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What are the risks of undergoing a bone marrow transplant usually and now (COVID19)? Should patients proceed with the transplant now, or can it wait until the COVID19 situation improves?

There are several risks related to the transplant.

Patients may develop bleeding and/or infections from the transplant chemotherapy. There are also unique risks related to transplantation using foreign cells (cells from another person) because of the interaction between the donor cells and the patient’s (recipient) body. Donor cells can potentially attack the recipient in a process called graft-versus-host disease (GvHD). After the stem cells are infused, the patient’s immune system needs time to adjust, grow, and mature. Thus, the patient’s immunity remains low for months following the transplant.

In these times of COVID-19, there are several issues that need to be taken into account. These include but are not limited to:

• The potential for the transplant recipient to contract COVID-19. Transplant recipients have weak immunity and may be severely affected if infected with the SARS-CoV2 virus.
• Screening of patients and donors for SARS-CoV2 virus.
• Blood product supply during pandemic. Patients undergoing transplant usually need transfusions of blood products (red blood cells and/or platelets) to help maintain safe levels while waiting for the transplanted cells to grow. The healthy donor pool may be reduced during times of pandemic. However, I personally have not had any issues with blood product supply even during this time.

Given the above risks, the decision whether to proceed with transplant during this COVID-19 pandemic needs to be carefully considered. In most instances however, the risk of not treating the underlying blood cancer (e.g. leukaemia) or delaying the transplant outweighs that of contracting the virus. This is because delays in treatment of aggressive blood cancers usually leads to relapse of the cancer. Discussion with the transplant physician should be carried out in detail.