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SARS-CoV-2 infection can impact survival of patients with acute myeloid leukemia (AML). International experts recommend considering delaying or stopping AML treatment, test patients who need intensive induction and s prioritizing outpatient treatment. However there is little published evidence in AML. Objective To analyze the clinical futures and outcome of SARS-CoV-2 infection in AML patients. Methods and patients Observational multicenter study between March and May 2020; 117 patients reported from 47 Spanish centers, but 13 had no PCR or antibody test documented, finally including 104 patients from 45 hospitals. Results The median age was 68 years, men (56.7% vs 43.3%), and the median time from AML diagnosis to SARS-CoV-2 was 4 months. The mean of comorbidities was 1.2, high blood pressure (40.4%), heart disease (17.3%), diabetes (13.5%), smoking (8.8%), chronic obstructive pulmonary disease or emphysema (7.7%), renal failure (6.7%) and liver dysfunction (1.9%). Cytogenetic risk was low in 16.9%, intermediate in 57.1% and high in 26.0%; 55.7% had active disease, 39.2% complete remission and 5.1% partial response. 29.4% were off-therapy and 70.6% under antileukemic treatment at the time of SARS-CoV-2: induction chemotherapy (25.3%), hypomethylating (19.3%), clinical trial (17.0%), consolidation chemotherapy (14.8%), venetoclax (3.4%), FLT3 inhibitors (3.4%) and/or maintenance (1.1%). Overall 3.7% were newly diagnosed (no prior therapy), 77.8% had received one line of treatment, 14.8% two and 3.7% four. 15.4% had prior allogeneic transplantation. Only 4.0% of the patients were asymptomatic, while the main signs and symptoms were fever (77.8%), pneumonia (75.0%), cough (65.3%), dyspnea (52.0%), diarrhea (20.4%), nausea and/or vomiting (12.2%), rhinorrhea (10.2%) and headache (7.4%). Analytical parameters were: neutrophils 3112 cells/µL (1900-7300), lymphocytes 1090 cells/µL (1000-3000), interleukin 6 118 pg/mL (0-100), ferritin 4505 ng/mL (15-150) and D-dimer 2823 ng/mL (20-500), with liver enzymes altered in 23.9% of cases. 84.2% received specific treatment for coronavirus infection: chloroquine or hydroxychloroquine (82.2%), lopinavir/ritonavir (54.0%), corticosteroids (39.6%), azithromycin (33.0%), tocilizumab (15.8%), plasma convalescent (3.0%), clinical trial medication (3.0%), remdesivir (2.0%) and/or anakinra (1.0%). The course was mild in 14.7% (no hospitalization), moderate in 32.0% and severe in 53.3%. The implementation of intensive measures was assessed in 48.2%(14.9% admitted to the ICU and the remaining 33.3% rejected). The mean time to negativization was 20.5 days, duration of symptoms 17.6 days and the hospital stay 11.1 days. In 48.1% of the cases treatment for AML was maintained, in 26.6% delayed and in 25.3% modified due to coronavirus disease.47.5% died, establishing an association between mortality and age over 60 years (58.3% vs 36.4%, p=0.043), ≥2 lines of treatment (72.7% vs 44.3%, p=0.020), active disease (62.5% vs 29.4%, p=0.002) and pneumonia (61.2% versus 22.7%, p=0.002). Overall 47.5% overcame the infection, and in 5.0% SARS-CoV-2 genetic material was still detected at the time of analysis. A non-significant lower mortality rate was observed among: previous transplantation (45.7% vs 64.3%, p=0.19), neutrophil >1900 cells/µL (41.1% vs 60.0%, p=0.09), lymphocyte >1000 cells/µL (42.9% vs 63.6%, p = 0.09) and hydroxychloroquine/chloroquine plus azithromycin (35.3% vs 60.0%, p=0.10). Conclusions SARS-CoV-2 infection produces high mortality among AML patients. Mortality was correlated with age, active disease and pneumonia. Disclosures Martinez-Lopez: Janssen-cilag: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; BMS: Consultancy, Research Funding; Novartis: Consultancy; Janssen: Consultancy, Honoraria; Incyte: Consultancy, Research Funding.

Introducción: Algunos pacientes con leucemia linfocítica crónica (LLC) terminan el tratamiento con ibrutinib por toxicidad o progresión de la enfermedad (PE). El inicio de otros tratamientos puede asociarse a una rápida PE debido a la interrupción de ibrutinib. Objetivo: Lograr la transición de los pacientes en tratamiento con ibrutinib a regímenes basados en venetoclax mediante un protocolo que minimice el riesgo de eventos adversos. Material y métodos: Cuatro pacientes con LLC que progresaron y requirieron una transición fueron manejados con nuestro protocolo, que consiste en un periodo de cinco semanas de reducción de la dosis de ibrutinib y aumento de la de venetoclax. El venetoclax se inicia a 20 mg diarios con un aumento semanal hasta un máximo de 400 mg diarios y el ibrutinib se reduce durante tres semanas hasta la suspensión definitiva del tratamiento en la semana 4. Los pacientes son monitorizados para identificar el riesgo o la aparición de síndrome de lisis tumoral. Resultados: Todos los pacientes alcanzaron una transición exitosa, sin PE rápida ni eventos adversos. Conclusiones: El protocolo de transición de cinco semanas puede aplicarse exitosamente para los pacientes con LLC que requieren un cambio de ibrutinib a venetoclax.

Background: Some patients with chronic lymphocytic leukemia (CLL) terminate ibrutinib treatment due to toxicity or disease progression (DP). Initiation of other treatments may be associated with a rapid DP due to ibrutinib discontinuation.Objective: This study aims to successfully transition patients from ibrutinib-to venetoclax-based regimens through a clinical protocol that minimizes the risk for adverse outcomes. Methods: Four patients with CLL who progressed and required a transition were managed using our switch protocol which consists of a 5-week period during which the dose of ibrutinib is reduced and the dose of venetoclax increased on a weekly basis. Venetoclax is initiated at 20 mg daily with a weekly escalation to a maximum of 400 mg daily and ibrutinib is decreased over a 3-week period with a definitive suspension of treatment at week 4. Patients are monitored for the risk or onset of de lisis tumoral. Results: All patients were successfully transitioned without rapid DP or adverse events commonly associated with ibrutinib discontinuation. Conclusions: A 5-week transition protocol can be successfully applied for the transition of patients with CLL requiring a switch from ibrutinib to venetoclax due to toxicity or DP.