Objective: To communicate interim guidelines to safely manage transplant candidates
A novel coronavirus of a zoonotic origin, (named SARS-CoV-2) emerged in the beginning of this year and the infection is called coronavirus disease of 2019 (COVID-19). It was classified as a pandemic on March 19 with rapidly increasing number of cases worldwide.
Due to fast spreading of COVID-19, a panel of experts of European Society for Bone and Marrow Transplantation (EBMT) recommends the following guidelines for transplant units, recipients, and donors of hematopoietic cells:
- Visitors should be restricted as much as possible to transplant floors.
- Non-urgent transplants should be deferred as much as possible.
- Minimize the risk by home isolation- Patients planned to be admitted for a transplant or to undergo chimeric antigen receptor-T (CAR-T) cell therapy should try to minimize the risk by home isolation of 14 days before the start of the transplant conditioning. Non-necessary clinic visits should be avoided.
- Testing- All patients should be tested for SARS-CoV-2 and the test results should be negative before start of the conditioning regardless of whether upper respiratory symptoms are present.
- Deferred- If a transplant candidate with planned CAR-T cell therapy gets COVID-19, patients are ought to be deferred for at least three months. However, this is not always possible due to the risk from the underlying disease. Therefore, in patients with high risk disease, Hematopoietic cell transplantation (HCT) should be deferred until the patient is asymptomatic and has two repeated virus PCR negativity at least one week apart (deferral of 14 days minimum). In patients with low risk disease a three-month Hematopoietic cell transplantation (HCT) deferral is recommended.
- Monitoring- In case of close contact with a person diagnosed with COVID-19 any transplant procedures (Peripheral blood stem cell mobilization, bone marrow harvest, conditioning) shall not be performed within at least 14 days, preferably 21 days from the last contact. Patient should be closely monitored for the presence of COVID-19, with confirmed PCR negativity before any transplant procedure is undertaken.
Reference: Coronavirus Disease COVID-19: EBMT recommendations: https://www.ebmt.org/sites/default/files/2020-03/EBMT COVID-19 guidelines v.4.3 (2020-03-23).pdf Accessed May 1, 2020