Managing the front‐line treatment for diffuse large B cell lymphoma and high‐grade B cell lymphoma during the COVID‐19 outbreak

Abstract

Summary The COVID‐19 pandemic has dramatically challenged care for cancer patients, especially those with active treatment who represent a vulnerable population for SARS‐CoV‐2 infection. Aggressive lymphoid neoplasms, such as diffuse large B cell lymphoma and high‐grade B cell lymphoma, need to be treated without delay in order to get the best disease outcome. Because of that, our clinical practice was changed to minimise the risk of SARS‐CoV‐2 infection while continuing haematological treatment. In this report, we analyse the management of front‐line therapy in 18 patients during the COVID‐19 outbreak, as well as the results of the implemented measures in their outcome.

Multicenter Study of the Seroprevalence of Antibodies against Covid-19 in Patients with Lymphoma: An Analysis of the Oncological Group for the Treatment and Study of Lymphomas (Gotel)

“…Although the data can be alarming, it is also important to carry out an adequate diagnosis and treatment of new haematological patients, since many of the treatments will have curative intent. For this, several scientific societies have developed guidelines for the management of patients with haematological malignancies to optimize treatment and minimize the risk of infection by SARS-CoV-2 [ 14 , 21 , 22 , 23 ]. Some of the most notable things are the efforts to avoid diagnostic and treatment delays, educate the patient on possible signs and symptoms of COVID-19, and perform diagnostic tests for the disease, according to local protocols.…”

“…This action makes it possible to give priority to the intensive management of patients to achieve their cure. Only one patient was infected with SARS-CoV-2 coinciding with an episode of febrile neutropenia [ 23 ].…”

The management of hematologic malignancies during the COVID-19 pandemic

“…Delays in diagnostic procedures and therapy might result in significant worsening of the outcome of patients with aggressive lymphomas. de la Cruz-Benito et al propose that the implementation of a few simple rules into general practice, and the good adaptation of the health-care system to the local epidemiological situation may avoid significant disruptions in the treatment of patients with aggressive lymphomas, even in a country as severely affected by the COVID-19 epidemic as Spain [98]. In this study, 18 patients with DLBCL (diffuse large B-cell lymphoma) or plasmablastic lymphoma or high-grade B-cell lymphoma were actively treated with immunochemotherapy (such as R-CHOP (rituximab, cyclophosphamide, vincristine, doxorubicin, prednizon) or R-mini-CHOP) or chemotherapy (DA-EPOCH; dose-adjusted etoposide, cyclophosphamide, vincristine, doxorubicin, prednizon) during COVID-19 outbreaks.…”

“…Mild SARS-CoV-2 infection was diagnosed only in one patient, who was treated with hydroxychloroquine and azithromycin; after resolution of infection, confirmed by two consecutive negative SARS-CoV-2 PCR results, the patients continued chemotherapy without severe complications. In order to minimize the risk of COVID-19 infection in these patients, several rules were implemented to general practice: (1) a checklist of symptoms and temperature screening was performed before accessing the outpatient area; (2) no entry was allowed for any individual with suspicion of COVID-19 and no visitors were permitted; (3) follow-up was carried out remotely by telemedicine in patients who were not receiving active treatment, if possible; (4) patients were tested for SARS-CoV-2 by nasopharyngeal swab before each new treatment [98].…”

Lessons learned for successful treatment of AML in the second wave of COVID-19 outbreak

“…First of all, we designed a strict protocol to minimize the risk of infection amongst our patients [7]. From the beginning, we maintain a free-COVID-19 circuit around hematology areas.…”