Patients Struggle to Access BMT During COVID-19
By Addi Watters, RN, OCN®, BMTCN®
Cancer does not stop progressing because of a pandemic. Although the COVID-19 coronavirus does not recognize that someone with leukemia has been fighting for months, even years, for remission to receive a lifesaving blood and marrow transplantation (BMT), a new program is ensuring that marrow products are available when patients need them.
On March 19, 2020, the Centers for Disease Control and Prevention granted a travel ban waiver (https://bethematch.org/news/news-releases/trump-administration-grants-waiver-of-european-travel-ban-to-be-the-match-to-continue-delivering-life-saving-bone-marrow-to-u-s--patients/) to allow couriers from Europe to transport (https://www.theguardian.com/world/2020/mar/18/cancer-stem-cells-coronavirus-logistical-nightmare#maincontent) bone marrow into the United States. Prior to the waiver, couriers and the marrow they were transporting waited 14 days in isolation (https://www.theguardian.com/world/2020/mar/18/cancer-stem-cells-coronavirus-logistical-nightmare#maincontent) to ensure that they and the products they carried were not infected with COVID-19.
Why This Matters
According to the Blood and Marrow Transplant Information Network (BMT InfoNet), which offers support and resources (https://www.bmtinfonet.org/about-us) for BMT recipients, transplant recipients have an increased risk for complications from COVID-19 until they’ve been off immunosuppression for at least two years. MD Anderson Cancer Center in Houston, TX, explained that the immune system isn’t adequate (https://www.mdanderson.org/publications/cancerwise/covid-19-and-stem-cell-transplants-what-you-should-know.h00-159380367.html) enough to respond to threats for at least the first six months following a transplant.
Areej El-Jawahri, MD, director of the Bone Marrow Transplant Survivorship Program at Massachusetts General Hospital, said in a recent BMT InfoNet webinar (https://www.bmtinfonet.org/video/coronavirus-what-transplant-recipients-need-know) that many transplant centers across the United States are delaying elective transplants, although most transplants are considered urgent.
What Else Can Be Done
Some experts proposed additional options (https://www.nature.com/articles/s41409-020-0873-x.pdf), such as pre-emptively cryopreserving donor cells to allow time for more rigorous pretransplant infectious workups or using more cord blood products that were collected before COVID-19 infections. However, no current studies have investigated whether COVID-19 is transmissible through donor products.
Additional Action and Resources
The European Society for Bone and Marrow Transplantation (EBMT) updated its COVID-19 guidelines and recommendations on April 7, 2020. EBMT also partnered with organizations on a series of webinars (https://www.ebmt.org/covid-19-webinars) about how the pandemic is affecting various aspects of BMT.
Organizations like the World Marrow Donor Association (https://wmda.info/) and the Center for International Blood and Marrow Transplant Research are also advocating to break down barriers for patients and donors navigating BMT. More information is available from the American Society for Transplantation and Cellular Therapy (ASTCT).
The Transplant Associated Learning Network Team, according to ASTCT (https://www.astct.org/communities/public-home?CommunityKey=d3949d84-3440-45f4-8142-90ea05adb0e5), is an international initiative for BMT professionals to share guidelines and resources related to COVID-19. To get involved, email Hannah Ingraham (mailto:Hannah.ingraham@cchmc.org), RN, at the Cincinnati Children’s Hospital Medical Center.
How Oncology Nurses Can Help
As a nurse, you are more than a caregiver. You are an advocate and liaison between the disciplines. Coordinate a meeting with patients and their families, providers, and care team to discuss options. You may not have all the right answers, but providing clarity in an uncertain future goes a long way.
Patients may ask difficult questions like “Will I get my transplant?” During times of high anxiety and stress, lack of communication can invoke panic, but an open and honest conversation about each patient’s plan of care can prevent emotions from escalating.