged immune suppression, such as during a hematopoietic stem cell transplant (HSCT). Case Report: We describe the case of a 74-year-old man with primary central nervous system lymphoma (PCNSL) who required an autologous stem cell transplant (ASCT) as part of curative treatment for this condition but was identified to have acute HEV infection at the time of CD34 stem cell harvest. This meant he would be re-exposed to a contaminated product with HEV infection at high viral load precisely at the time of most severe immune suppression. Results: This is the first case of the prospective use of a CD34-contaminated hepatitis E stem cell product with a high viral load (2,950,000 IU/mL) in an autologous stem cell transplant setting. We describe the successful prophylaxis with ribavirin. This case provides a practical management strategy for a HSCT, particularly in the allogeneic setting, where time-critical donor CD34 products are required where acute HEV infection is detected. Our patient remains alive at >12 months post-transplant with no evidence of HEV re-activation.