• In HSCT candidates
In patients not known to have COVID-19 (asymptomatic - the significant considered symptoms are fever, cough, shortness of breath - AND no history of close contact with a diagnosed case of COVID-19):
We would recommend patients for home isolation 14 days before hospital admission, and we would check for CBC, Diff, CRP and COVID-19 test by RT-PCR before admission. A negative result of COVID-19 test (by RT-PCR), 48 hours before the initiation of conditioning regimen is demanded.
In patients known or suspected to have COVID-19 (symptomatic1 OR history of close contact with a diagnosed case of COVID-19): we would check for CBC, Diff, CRP, COVID-19 test by RT-PCR and chest CT scan before admission:
If a patient who is considered high risk for disease progression (i.e. acute leukemia, high-grade lymphomas), would have a positive RT-PCR test for COVID-19 or chest CT scan suspicious of COVID-19, HSCT should be deferred until symptoms are resolved and two separate negative RT-PCR tests, at least one week apart, are obtained.
If a patient whose underlying disease is considered low risk, would have a positive RT-PCR test for COVID-19, HSCT should be deferred for at least three months.
In patients who have a history of close contact with a known case of COVID-19, but their RT-PCR test for COVID-19 is negative, and their chest CT scan is normal, the conditioning regimen should be deferred until 14 days after the mentioned contact, and one negative RT-PCR test should be obtained before the initiation of the conditioning regimen.
We recommend deferring the HSCTs until the risks associated with the COVID-19 pandemic have passed: non-urgent indications (i.e. Multiple Myeloma in first complete remission - As some novel agents like Ibrutinib or Daratumumab aren’t easily available for multiple myeloma patients, we can only defer auto- HSCT for patients in their first complete remission -, low-grade lymphoproliferative diseases, and consolidative transplants for solid tumors such as germ cell tumors) and non-malignant indications.
We recommend deferring the following allogeneic HSCTs until the risks associated with the COVID-19 pandemic have passed: HSCTs from international unrelated donor and HSCTs for non-malignant disorders (i.e. Thalassemia, etc.)