April 16, 2020

Keeping Bone Marrow Transplant Patients Safe and Healthy During the COVID-19 Pandemic

By A. Kate MacDougall

One thing we do know for certain about the novel SARS-CoV-2 virus is that people who are immunocompromised, such as those undergoing bone marrow transplant (BMT), are at an increased risk of experiencing severe effects from the virus. And in addition to taking extreme precautions against COVID-19 exposure, BMT patients and their providers are navigating myriad other changes and hurdles in order to ensure continued safe care during the pandemic.

“The pandemic has really affected, from beginning to end, the [bone marrow] transplant process,” said Cathy Featherstone, FNP, Advanced Practice Provider Manager for Adult BMT and Lymphoma and Myeloma Services Memorial Sloan Kettering Cancer Center. “Transplant is such a well-coordinated effort on so many people’s parts, between getting the patient ready, getting the donor ready, and having those two things merge at just the right moment…that any disruption in any of those processes really puts a monkey wrench in everything.”

BMT providers are having to weigh many factors when it comes to scheduling transplants during the pandemic. Is the hospital, which may be treating COVID-19 patients, a safe environment for BMT patients? Can the transplant be delayed and consolidative therapy continued for a month or two until it’s safer for the BMT to take place? And what about the safety of the patient after discharge from the hospital?

“Discharge [after BMT] usually involves having a caregiver with the patient at home, but what if the caregiver is sick? What if there is COVID in the home?” Featherstone said. “Do we have a safe place to discharge a patient to?”

But the new challenges don’t stop there. Beyond keeping the transplant recipients safe and healthy, there may still be issues on the donor side, including donor cell transport delays or donors contracting COVID-19 prior to transplant.

Taking these changes and uncertainty in stride, APs and their fellow clinicians are doing what they can to minimize the patient’s risk of COVID-19 exposure and to support patients through the process. Featherstone said that she and her team are utilizing virtual visits, when possible, with patients from their homes or even from their recovery rooms, as well as checking in more often with BMT patients in recovery who, during the pandemic, are having to recover alone, without visits from family or friends.

“On an AP level, we really have a unique opportunity to [just be] there for the patient, even though we’re trying to limit face-to-face interactions and we need to conserve our PPE and decrease risk of transmission,” Featherstone said. “Just check in more often with patients, be visible to them, even if it’s through the glass window. Let them know that we’re here for them.”

Featherstone also said that as many staff across her institution are being reassigned to care for COVID-19 patients and to other areas to help with continued critical patient care, including her BMT team, it has been impressive to watch everyone coming together for patients.

“How we are [functioning now] is very different than how we operate on a day-to-day basis,” she said. “But…APs have been phenomenal at stepping up to the challenge to meet the needs in this new COVID world.”

Read more from the APSHO Advance: Special COVID-19 Series