EBMT-WMDA Transplant Coordinator Day - Monday 31 August, 09:30-10:30H, Auditorium 5
The impact of COVID-19 is being covered by multiple sessions at this year’s special online EBMT congress. In this Monday morning session, the first of the EBMT-WMDA Transplant Coordinators Sessions, three speakers will address the steps taken to ensure the continued supply of stem cells in these unprecedented times, including protecting donors.
Dr Nicoletta Sacchi, Director of the Italian National Bone Marrow Donor Registry (IMBDR), Genoa, Italy, will look back on the impact of SARS-CoV-2 on Italy, the first European nation to be hit hard by the pandemic, with more than 245,000 confirmed total cases and more than 35,000 deaths to date. “The pandemic, mainly located in northern Italy, has had serious implications for unrelated hematopoietic stem cell (HSC) donation and transplantation,” she explains. “I will describe the pandemic from the perspective of IBMDR. We promptly reacted, introducing new operational procedures in order to guarantee the continuity of care for all patients waiting for a HSC transplant, while protecting donors.”
The speed of this transition was rapid. New transport modes were developed within a few days to bring stem cell products safely to the transplant centres, despite border closures, travel bans, quarantine requirements for couriers and reductions in passenger air traffic. Cryopreservation of stem cell products became the new standard during the pandemic to minimise risks due to transport logistics and donor availability.
New procedures for the selection and testing of the donors were set up and "COVID free" safe tracks were identified for both donors and recipients. Dr Sacchi concludes: “These new procedures were immediately shared through WMDA with other international HSC donor registries, with the aim to be of help and inspiration for other subsequently affected countries.”
Following this, Dr Rachel Pawson, Consultant Haematologist and Medical Director of the NHS Cord Blood Bank and British Bone Marrow Registry, UK, will discuss how the COVID-19 pandemic has posed many challenges in the field of HSC transplantation.
“Initial concerns focussed on the safety of the recipient but the protection of their donors – related and unrelated – is vital to ensuring the supply of HSCs,” explains Dr Pawson. “There are risks to donors of contact with healthcare professionals and facilities as well as concerns about the donation processes themselves. Is giving granulocyte colony-stimulating factor (G-CSF) to a healthy individual who may be an asymptomatic carrier of the SARS-CoV2 virus safe? Does a general anaesthetic pose any increased risk?”
Dr Pawson will say that, in the UK, registries have made many changes to donor selection and management pathways to try and minimise the risk to donors. The role of donor testing is controversial but has been adopted in the UK and she will share details of this process. At the same time, transplant centres have also changed their procedures with widespread introduction of cryopreservation of HSC products. This has had an unexpected impact on donors which will be outlined in this presentation.
In the final part of this session, Dr Irina Evseeva, Head of Specialist Services at the blood cancer charity Anthony Nolan, London, UK, will say that one of the ways to mitigate the challenges of adult donor availability (shipment of fresh cells as well as provision of cryopreserved adult cells caused by the COVID-19 pandemic) was consideration of an alternative source of HSCs.
She says: “For many years cord blood stem cells have mostly been used for patients with rare HLA phenotypes due to better tolerance of HLA mismatches. During the COVID-19 pandemic, interest in Cord Blood Units (CBUs) increased as they are not affected by donor availability and are shipped cryopreserved by cargo flights, as well as having well-established protocols of thawing and infusion.”
In the UK, there has been a sharp increase in CBU searches, reservations and shipments during spring-summer 2020 compared to the same period in 2019. In April-June, adult donor provisions showed a decrease of 19%, but CBU usage for UK patients increased by 60%, including national provisions and imports. Dr Evseeva says: “To support this change, the Anthony Nolan registry in collaboration with national cord blood banks introduced a new free service of identifying and reserving (with all releasing tests in place) a suitable national back-up CBU for all adult donors at work-up for UK patients. Our Cord Support Programme was available for all transplant centres free of charge.”