COVID-19 FAQs for Blood / Bone Marrow Transplant and Cellular Therapy Patients

Older adults (age 60 and older) and those with serious chronic medical conditions such as heart disease, diabetes, lung disease and cancer are more likely to get very sick from COVID-19. Patients who are immunocompromised are also at higher risk.

Being immunocompromised means having a weakened immune system. White blood cells fight infections. If white blood cell counts are low or the white blood cells are not functioning well, the body cannot fight infections effectively.

Immunocompromised patients can include those with cancer, being treated with chemotherapy, who are undergoing an autologous or allogeneic stem cell/bone marrow transplant, and those who are undergoing cellular therapy (such as CAR T-cell therapy). Allogeneic transplant recipients who are taking immunosuppressants (medications to prevent donor immune cells from attacking the transplant recipient’s body) are at increased risk because these medications also impair the immune system’s ability to fight threats like viruses, bacteria and fungi.

Immunocompromised patients can also include patients with HIV and those with other known immunodeficiencies.

A recent study of patients with cancer who had COVID-19 found that patients who had undergone chemotherapy or surgery in the previous month had a higher risk compared with those who had not received recent treatment. The risk of severe illness from COVID-19 appears to be higher in patients with more than one chronic medical condition.

Patients undergoing active treatment for cancer are presumably at higher risk than those who are in remission. Patients in their first year after stem cell transplantation or cellular therapy (such as CAR T-cell) could be at higher risk for severe illness and complications if infected by COVID-19. Those who are beyond one year after transplantation and still considered immunocompromised may also have an elevated risk for complications.

That is why it's important to take precautions to prevent infection.

To protect everyone's health and well-being, we encourage you to follow local and state protocols, and avoid being exposed to the coronavirus. Here are other steps to take if you're at higher risk from COVID-19:

• If there's a stay-at-home order in your region, do not go out except for taking care of essential needs.
• Have a 30-day supply of all medications, and request refills at least 7 days before running out.
• Practice social distancing.
• Wear a mask — a bandana, scarf or homemade face covering — if you leave home for any essential purpose.
• Avoid crowded places and close contact with sick or unmasked people.
• Stay home when you're sick.
• Try not to touch your eyes, nose and mouth.
• Wash your hands often with soap and water (for 20 seconds) or use hand sanitizer.
• A caregiver should clean and disinfect frequently touched objects and surfaces, like keyboards, phones, remote controls and door handles, and thoroughly wash glasses and utensils.
• Cover your mouth and nose with a tissue when you cough or sneeze — or use the crook of your arm — and throw the tissue in the trash. Then wash your hands with soap and water.
• Don't travel to places with widespread or sustained community transmission of the novel coronavirus. Visit the CDC's travel advisory page for reliable travel information.
• Practice healthy habits to boost your immune system: Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids and eat nutritious food.

Decisions about postponing cancer treatment, blood and marrow transplant and cellular therapy must be made on an individual basis in consultation with your doctor. If you have questions or concerns, please contact your doctor's office.

The risk of acquiring COVID-19 from a donor is low. Donors are being screened for COVID-19 symptoms and exposure history, including travel. At UC San Diego Health, we are testing our related donors for COVID-19 prior to the donor’s collection. We only accept donors who test negative for the novel coronavirus.

UC San Diego Health, as well as other U.S. and international collection centers, are screening and testing all donors for COVID-19. Donors who have been to high-risk areas or have been exposed to someone diagnosed or evaluated for COVID-19 infection are generally asked to postpone donation for 14 to 28 days after exposure or return from travel. They are tested prior to stem cell donation, as well.

Also, donors are asked to not travel to high-risk areas for at least 14 days before donation and to monitor themselves for symptoms. At UC San Diego Health, we have continued to safely perform lifesaving transplants during this pandemic.

We screen all patients, staff and visitors for COVID-19 symptoms upon arrival every day.

If you are undergoing cancer treatments, you will require periodic COVID-19 testing. This test is also required prior to surgical procedures and before admission to the hospital.

