7 Prioritising treatment

7 Prioritising treatment

7.1 Use table 1 to help assess the risks and benefits for patients having haematopoietic stem cell transplantation (HSCT). Take into account:

  • the balance of risks posed by their disease compared with the post-HSCT risks of becoming seriously ill from COVID‑19

  • the risk of needing critical care support and risk of disease relapse

  • service capacity issues, such as limited resources (workforce, facilities, intensive care, equipment).

Table 1 Prioritising treatment for patients having haematopoietic stem cell transplantation

Priority level

Categorisation based on treatment intent and risk:benefit ratio of treatment

1

Urgent allogeneic HSCT where delaying the procedure presents a high risk of disease progression, morbidity or mortality.

2

High-grade lymphomas and other urgent cases needing autologous HSCT for curative intent (for example, diffuse large B-cell lymphoma and Hodgkin lymphomas).

3

Chronic conditions including most non-malignant indications and low-risk malignant indications for allogeneic HSCT (most should be deferred until the risks associated with the COVID‑19 pandemic have passed).

4

Allogeneic HSCT recipients with a relatively low predicted survival (for example, 20% to 30% at 5 years based on pre-HSCT characteristics; all but exceptional cases should be deferred until the risks associated with the COVID‑19 pandemic have passed).

5

Autologous HSCT for myeloma, low-grade lymphoproliferative diseases and non-malignant indications (all but exceptional cases should be deferred until the risks associated with the COVID‑19 pandemic have passed).

Adapted from the BSBMTCT recommendations for the management of adult patients and allogeneic donors during the COVID-19 outbreak (March 2020).

7.2 Consider using transplant outcome predictive tools such as the refined disease risk index (DRI) and the haematopoietic cell transplantation-specific comorbidity index (HCT-CI), when appropriate, to inform decision-making with patients, but be aware of the limitations of these tools.

7.3 Consider deferring HSCT in patients with predicted poor outcomes, or if the risk from further treatment and immunosuppression would put them at more risk from COVID‑19 in the community.

7.4 Discuss the risks, benefits and possible likely outcomes of the different treatment options with patients, families and carers using decision support tools (where available) so that they can make informed decisions about their treatment whenever possible. Communicate decisions with written documentation.

7.5 Make treatment decisions as part of a multidisciplinary team and ensure each patient is considered on an individual basis. Ensure the reasoning behind each decision is recorded.