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EBMT 2020 | Spain & COVID-19: HSCT, CAR-T and clinical practice

Anna Sureda, MD, PhD, Catalan Institute of Oncology, Barcelona, Spain, discusses how hematopoietic stem cell transplants (HSCT) in Spain have been impacted by COVID-19. This interview was recorded via an online conference call with The Video Journal of Hematological Oncology (VJHemOnc).

Transcript (edited for clarity)

So, Spain has been one of the European countries that unfortunately has had the highest number of infected people and even probably the highest number of healthcare professionals infected by the virus. So as of mid-August, I saw only one. Some days ago, we had almost 350,000 people infected and a little bit more than 50,000 healthcare professional infected. And this situation has happened really in a very short period of time...

So, Spain has been one of the European countries that unfortunately has had the highest number of infected people and even probably the highest number of healthcare professionals infected by the virus. So as of mid-August, I saw only one. Some days ago, we had almost 350,000 people infected and a little bit more than 50,000 healthcare professional infected. And this situation has happened really in a very short period of time.

So the healthcare system in Spain, the public one has had to face really a huge pressure in a very small amount, or a very short period of time. And this pressure has been seen from the primary practice point of view, going to the community hospitals and to the, let’s say university big hospitals, from the hospital wards to ICU.

This really strong pressure has had a significant impact, not only in patients that have been infected with COVID-19, but also in those patients that needed some sort of treatment during the COVID-19 pandemic and probably the treatments or one of the treatments or the treatment strategies that have been affected most are these very specialized and very complex treatment strategies.

And one of the best examples for that, probably the most clear example for that in the hematology setting is stem cell transplantation and other strategies, other cellular therapy strategies such as CAR-T cell therapy.

So going to the numbers, what we have seen, and we have a comparison with the numbers of stem cell transplantation and request for CAR-T cell therapies between 2020 and 2019, is that the number of transplants have significantly decreased starting in March, 2020. Just remember that the official lockdown day in Spain was March 13. And we ended up the first national lockdown on the 23rd, of June.

So what we have seen is a significant decrease in the number of a stem cell transplantations. We have clear numbers now, basically regarding unrelated donor stem cell transplant and unrelated stem cell donation that have really decreased basically during March and April 2020.

And they began to recover in May and in June and July, even with highest numbers than the ones that we have in 2019, probably because centers and teams are trying to catch up with the patients that were not able to be transplanted during these period with the highest peak of COVID-19 infection.

And the same situation basically applies for the request of CAR-T cell therapy procedures and for the number of patients that have been treated with CAR-T cell over the past few months. Of course, these analysis are quite preliminary because unfortunately we cannot have these data real time. We are working on that, and we are also working on some of these so called collateral damages that COVID-19 pandemics has had in the stem cell transplantation and cellular therapy and daily practice in Spain. And probably we will be able to have these data pretty soon.

Apart from the change in numbers and from the significant decrease in our activity, of course, we have been able to change the way that patients are being treated and are being followed in the inpatient unit and the outpatient environment.

And I guess that all the Spanish teams have followed all the national and international regulation. So we have selected in a different way, our patients candidates for stem transplantation, trying to prioritize the urgency and trying to decrease as much as possible the additional risk we were giving to the patients just because of the stem cell transplantation itself.

We have established really strong measures not to perform any treatment in somebody that was PCR positive. So we have been doing PCRs in any single patient that had to be admitted to the ward. We have implemented all the telemedicine strategies to try to decrease as much as possible the number of times that the patients were coming to the hospital.

We have switch to oral therapies as much as possible, just basically for the same reason. And we have reduced as much as possible the number of visitors and family members to decrease as much as possible the possibility to have outbreaks in the hospital from people coming from the outside.

 

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