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Guidance for managing patients

Professional resources and guidance for managing your patient community during the coronavirus pandemic.

The guidance in these pages draws together information from reputable organisations within the UK and wider, as well as advice provided by experts, to support the management of coronavirus in relation to haemato-oncology.

These pages are currently up-to-date and based on the most recent guidance available. We will continue updating this page to share new guidance as it is released.

Last updated 3 August 2020.

Some healthcare teams and hospitals may have already adapted to the current situation in many ways. Here we’ve highlighted some practical recommendations, drawn from more detailed guidelines available on this page.

These recommendations should be interpreted in the context of local Trust guidance and guidance already issued by the government and NHS.

  1. Provide latest advice through email or text to your patient group.
  2. Arrange telephone appointments or video calls for out-patient clinics if possible.
  3. Arrange prescription deliveries and local/home bloods if possible.
  4. Consider extending the interval between monitoring blood tests, particularly to avoid mass gatherings in the waiting area.
  5. Ask patients to wait in their car until the clinician is ready to see them. This arrangement can perhaps take place for collecting medicines too.
  6. Individualised decisions on the benefits and risks of continuation of maintenance chemotherapy will have to be taken if the infection rates are rising in the local area.
  7. Already, patients’ loved ones are being discouraged from visiting the hospital or from accompanying them to appointments but there may be virtual ways of reducing isolation in your patient group.
  8. Encourage patients to ask friends and family to help collect medicines on their behalf and to register to receive government support in their country of the UK.

General guidance from government and NHS on coronavirus

NICE guidance on treatment

NICE rapid guidance on delivering cancer treatment during coronavirus, to protect patients, staff and NHS resource. Read more on NICE guidance.

  1. Autologous transplant recipients - Clinicians are recommended to defer non-urgent cases apart from exceptional cases of myeloma, low grade lymphoproliferative diseases and non-malignant indications, until the risks associated with the coronavirus pandemic have passed.
  2. Allogeneic transplant recipients - Clinicians are recommended to defer most non-urgent cases and patients with chronic haematological malignancies, until the risks associated with the coronavirus pandemic have passed.
  3. Allogeneic transplant recipients - If patients have been exposed to somebody with coronavirus, clinicians are recommended to defer treatment for 3 weeks if possible.
  4. Treatment decisions should be made by a multidisciplinary team that considers each patient on an individual basis and the reasoning behind each decision should be recorded.
  5. The management of transplant recipients/donors in relation to CAR-T cell therapy have been covered in guidelines provided by the European Society for Blood and Bone Marrow Transplantation (23 March 2020).

Acute myeloid leukaemia (AML) specific guidance

Please also refer to the NICE guidance on treatment above, which is also relevant for AML.

From the NICE Interim treatment change options during the COVID-19 pandemic guidelines:

  • Allow the use of venetoclax with either low dose cytarabine or azacitidine instead of standard induction chemotherapy for newly diagnosed acute myeloid leukaemia, to reduce need for prolonged in-patient admission and reduce risk of neutropenia.
  • Use of gilteritinib for relapsed/refractory FLT3+ acute myeloid leukaemia was superseded on 16 July 2020 by NICE's final appraisal document and availability is governed by usual funding processes.

From the NCRI AML Working Party:

Chronic myeloid leukaemia (CML) specific guidance

Please also refer to the NICE guidance on treatment above, which is also relevant for CML.

From the NCRI CML Subgroup:

Hodgkin lymphoma specific guidance

Please also refer to the NICE guidance on treatment above, which is also relevant for Hodgkin lymphoma.

From the NICE Interim treatment change options during the COVID-19 pandemic guidelines:

  • Option to give brentuximab earlier in treatment pathway to replace salvage chemotherapy, to reduce toxicity of treatment and number of admissions needed for intensive treatment.
  • Option to give nivolumab earlier in treatment pathway - after brentuximab to replace salvage chemotherapy - to reduce admission time and reduce risk of neutropenia.

From the subgroup of NCRI Lymphoma Research Group:

  • Guidance for the management of patients with lymphoma during the COVID-19 health emergency: a statement from a panel of UK lymphoma experts (29 April 2020):

Non-Hodgkin lymphoma specific guidance

Please also refer to the NICE guidance on treatment above, which is also relevant for non-Hodgkin lymphoma.

From NICE Interim treatment change options during the COVID-19 pandemic and NICE Delivery of systemic anticancer treatments:

  • Suspend rituximab maintenance to avoid patients attending hospital.
  • Suspend obinutuzumab maintenance to avoid patients attending hospital.
  • Allow the use of polatuzumab (in combination with bendamustine and rituximab) for diffuse large B cell lymphoma as bridging therapy for patients approved for CAR-T therapy, both before and after apheresis.
  • Switch intravenous rituximab to subcutaneous rituximab in follicular lymphoma patients receiving rituximab with lenalidomide to reduce the time patients spend in hospital.
  • Allow option to give oral ibrutinib (with or without rituximab) first line instead of intravenous chemotherapy in patients with mantle cell lymphoma to reduce toxicity of treatment and number of admissions required.

From the subgroup of NCRI Lymphoma Research Group:

  • Guidance for the management of patients with lymphoma during the COVID-19 health emergency: a statement from a panel of UK lymphoma experts (29 April 2020):

Myeloma specific guidance

Please also refer to the NICE guidance on treatment above, which is also relevant for myeloma.

From NICE Interim treatment change options during the COVID-19 pandemic and NICE Delivery of systemic anticancer treatments:

  • Allow oral pomalidomide with dexamethasone as second- or third-line therapy instead of intravenous treatments in patients previously treated with lenalidomide to reduce the need for chemotherapy and reduce admissions and risk of neutropenia.
  • Allow first line lenalidomide and dexamethasone for transplant eligible myeloma patients in preference to regimens that need more hospital attendances and parenteral administrations to reduce toxicity of treatment and number of admissions needed for treatment.
  • Allow second line ixazomib with lenalidomide and dexamethasone for patients who have not been previously treated with bortezomib.

From the UK Myeloma Forum:

Additional resources

Here you can find podcasts and webinars related to haematology and COVID-19:

Information for patients

We have created separate information about coronavirus for blood cancer patients, which covers risk, shielding, coping and government support. The information may be useful for healthcare professionals as well.

Information in alternative formats:

Your feedback

Please do get in touch with us if:

  • there is anything you feel that Blood Cancer UK could be doing to support your work
  • there is a resource that has been helpful to you that is not listed here
  • there is content here that you believe is inappropriate or outdated.

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