8 Modifications to usual care

8 Modifications to usual care

8.1 Report all cases of COVID‑19 in patients having haematopoietic stem cell transplantation (HSCT) to the European Society for Blood and Marrow Transplantation prospective survey.

8.2 Think about how to modify usual care to reduce patient exposure to COVID‑19 and make best use of resources (workforce, facilities, intensive care, equipment), such as by minimising in-patient and day-case admissions.

8.3 Risk assess ambulatory transplant pathways to minimise exposure to COVID-19. This review should be reflected in the quality management plans and standard operating procedures in line with NICE's guideline on haematological cancers and JACIE standards. [29 July 2020]

8.4 Work within clinical networks to support stem cell processing and harvesting, specialised diagnostics and cryopreservation.

8.5 Make decisions about modifications to usual care at an organisational level according to current quality management systems within the HSCT programme and other JACIE accreditation requirements. If a centre cannot meet quality standards, temporary closure is an option.

8.6 If a centre is temporarily closed, work within clinical networks to prioritise clinically urgent HSCT and transfer patients as needed. If patients are transferred:

  • tell them who is in charge of their care

  • ensure that they have a named key worker that they can contact with any questions, and

  • take into account their practical needs, for example transport and accommodation. [amended 29 July 2020]

8.7 For patients having allogeneic HSCT, identify a back-up donor or cord blood unit in case there are problems with harvesting or transport.

8.8 Be aware of the availability of any planned conditioning treatments and arrange alternatives based on availability and clinical indication.

8.9 If a donor tests positive for COVID‑19, assess the storage of cells for risk of cross contamination to other stored products and manage accordingly. [amended 29 July 2020]

8.10 Think about undertaking viability testing on cryopreserved stem cells if there is any concern about the collection, transfer or cryopreservation of cells. This includes discretionary viability testing of cell therapy products cryopreserved in laboratories not associated with the transplant centre or at the request of the transplant director. [29 July 2020]

8.11 Ship and cryopreserve all donations before starting conditioning, unless exceptional circumstances mean this is not possible. Cryopreserve separate graded dose aliquots of lymphocytes for potential donor lymphocyte infusions from donor stem cell harvests, when possible. Work with local processing laboratories to warn them of each donation and whether to cryopreserve or not.

8.12 For stem cell mobilisation in adults having autologous HSCT, use granulocyte-colony stimulating factor (G-CSF) alone to minimise the use of chemotherapy priming. See the BSBMTCT recommendations for the management of adult patients and allogeneic donors during the COVID-19 outbreak.

8.13 Use G-CSF mobilised peripheral blood stem cells as the primary choice of haematopoietic stem cells from adult donors, to reduce demand on theatres for bone marrow harvesting.

8.14 For children and young people under 16 years, use the most appropriate source of stem cells based on donor age, access to theatres for bone marrow harvesting, urgency of HSCT and drug licensing considerations. See the UK/Ireland Paediatric BMT Group guidelines on prevention and management of COVID-19 in paediatric HSCT patients.

8.15 Services, including satellite units, should have separate pathways and accommodation for patients who test positive for COVID-19, to minimise the risk of COVID-19 for other patients. These should be reflected in quality management plans and standard operating procedures and should meet JACIE standards. [29 July 2020]