BENGALURU: Bone marrow transplant is a curative intent treatment for a lot of blood diseases. The common indications are blood cancers like acute leukemias, lymphomas and myeloma. In addition non-cancerous blood disorders like thalassemia and aplastic anemia also need BMT as a curative option. BMT is a complicated treatment lasting over 3-6 months during which the patient’s immune system is compromised. During the hospital stay for BMT the patient needs blood product support like red blood cells and platelets. These patients need to regularly follow with hospital visits.
The pandemic has affected this treatment significantly over the past one-and-a-half years. When the vaccine was not available there was risk of health care workers picking up infection and transmitting to the patients. The patients themselves had a risk of infection coming to the hospital. Hence follow up patients were advised video consultations. Another problem was the lockdown. When it was imposed the number of people donating blood dropped by 80 per cent in most banks. This produced a shortage, forcing hospital staff to donate blood for emergencies. All elective surgeries had to be deferred and non-urgent BMTs were postponed.
The second problem produced by the pandemic was infection of the BMT patients and sometimes even the donors. If the donors got infected then the BMT had to be postponed by at least a month. BMT patients are immunocompromised. There is a higher mortality of Covid infections in BMT patients. Western literature reports 20 to 30 per cent mortality rates and Indian data, which is awaiting publication, shows mortality in the 30 per cent range. These are patients who are otherwise doing well but dying due to Covid-19. BMT patients will have to get revaccinated six months from BMT. The recommendation for the Covid vaccine is also similar though some recommend that it can be given after three months from BMT. In fact, The Indian Society for Blood and Marrow Transplant (ISBMT) has provided guidelines for BMT patients titled HSCT Guidelines for Transplant Practices during the Covid-19 Pandemic in India.
But larger measures would be required. Firstly complete vaccination of all healthcare workers. Next would be to target the patient and caretaker population. We need to encourage voluntary blood donors to take the vaccine and come forward for regular blood donation. Because of black, yellow and white fungus, there is shortage of anti-fungal drugs like amphotericin, which is used in bone marrow transplant patients. We need special provisions to make this drug available for transplant and chemotherapy patients. (The author is the senior consultant haematologist and clinical director, MSMC, Narayana Health City)