COVID-19 in a patient with chronic myelomonocytic leukemia: a twisting tale

COVID 19 and febrile neutropenia: Case report and systematic review

“…16 case reports were eligible for review ( Table 1 ). 19 cases were reported [ [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] ]. 12 countries represented (USA (n = 3); India, and UK (n = 2); Argentina, Belgium, China, Italy, Japan, Pakistan, Qatar, Spain and Ukraine (n = 1).…”

“…Seven of the cases received steroids and 12 of them received G-CSF for treatment. Five cases were developed respiratory failure after G-CSF use and the failure was suggested to associate with neutrophil to lymphocyte ratio (NLR) [ 19 , 22 , 24 ]. In their case series, Nawal et al reported respiratory decline in all three patients with NLR of >5 at 72 after administration of GCSF.…”

“…In their case series, Nawal et al reported respiratory decline in all three patients with NLR of >5 at 72 after administration of GCSF. Jain et al [ 19 ] reported a possible G–CSF–induced ARDS on the same day of G-CSF administration, with a sudden increase in neutrophils (10-fold) and also in NLR (5-fold). In the report of Mertens et al [ 22 ] an association between increase in neutrophil count following G-CSF administration and concurrent worsening of respiratory failure/pulmonary infiltrates was described.…”

“…In this systematic review, we noted that respiratory distress developing after G-CSF use was described in five patients [ 19 , 22 , 24 ]. Another patient with renal transplant and COVID-19 disease associated with neutropenia without fever has been reported to experience deterioration after G-CSF use [ 40 ].…”

The Care of the Leukemic Patients in Times of SARS-CoV-2

“…MDS/MPN (myelodysplastic syndrome and myeloproliferative neoplasm) overlap entities such as chronic myelomonocytic leukemias have baseline inflammatory cytokine profile and higher expression of ACE2 (angiotensin-converting enzyme 2) expression in monocytes and macrophages [61,62]. Few cases of severe COVID-19 have been reported in patients with CMML and prophylactic cytoreduction is suggested as a strategy to reduce the risk of cytokine storm in the event of COVID-19 infection later [63][64][65] The same principles discussed earlier for MDS can be used for managing patients with these entities.…”