Infection Risks, Impact of COVID-19 in Stem Cell Transplants for Blood Cancers

CURE® recently invited patients, survivors, caregivers, advocates and health care professionals to attend its first-ever live webinar, “Hear from the Experts: COVID-19 & Cancer Care for Patients.”

Sponsored by Janssen and Pharmacyclics, the webinar was designed to provide those affected by chronic lymphocytic leukemia (CLL) and myeloma with information and updates as they pertain to the current landscape of cancer care during the uncertain times of the new coronavirus (COVID-19).

Dr. Saad Usmani, chief of the Plasma Disorders Program and director of clinical research in hematologic malignancies at the Levine Cancer Institute served as the moderator for the webinar. Panelists included:

• Dr. Zainab Shahid, medical director of bone marrow transplant infectious diseases at the Levine Cancer Institute
• Dr. Farukh Awan, director of the Lymphoid Malignancies Program at the Harold C. Simmons Comprehensive Cancer Center at UT-Southwest
• Dr. Ian Flinn, director of the Lymphoma Research Program at Sarah Cannon Research Institute
• Dr. Lee Greenberger, chief scientific officer at the Leukemia and Lymphoma Society

In the first part of this series, Dr. Farukh Awan addressed concerns about the possibility of developing COVID-19 or any infection after a stem cell transplant to treat a blood cancer.

Awan: We have to be clear what kind of a stem cell transplant we're talking about. If we're talking about an autologous stem cell transplantation, the risk of infections is definitely higher in patients not just during the chemotherapy period and right after, but even for the immediate post-transplant phase.

I would argue that maybe up to three to six months after the transplant they would still be considered immunocompromised, if not longer, even though their numbers might have recovered by then; the T-cell function and the other immune cells in the body take a long time to recover.

Anyone who is going through a transplant, or who has to go through a transplant, we have to be extremely cautious with them. We have to take very close care of those patients. We have to make sure that their exposure is minimized. We have to make sure that there is not an issue with the availability of blood product in the area where we're planning to do this transplant. Those are the precautions that we would have to take for those patients, so if a patient can put off the transplant by a few months safely then I would probably go with that.

Similarly, on the allogeneic transplant side, that's an even bigger undertaking. But I know that for a lot of those patients, especially patients who have an acute leukemia or who have really aggressive lymphomas, without an allogeneic transplant they may not have good disease control. So, we have to control the disease when we also realize that the complications from allogeneic transplant and the immune suppression that is needed will go on for months and years following the transplant.

I think it will impact a lot of our patients, patients who have already gone through a transplant and are immunocompromised, and even patients who are going through an autologous transplantation for myeloma or for lymphoma, I think all of those patients, in my opinion, would be considered high risk and I would be very, very cautious with those patients. But I would not necessarily delay all of those transplants. I would do it on a case-by-case basis.