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EBMT 2020 Annual Meeting - The impact of COVID-19 in Haematology, Transplantation and Cellular Therapy

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Events

Special Session - Saturday 29 August, 13:30-14:30H, Auditorium 1

No medical specialty has been spared from the effects of COVID-19, and haematology is no exception. In this session addressing the challenges of the pandemic, four experts from across Europe will discuss their experiences.

The COVID-19 pandemic has presented the haematopoietic stem cell transplant community with an unprecedented challenge, necessitating rapid collection of information and the need to support transplant centres regarding how to deal with the situation, with the aim to, as much as possible, protect this patient population known to be vulnerable to viral infections,” explains first speaker Per Ljungman, Professor Emeritus of Hematology at the Karolinska Institutet and based at Karolinska University Hospital, Stockholm, Sweden.

The Infectious Diseases Working Party at his institute began to collect information and produce recommendations about several topics dealing with the care of stem cell transplant and CAR T-cell treated patients including diagnosis, isolation procedures, and management of both patients undergoing transplantation and those surviving after a transplantation.

“These recommendations have been regularly updated, at first every week, and more recently at longer intervals, to keep up with new knowledge,” he explains. During the process, his team collaborated closely with the American Society for Transplantation and Cellular Therapy (ASTCT), the European Hematology Association (EHA), and the World Marrow Donor Association (WMDA). The EBMT registry also started a prospective data collection of patients diagnosed with COVID-19 and the results of the first 260 patients are now being analysed and a manuscript is being prepared. Professor Ljungman’s presentation will discuss these two topics.

The challenge of COVID-19 for HSCT in Spain will then by addressed by Dr Anna Sureda, Head of the Clinical Haematology Department at the Catalan Institute of Oncology in Barcelona, Spain. Dr Sureda is also Chair of this year’s EBMT Scientific Programme.

Spain has been one of the European countries most affected by COVID-19 pandemic. The official lockdown started on March 13, 2020 when the number of positive cases per day was almost 10,000. Madrid and Catalonia have been the most affected areas. Spain has seen almost 350,000 people infected and almost 29,000 deaths (as of August 2020). 

“This high number of infected people in a very short period of time presented a real challenge for our health care system, from primary care physicians to intensive care units, with re-allocation of resources and disruption of the HCT teams, partly because of infected and quarantined professionals,” explains Dr Sureda. “There has been a significant reduction in the unrelated donor (URD) transplants performed from March to May 2020 compared with the numbers for 2019 and the same pattern was seen in the URD stem cell collections and requests for CAR T-cell procedures.”

The Spanish Group for Stem Cell Transplantation and Cellular Therapy (GETH) (of which Dr Sureda is the current President) promptly published standard operational procedures for diagnosis, treatment and preventive measures for HSC recipients. A retrospective analysis of 367 infected patients with haematological malignancies showed that overall mortality was lower in transplant recipients and that severity of the disease and related mortality were basically associated with patient and disease characteristics.

“The future is quite uncertain, but we will be able to apply what we have learned in this first wave trying to establish a balance between those patients that need a cellular therapy strategy and the additional risk that they have to assume because of that,” explains Dr Sureda. “Strong infectious disease control measures both in the inpatient and outpatient department, implementation of telemedicine and a network of transplant centers will also be taken into consideration.”

Dr Kim Orchard will then present the UK perspective. Dr Orchard is a Senior Lecturer and Consultant Haematologist and Director of Wessex Blood and Marrow Transplant Programme, UK, as well as currently serving as the President British Society of Blood and Marrow Transplantation & Cellular Therapy.

In the UK, the respiratory and multi-system illness COVID-19, caused by the coronavirus SARS-CoV-2, has had and continues to have a major impact on the delivery of health services in the UK, including the delivery of haematopoietic stem cell transplantation (HSCT). The first confirmed case of COVID-19 in the UK was on January 31, 2020, and the incidence of infection peaked in mid-April when nearly 1,000 COVID-19 related deaths were recorded.

“Transplant teams were fully aware of the risk to HSCT patients caused by the new virus. Patients post-HSCT were known to be vulnerable to severe complications from the ‘usual’ respiratory viral pathogens such as RSV, parainfluenza and rhinovirus with morbidity and mortality much greater than in non-transplant individuals. It was therefore highly probable that SARS-CoV-2 would be a serious threat,” explains Dr Orchard. “My presentation will detail the response made by the transplant organisations and teams in the UK, together with the UK data from the EBMT COVID-19 survey.”

Also in this session, the situation in Italy will be presented by Professor Fabio Ciceri, Head of the Hematology and Hematopoietic Stem Cell Transplantation Unit at IRCCS Hospital San Raffaele, and also based at the Vita Salute San Raffaele University, Milan, Italy.