Dr Miller went on to explain that the pandemic may cause some patients may consider medical tourism, which has its own inherent risks. As clinicians know all too well there are some patients who just want their tumor removed as quickly as possible and may be willing to travel significant distances for treatment. “One thing I’ve wondered is whether a patient in that predicament could go to a hospital in a part of the country not severely affected by the coronavirus and have the procedure done there. A major teaching hospital might be able to schedule it quickly if they were provided the scans and pathology report,” said Dr Miller.
Mark James Levis, MD, PhD, who is a program leader in the Hematologic Malignancies and Bone Marrow Transplant Program at Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins in Baltimore, Maryland, told Hematology Advisor that his center has cancelled autologous transplants, which are primarily for multiple myeloma (MM), because these patients have alternate treatment options. “We feel a delay is not likely to have a big impact in their overall survival (OS). Acute leukemia is another story. This is a disease that really can’t wait for definitive therapy. Relapse usually equals eventual death. Therefore, we are continuing to schedule allogeneic transplants, but the large majority of our transplants use related donors or at least have a related donor as an option,” he said Dr Levis.
He said if a patient’s transplant can be delayed by giving them a maintenance regimen, such as a tyrosine kinase inhibitor (BCR-ABL inhibitor, FLT3 inhibitor), they are usually opting for that. At Hopkins, they are also using reduced intensity transplants (RIC) with related donors, most commonly haplo-identical. “The Hopkins platform of post-transplant cyclophosphamide is uniquely situated to safely carry out these transplants with a minimum of supportive transfusions,” said Dr Levis. “Stem cell products from matched unrelated donors from the registry have to be frozen on site and shipped to us, so we are trying to minimize the use of these when possible.”
He went on to explain that as of March 29, 2020, there have not had any big outbreaks among the hematology malignancy patients at Johns Hopkins and this may be due to the fact that the patients already were trained to avoid viral infections prior to the pandemic. “These patients have routinely showed up for visits wearing masks and being careful what they touch, long before coronavirus hit. Hopefully that will continue,” said Dr Levis.
Henry Chi Hang Fung, MD, who is vice chair of the Department of Hematology/Oncology at the Fox Chase Cancer Center in Philadelphia, Pennsylvania, said select patients with hematologic cancers may die without a transplant and to postpone a transplant would require unnecessary bridging chemotherapy, which has the potential to be harmful. “We evaluate our patients on an individual basis and this is based on their disease, disease status, availability of alternative treatments, and availability of resources to continue transplanting our patients. We postpone some transplants and we also are cautiously transplanting some patients,” Dr Fung explained in an interview with Hematology Advisor.
Amanda F. Cashen, MD, Washington University School of Medicine Division of Oncology, Section of Stem Cell Transplantation, said at the Siteman Cancer Center and Washington University in St. Louis they are minimizing patient visits and procedures, including bone marrow biopsies and scans. “We have not cancelled all stem cell transplants, but we are delaying transplants when we don’t think the delay will have an adverse consequence for patients. So far, we have been able to provide the care that our patients need, but we are constantly reassessing the situation as the number of COVID-19 cases increases in our community.”
As the COVID-19 pandemic evolves, oncology care facilities will undoubtedly continue to make changes and adjustments to their policies and procedures; with individualized patient care considerations being at the forefront of those considerations.
This article originally appeared on Hematology Advisor