The Impact of the COVID-19 Pandemic on an Immunocompromised Patient with Allogeneic Haematopoietic Stem Cell Transplant: A Dual Perspective from Patient and Physician Standpoints

This collaborative article is co-authored by a haematologist and her patient who was immunocompromised following a bone marrow transplant for acute myeloid leukaemia (AML), which was probably chemotherapy-induced following treatment for a BReast CAncer gene 1 (BRCA1)-mutated breast cancer. The patient shares her story of resilience up to her AML diagnosis and treatment, through the bone marrow transplant, and then on to the challenges faced as an immunocompromised patient during the coronavirus disease 2019 (COVID-19) pandemic. The haematologist offers detailed insights into AML and treatment options, including chemotherapy and allogeneic haematopoietic stem cell transplantation. She comments on the challenging journey of her patient, and the complexities of managing immunocompromised patients during the pandemic, who failed to respond sufficiently to vaccination. In addition, she outlines the prophylactic strategy implemented in her centre, and the introduction of alternative immunisation with monoclonal antibodies for this high-risk immunocompromised patient population. This case provides a unique combination of personal patient experience during the COVID-19 pandemic and medical insights. In this article, a haematologist and her immunocompromised patient discuss the challenges associated with vaccination in highly immunocompromised individuals during the coronavirus disease 2019 (COVID-19) pandemic. The patient developed acute myeloid leukaemia (AML) following chemotherapy for breast cancer. She describes her AML diagnosis and treatment, and subsequent bone marrow transplant, and how she managed as an immunocompromised person during the pandemic, including the issues associated with COVID-19 vaccination and how these were managed, and her ongoing approaches to protecting herself from infection. The patient's haematologist outlines the characteristics of AML and the treatment options for the disease, including chemotherapy and allotransplantation, and the immunosuppression that followed the latter. She comments on the experiences of her patient and on the complexities of managing immunocompromised patients during the COVID-19 pandemic, particularly how to manage insufficient response to vaccination. The haematologist describes the COVID-19 vaccination plan implemented by the transplant centre in which she works, and the centre's introduction of alternative immunisation using a combination of the monoclonal antibodies tixagevimab and cilgavimab for high-risk immunocompromised patients. After 5 years of monitoring, the patient is showing signs of recovery from AML. Currently, she does not require immunosuppressant treatment, she is gradually responding to vaccines and her immune function is normalising. This article provides medical insights into the vaccination challenges in highly immunocompromised patients and offers hope for the prophylaxis and treatment of COVID-19 in this patient population.