NICE guideline on COVID-19 and haematopoietic stem cell transplantation

  • National Institute for Health and Care Excellence

  • Oncology guidelines update
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NICE has published its set of rapid guidelines on the provision of bone marrow transplant during the COVID-19 pandemic.

Key recommendations include:

  1. Support patients’ mental health.
  2. Avoid face-to-face consultations where appropriate.
  3. Advise patients to contact their dedicated transplant programme helpline rather than NHS 111 for full assessment.
  4. Immunocompromised patients may have atypical presentations of COVID‑19.
  5. Patients not known to have COVID‑19
  • ≥2 weeks prehaematopoietic stem cell transplantation (HSCT), patients should follow UK government guidance on shielding and protecting.
  • Test patients for respiratory viruses and COVID‑19 at least once 72 hours before starting conditioning.
  1. Autologous transplant recipients
  • Defer all but exceptional cases of autologous HSCT for myeloma, low-grade lymphoproliferative diseases, and nonmalignant indications.
  1. Allogeneic transplant recipients
  • Defer most cases of allogeneic HSCT for any nonurgent indications and chronic haematological malignancies.
  • Defer allogeneic HSCT for 3 weeks for patients who have been in close contact with somebody with COVID‑19 within the last week.
  1. Patients known or suspected to have COVID‑19
  • Defer HSCT by ≥3 months in patients who test positive for COVID‑19, except where high risk of disease progression, morbidity, or mortality exists.
  1. Donors not known to have COVID‑19
  • Advise sibling donors that for at least 4 weeks before donating, they should follow the UK government advice on staying at home and social distancing.
  • Defer by ≥4 weeks for donors who are self-isolating, have previously self-isolated, or have been in close contact with someone with COVID‑19.
  • For cryopreservation donations, test for COVID‑19 at assessment and again at harvest of stem cells or donor lymphocytes.
  1. Donors with COVID‑19
  • Defer donations by 3 months from when symptoms resolve.
  • If HSCT is urgent and there are no suitable available donors, assess risk and liaise with the registry.
  1. Transplant recipients post-transplant
  • Treat in strict protective isolation.
  • Tell patients to follow government guidance on shielding and protecting if:
    • They have had an autologous HSCT within the last year.
    • They have had an allogeneic HSCT within the last 2 years, or are receiving continuous immunosuppressive therapy, have chronic graft versus host disease (GvHD), or there is evidence of ongoing immunodeficiency (or other vulnerable groups).
  • Isolate COVID-19-positive patients in negative pressure cubicles, or neutral pressure cubicles if this is not possible.
  1. Prioritise treatment as follows:
  • Urgent allogeneic HSCT where delaying the procedure presents a high risk of disease progression, morbidity, or mortality.
  • High-grade lymphomas and other urgent cases needing autologous HSCT for curative intent (for example, diffuse large B-cell lymphoma and Hodgkin lymphomas).
  • Chronic conditions including most nonmalignant indications and low-risk malignant indications for allogeneic HSCT (most should be deferred until the risks associated with the COVID‑19 pandemic have passed).
  • Allogeneic HSCT recipients with a relatively low predicted survival (for example, 20% to 30% at 5 years based on pre-HSCT characteristics; all but exceptional cases should be deferred until the risks associated with the COVID‑19 pandemic have passed).
  • Autologous HSCT for myeloma, low-grade lymphoproliferative diseases and nonmalignant indications (all but exceptional cases should be deferred until the risks associated with the COVID‑19 pandemic have passed).