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).
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.