Division of Pharmacy, University of Kansas Cancer Center, University of Kansas Health System, Lawrence, Kansas.
Division of Pharmacy, University of North Carolina, Chapel Hill, North Carolina.
Biol Blood Marrow Transplant. 2020 Jun;26(6):1043-1049. doi: 10.1016/j.bbmt.2020.04.005. Epub 2020 Apr 17.
The coronavirus-19 (COVID-19) pandemic poses a significant risk to patients undergoing hematopoietic stem cell transplantation (HCT) or cellular therapy. The American Society for Transplantation and Cellular Therapy Pharmacy Special Interest Group Steering Committee aims to provide pharmacy practice management recommendations for how to transition clinical HCT or cellular therapy pharmacy services using telemedicine capabilities in the inpatient and outpatient settings to maintain an equivalent level of clinical practice while minimizing viral spread in a high-risk, immunocompromised population. In addition, the Steering Committee offers clinical management recommendations for COVID-19 in HCT and cellular therapy recipients based on the rapidly developing literature. As the therapeutic and supportive care interventions for COVID-19 expand, collaboration with clinical pharmacy providers is critical to ensure safe administration in HCT recipients. Attention to drug-drug interactions (DDIs) and toxicity, particularly QTc prolongation, warrants close cardiac monitoring and potential cessation of concomitant QTc-prolonging agents. Expanded indications for hydroxychloroquine and tocilizumab have already caused stress on the usual supply chain. Detailed prescribing algorithms, decision pathways, and specific patient population stock may be necessary. The COVID-19 pandemic has challenged all members of the healthcare team, and we must continue to remain vigilant in providing pharmacy clinical services to one of the most high-risk patient populations while also remaining committed to providing compassionate and safe care for patients undergoing HCT and cellular therapies.
新型冠状病毒(COVID-19)大流行对正在接受造血干细胞移植(HCT)或细胞治疗的患者构成重大风险。美国移植与细胞治疗协会药房特别兴趣小组指导委员会旨在提供药房实践管理建议,指导如何在住院和门诊环境中利用远程医疗能力来过渡临床 HCT 或细胞治疗药房服务,以维持在高风险免疫功能低下人群中保持等效的临床实践水平,同时将病毒传播降至最低。此外,指导委员会还根据迅速发展的文献,为 HCT 和细胞治疗受者中的 COVID-19 提供临床管理建议。随着 COVID-19 的治疗和支持性护理干预措施的不断扩大,与临床药剂师的合作对于确保 HCT 受者的安全管理至关重要。需要密切监测药物-药物相互作用(DDI)和毒性,特别是 QTc 延长,可能需要停止同时使用的延长 QTc 药物。羟氯喹和托珠单抗的扩展适应证已经对常规供应链造成了压力。可能需要详细的处方算法、决策途径和特定的患者群体库存。COVID-19 大流行对医疗保健团队的所有成员都构成了挑战,我们必须继续保持警惕,为最具高危风险的患者群体之一提供药房临床服务,同时继续致力于为接受 HCT 和细胞治疗的患者提供富有同情心和安全的护理。