Navigating the Uncertainty

More than a year has passed since the start of the COVID-19 pandemic, marking an appropriate milestone to reflect on how the healthcare system has evolved, the difficulties we have faced, and what we have accomplished for patients during this challenging time. For our team of hematology and blood and marrow transplant specialists at Stanford Health Care, the past year has been full of obstacles but – importantly – also innovative solutions. 

At the start of the pandemic, we made a crucial decision to continue bringing blood and marrow transplantation (BMT) to patients during COVID-19 as long as we could do it safely. Over the past year, we’ve learned a great deal. The pandemic forced us to quickly adapt our practices, which has made us more efficient in ways that we anticipate will continue to save lives.

For the past six years, I have worked at Stanford as a physician specializing in BMT. Though I am one of the attending physicians on our team, the full experience of transplanting a patient often requires experts who identify suitable donors, address financial and logistical roadblocks and, in general, make the work that I do possible. In addition to donor search coordinators Jennifer McAtee and Leah Schroer, who work tirelessly every day to oversee and manage the intricate details of patient case progression, one of our strongest collaborators is the National Marrow Donor Program (NMDP)/Be The Match – a nonprofit organization that manages the collection and transport of donor cells through a worldwide network of affiliated organizations. From early-morning emergency meetings to late-night texts with Jenn and Leah to confirm a successful match, my work is part of a delicate process enabled by a collaborative network of people all working toward the same goal: saving lives.

The current pandemic has made the importance of that network even clearer. As new challenges – including a >70 percent reduction in commercial flights (rendering cell transport extremely difficult) and restrictions on in-person donor and patient appointments – were introduced in spring 2020, our team remained focused on our commitment to patients, most of whom were not in a position to wait for a lifesaving transplant.

Making transplantation possible during a pandemic required looking beyond our standard practices. We expedited new initiatives to streamline donor matching and cell collection, overcome logistical barriers, and prioritize donor and patient safety. NMDP/Be The Match provided essential support within each of these areas.

For example, we knew we needed to expedite HLA confirmatory typing to quickly match donors to patients and speed the path to transplant. Using NMDP/Be The Match’s FastTrack Testing service allowed us to do that. Our team helped NMDP/Be the Match pilot the FastTrack program prior to the start of the COVID-19 pandemic – and the benefits of that early partnership were greater than we could have imagined.

Another change made by NMDP/Be the Match in response to travel uncertainty was to collect donor cells farther in advance of a patient’s transplant therapy and to have transplant centers cryopreserve donor cells (i.e., freezing cells rather than delivering them fresh) to ensure that they’re available on time for patients. This provided certainty but also introduced new logistical challenges, because some of Stanford’s cutting-edge cell therapy research requires the use of fresh, unfrozen cells. We carefully reviewed each patient’s case to determine who qualified for these clinical trials and whether their donor was close enough to our center to avoid courier travel delays, ensuring that important cancer research could continue despite the pandemic.

Our BMT program also chose to use in-home and remote typing for our related donor transplants through NMDP/Be The Match’s Related Donor Services program, which provides financial and logistical support for donors within families (reducing or eliminating the need for family members to travel). Importantly, the NMDP/Be The Match team developed a novel support system to enable related donor collections during the pandemic, including custom workup programs to ease the process of clearing donors for transplant centers like ours. All these changes provide efficiencies that extend beyond the pandemic.

We also worked closely with NMDP/Be The Match to advance their donor optimization efforts, which included the development of a Donor Readiness Score to calculate key components of donor matching and identify the best candidates as quickly and smoothly as possible.

Though the relevance of these initiatives goes beyond the current pandemic, their advancement during this challenging time was critical. Through the support of our program’s stellar team and our partnership with NMDP/Be The Match, we not only managed to continue providing transplants during the pandemic, but performed over 400 transplants in 2020 – more than any other year of our program’s 30+ year history.

The way I communicate with patients has evolved, too. Although I have always prioritized conversations that allow my patients to feel comfortable, the increased uncertainty introduced by COVID-19 has significantly underscored the benefits of transparent, continuous communication throughout the transplant process. As an avid skier, I like to tell my patients that navigating the steps leading to transplantation is like skiing the bumps – you have to be nimble and flexible throughout the process. As the pandemic has evolved, the team and I learned to anticipate problems sooner and coach patients more smoothly through the bumps, helping them overcome the uncertainty by emphasizing the support systems in place to guide them.

COVID-19 has introduced an unprecedented level of uncertainty and challenge to the transplant field, but it has also led to important positive outcomes for researchers, physicians, and patients. Our collaborative work with NMDP/Be The Match has helped us advance the field of stem cell transplant in ways that will have an impact far beyond COVID-19. Collectively, we are stronger and smarter than we were a year ago – and, through every change, our focus on patients has endured. As our knowledge evolves, we will continue to prioritize sharing our insights with the broader transplant community and encouraging others to share their own experiences as we create space for continued innovation in the years to come.