NICE Amends Guidance on Haematopoietic Stem Cell Transplantation During the Pandemic

Dawn O'Shea

August 05, 2020

The National Institute for Health and Care Excellence (NICE) has amended its recommendations on advice and testing for COVID-19 among patients undergoing haematopoietic stem cell transplantation and donors.

As of 29 July 2020, changes have been made to the following sections:

  • Advice for patients to limit the number of family members who attend appointments (recommendation 1.3) and explaining measures to limit infection risk (new recommendation 1.4).

  • Advice for patients on minimising risk of respiratory infections before transplantation (recommendation 3.1).

  • Testing for respiratory viruses before transplantation (recommendation 3.2).

  • Additional investigations for patients who test positive for or are suspected of having COVID-19 (new recommendation 3.7).

  • Tests for donors and actions if the results are positive (new recommendation 4.5 and recommendation 4.6); these recommendations now apply to related donors, not just sibling donors (recommendation 4.1).

  • Risk assessment for donors who test positive (recommendation 4.8) and a reduction in the delay in providing blood products after a positive test (recommendation 4.10).

  • Advice for patients post-transplant (recommendation 5.2).

  • Assessing when staff who test positive or have symptoms can return to work (recommendation 6.2).

  • Routine screening for staff (new recommendation 6.3).

  • Prioritising treatment (table 1).

  • Risk assessments for ambulatory transplant pathways (new recommendation 8.3).

  • What to do when a centre is temproarily closed (recommendation 8.6).

  • Assessing risk in storing cells from a donor with COVID-19 (recommendation 8.9) and the viability of cryopreserved stem cells (new recommendation 8.10).

  • Using granulocyte-colony stimulating factor to minimise the use of chemotherapy priming.

NICE has also removed recommendations (originally numbered 3.3, 3.4 and 7.3) that advised deferring most autologous and allogeneic haematopoietic stem cell transplants, and deferring transplants if further treatment or immunosuppression would put them at more risk from COVID-19 in the community. This is to reflect changes in the risk of infection and the capacity in services.

This article originally appeared on Univadis, part of the Medscape Professional Network.

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