Understanding bone marrow transplant: The guidelines and the protocols

The following guidelines will provide a pivotal tool for learning about the rapidly updated therapy landscape in Hematopoietic stem cell transplantation (HSCT).

Published: 04th February 2021 04:05 PM  |   Last Updated: 04th February 2021 06:46 PM   |  A+A-

For representational purposes

The outbreak of the Covid pandemic has made many patients reluctant to undergo treatments. While their apprehension seems to overpower them, doctors need to ensure that strict guidelines and protocols which assure the best quality service are followed. 

Among elective surgeries and transplants, bone marrow transplant cases have increased substantially in the past few months. Adhering to guidelines for pre-transplant evaluation and the management of a common complication, graft versus host disease (GVHD) is essential.

With the diversity of practice and expertise, the following guidelines will provide a pivotal tool for learning about the rapidly updated therapy landscape in Hematopoietic stem cell transplantation (HSCT).

The guidelines intended to provide a systematic approach for transplantation and help streamline clinical practices and educate new generations of physicians-in-training. Additionally, guidelines can help to evaluate a potential transplant recipient and determine if the patient is an eligible candidate for the procedure. 

Types and selection of transplantation: 

Selection of the type of transplantation for a patient depends on factors such as the type of malignancy, availability of a suitable donor, age of the recipient, the ability to collect a tumor-free autograft, the stage, the malignancy's susceptibility to the GVM effect,  and status of disease -- bone marrow involvement, the bulk of disease, chemosensitivity to conventional chemotherapy. This method is particularly applicable for Autologous or Allogeneic Transplantation where one can have a sibling donor or a matched unrelated donor. In the case of a matched unrelated donor, ensure that the collection is adequate and stem cells are available well in time especially if they are imported from countries in Europe.

A haploidentical transplant is another type of transplant that uses healthy, blood-forming cells from a half-matched donor to replace the unhealthy ones. The ideal donor in this case is a family member.

That said, for bone marrow transplant blood products are the backbone and it is important to ensure to have adequate supply before you begin with the transplant. 

What are the guidelines and protocols that can be adopted in current times?

Some measures for consideration are: 
●    Minimize face-to-face visits including monitoring and consider shifting to telehealth where feasible.
●    Some adaptive community measures like the hospital in the home services, community practices for blood collection, imaging, and support services.
●    For radiation oncology treatment, consider reducing fractions when supported by evidence
●    Consider alternative and less resource-intensive treatment regimes.
●    Minimize unnecessary visitors to cancer centers, for instance, limiting to only patients and their essential caregivers based on frailty and language needs
●    Screen for possible symptoms of COVID-19 and triage patients for admission. If necessary, the admission has to be directed to oncology/hematology departments rather than emergency departments. 
●    Immunocompromised patients are likely to have atypical presentations of COVID-19
●    For suspected checkpoint inhibitor-related pneumonitis prioritizes COVID-19 testing for an early decision regarding corticosteroid therapy.

These are some guidelines that you should heed during a bone marrow transplant. While it is imperative to be updated about the guidelines, timely intervention can reduce the other possible complications during the process.

(The author is the Director, Medical Oncology and Hemato Oncology, at Fortis Cancer Institute, Bangalore)


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