If you test positive for COVID-19, routine COVID-19 testing is discontinued for 90 days and will resume thereafter. During those 90 days, if your physician is concerned about any symptoms you are experiencing, you may be evaluated for recurrent COVID-19 infection. Your physician may also consult with infectious disease specialists who are part of our care team.

Your treatment may be delayed if you test positive for COVID-19 or are exposed to someone with suspected or known COVID-19 infection before transplant or cellular therapy. Your care team will offer specific guidance regarding any delay.

If you are COVID-19 positive and need to be admitted to the hospital, you will be admitted to a specific area of the hospital for your care. If you test positive while hospitalized, you may be moved to a different floor or unit in the hospital for your care.

If you test positive for COVID-19 after transplant or cellular therapy, your follow-up care will require special arrangements.

For a period of time, you may be required to receive your care in certain locations and at specific times. For instance, nursing visits for lab work and infusions may be provided in the Hillcrest infusion center.

Transplant/cellular therapy trained nurses will be available to care for you.

In-person appointments with your physician or advanced practitioner will be scheduled at the Moores Cancer Center at the end of the day.

If you have recently received a stem cell / bone marrow transplant or cellular therapy such as CAR T-cell, current recommendations are to delay COVID-19 vaccination for at least 3 months. Please check with your physician regarding the appropriate timing for vaccination.

Yes, you should continue to take your immunosuppressive medications as prescribed and follow your transplant team’s advice. Try to keep a 30-day supply of all medications, and request refills at least 7 days before running out.

Please contact your physician's office about opportunities for mailed prescriptions. We are also offering curbside prescription pickup at Moores Cancer Center in La Jolla.

No. All therapeutic cancer clinical trials at UC San Diego Health are open for new patients and for continuation of treatment for patients currently on a study. We also continue to open new clinical trials to ensure that our patients can participate in the latest research. Cancer is not taking a timeout during COVID-19.

Yes. Antibacterial wipes should be used to clean the steering wheel, door handles, gear shift and any other buttons or levers that might have been touched by someone else. If you are a post-transplant or post-cellular therapy patient, please follow your health care team’s guidance regarding what type of ride sharing is advisable (such as Uber and Lyft) as well as when it is safe for you to resume driving again.

Yes, masks are a simple, yet effective tactic, in slowing the spread of the virus, so it’s crucial we wear masks to protect ourselves and others. UC San Diego Health requires patients, visitors and staff in our facilities to wear face coverings or masks that cover the nose and mouth.

The CDC recommends that anyone who leaves their home for any purpose should wear a facial covering — such as a bandana, scarf or homemade mask — while maintaining social distancing and hand hygiene.

San Diego County health officials have mandated that people must wear masks in public settings when they're within 6 feet of other people. Businesses also must require their employees and others to wear a face covering at the workplace.

See more information on masks and tips for achieving a proper fit.

We recognize the importance of our classes and support groups and have worked to transition many of our in-person events to Zoom videoconferencing. Please visit Cancer Services Patient and Family Events to learn more.

Caregivers should follow county public health orders and CDC guidelines and are encouraged to do the following:

• Practice social distancing.
• Wear a mask — a bandana, scarf or homemade face covering — if leaving home for any essential purpose.
• Avoid crowded places and close contact with sick people.
• Try not to touch their eyes, nose and mouth.
• Wash hands often with soap and water (for 20 seconds) or use hand sanitizer.
• Routinely clean and disinfect frequently touched objects and surfaces, like keyboards, phones, remote controls and door handles, and thoroughly wash glasses and utensils.
• Cancel non-essential travel, including to places with widespread or sustained community transmission of the novel coronavirus. Check the CDC's travel advisory page for reliable travel information.
• Have enough household items, over-the-counter medical supplies and groceries available to limit the need to go out to the store.
  
• Consider delivery services for groceries and other household items.
• Practice healthy habits: Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids and eat nutritious food.