Concurrent Diagnosis of Acute Myeloid Leukemia and COVID-19: A Management Challenge

Abstract

The emergence of coronavirus disease 2019 (COVID-19) has created new challenges in the management of serious diseases. We describe a 41-year-old male who presented with fever, watery diarrhea, and epistaxis. Initial workup revealed pancytopenia with >50% blasts on the peripheral smear raising suspicion of acute myeloid leukemia (AML) (later confirmed by bone marrow biopsy as AML with myelodysplasia-related changes) and a positive polymerase chain reaction (PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Given the extraordinary risk, he was treated with remdesivir and convalescent plasma for COVID-19. On admission day 8, repeat PCR for SARS-CoV-2 returned negative and the patient was deemed stable for chemotherapy. Therefore, induction was done with liposomal daunorubicin and cytarabine. However, he did not respond to the therapy and was started on re-induction therapy with decitabine and venetoclax. In our discussion, we review the current principles of treatment of patients with concurrent COVID-19 and AML.

Newly Diagnosed Acute Myeloid Leukemia in a Patient With Severe SARS-CoV-2 Infection

“…As mentioned above, there are a few reports in the literature describing similar patients with undiagnosed acute leukemia and COVID-19 [ 8 , 9 ]. Although the diagnosis of leukemia, in the aforementioned studies, was performed earlier than our case, the prognosis of patients was also poor.…”

“…Recent reports described several patients with hematologic malignancies who also develop COVID-19 [ 6 , 7 ], but to the best of our knowledge, only two cases of COVID-19 with undiagnosed acute leukemia has been reported until now [ 8 , 9 ]. Such a similar case we describe below, suggesting that awareness for an underlying hematologic cancer should also be considered in cases of a persistent and complicated SARS-CoV-2 infection.…”

Potential use of convalescent plasma for SARS-CoV-2 prophylaxis and treatment in immunocompromised and vulnerable populations

“…Immunocompromised patients suffering from oncohematological cancers, due to their inability to mount an appropriate humoral immune response to SARS-CoV-2, represent the ideal candidate for passive immunotherapy by means of CCP transfusion [35]. There is increasing interest toward the CCP use in patients with hematologic malignancies and several investigators have explored this therapeutic possibility [36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55]. Details about disease severity, timing of CCP administration, number of doses, pre-and post-treatment nAb titers were unfortunately not available for the vast majority of patients.…”

COVID-19 neutralizing antibody-based therapies in humoral immune deficiencies: A narrative review

“…Patients with malignancies are particularly vulnerable to infections, including SARS-CoV-2, due to their immunodeficiency status secondary to the underlying disease and anti-cancer chemotherapy [ 17 ]. The lack of a significant neutralizing antibody response and the impaired clearance of SARS-CoV-2 in these immunocompromised patients represents the rationale for the use of passive CP immunotherapy [ 18 , 19 ], which has been explored by several investigators [ [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] ]. The largest published clinical experience is the case series by Tremblay and colleagues [ 17 ].…”