Introduction: Although CD could be transmitted by blood products and organs transplantation, HSCT might be performed safely in patients (pts) affected or with donors (D) infected with trypanosoma Cruzi, the etiological parasite. CD reactivation could be triggered by immunosupresion. Early diagnosis and an adequate treatment are essential to overcome this situation.

Patients and methods: From October 2001 to February 2022 a total of 1604 pts and D, ages 9 m. to 77 years-old, were pre-transplant or hematopoietic cells donation  screened for CD with 2 of the available serological tests: immune hemagglutination, immunofluorescence assay, or ELISA. A double positive result was considered as a marker of CD. Pts and D detected positive were further tested by one parasitological method:  Strout (from 2001 to 2010) or PCR specific test (from 2010 to 2022). Only Pts and D with a positive parasitological test were treated with benznidazole 5 mg/kg/D during at least 4 weeks or until reach a negative status.  HSCT or cells donation were postponed unto tested negative. In the post-transplant period, in pts with positive serology, a pre-emptive treatment strategy with benznidazole was implemented. PCR specific test was done every 2 weeks until day + 60 and then monthly until immunosupresion was over (in allogeneic setting). A PCR positive test triggered benznidazole treatment during 4 weeks. Medical records were reviewed looking for clinical signs suspected of CD. ECG and echocardiogram abnormalities were assessed.

Results: Twenty four pts/D (1.49%) were tested positive for CD. In the allogeneic setting 5 out of 457 (1,09%) pts and 5 out of 457 (1,09%) D with CD positive serology were found. Two D were also PCR positive and treated as mentioned before. Two out of 5 allogeneic pts.  with positive serology developed a positive PCR on day +43 and +65 post HSCT and were successfully treated. Fourteen out of 690 autologous transplant pts were serologically positive and 4 of them had a positive PCR and treated. No reactivation was proved in the autologous setting.

Conclusions: 1.49% of the pts and D were tested as CD carriers. PCR test for CD is effective and safe detecting parasites allowing proper and timely effective treatment. Benznidazole was effective and no hematologic toxicity was related to this treatment. No pts diagnosed and treated developed parasitemia again. HSCT could be performed safely, despite profound and prolonged immunosuppression in pts with CD positive serology and also in those with circulating parasites if they were properly treated and monitored.