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 HSCT procedures where delaying the procedure presents a high risk of disease progression, morbidity or mortality. This group will include consideration of:

  • high cure fraction or other clinical and long term effectiveness.

2

HSCT procedures where there is risk of disease progression or clinical complications if delayed significantly (as determined by the relevant multidisciplinary team):

  • intermediate cure fraction or effectiveness.

3

HSCT procedures where the risk of disease progression or clinical complications if significantly delayed is low (as determined by the relevant multidisciplinary team), including:

  • procedures where the risks associated with undertaking an HSCT procedure within the current environment are deemed to be higher than the benefits of the procedure

  • procedures that are not of curative intent or limited long-term effectiveness.

Adapted from the BSBMTCT recommendations for the management of adult patients and allogeneic donors during the COVID-19 outbreak. [amended 29 July 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 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.

7.4 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.