Rewriting the rules for care of MDS and AML patients in the time of COVID-19

Raza, Azra; Assal, Amer; Ali, Abdullah Mahmood; Jurcic, Joseph G.

doi:10.1016/j.lrr.2020.100201

Cited by 16 publications

(24 citation statements)

References 8 publications

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“…However, this study has important limitations including the heterogeneous patient population, hematologic diagnoses and disease states, confounding covariates such as therapy of hematologic cancers, hospitalization, and interval to developing CO-VID-19; therefore, the independent role of the underlying malignancy in the evolution of the viral disease could not be documented. Due to the lack of good-quality data, the question of how to manage hematologic diseases, in particular malignancies, during the COVID-19 pandemic is a challenging issue, even if some not-evidence-based indications have been addressed by scientific societies and opinion leaders [14][15][16][17][18][19][20][21][22][23][24][25][26][27]. A risk-benefit evaluation should consider, on the one hand, that patients may be at a high risk of contracting the infection and dying from it and, on the other hand, that patients may be at a high risk of a fatal hematologic disease progression if not treated appropriately and timely.…”

Section: Epidemiologic and Clinical Characteristics Of 6 Patients Witmentioning

confidence: 99%

“…A further challenging issue is represented by prevention and management of the infection as well as the safe and timely administration of hematologic therapy, considering that guidelines for the management of hematologic patients in the current SARS-CoV-2 outbreak are not evidence based [14][15][16][17][18][19][20][21][22][23][24][25][26][27].…”

Section: Introductionmentioning

confidence: 99%

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COVID-19 in Patients with Hematologic Disorders Undergoing Therapy: Perspective of a Large Referral Hematology Center in Rome

et al. 2020

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Introduction: Patients with cancer may be more susceptible to and have higher morbidity and mortality rates from COVID-19 than the general population, while epidemiologic data specifically addressed to hematologic patients are limited. To investigate whether patients with hematologic diseases undergoing therapy are at increased risk for acquiring SARS CoV-2 infection compared to the general population, a retrospective study was carried out at a referral hematologic center in Rome, Italy, during the period of the greatest epidemic spread (March 8 to May 14, 2020). Methods: All adult and pediatric patients with a diagnosis of a neoplastic or a nonneoplastic hematologic disease who underwent treatment (chemotherapy or immunosuppressive or supportive therapy) during the study period or in the previous 6 months were considered. The prevalence of COVID-19 in the overall outpatient and inpatient population undergoing hematologic treatment compared to that of the general population was analyzed. The measures taken to manage patients during the epidemic period are described. Results: Overall, 2,513 patients with hematological diseases were considered. Out of 243 (9.7%) patients who were screened for SARS CoV-2, three of 119 (2.5%) outpatients with fever or respiratory symptoms and none of 124 asymptomatic patients were diagnosed with COVID-19. Three further patients were diagnosed with COVID-19 and managed in other hospitals in Rome. As of May 14, 2020, the prevalence of COVID-19 in our hematologic population accounted for 0.24% (95% CI 0.23–0.25; 6 of 2,513 patients: 1 case in every 419 patients) as compared to 0.12% (7,280 of 5,879,082 residents; 1 case in every 807 residents) in the general population (p = 0.14). Three of 6 patients diagnosed with COVID-19 required critical care and 2 died while still positive for SARS CoV-2. Out of 225 healthcare providers on duty at our Institution during the study period, 2 (0.9%) symptomatic cases were diagnosed with COVID-19. Conclusion: In our experience, the prevalence of COVID-19 in hematologic patients, mainly affected by malignancies, was not significantly higher compared to that of the general population. Definition of adapted strategies for healthcare services, while continuing to administer the standard hematologic treatments, represents the crucial challenge for the management of hematologic diseases in the COVID-19 era.

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Section: Epidemiologic and Clinical Characteristics Of 6 Patients Witmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

COVID-19 in Patients with Hematologic Disorders Undergoing Therapy: Perspective of a Large Referral Hematology Center in Rome

et al. 2020

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“…No significant differences in baseline characteristics were observed between the patients with hematologic malignancies who developed COVID-19 and those who did not. However, COVID-19 appeared to be more severe, and more deaths were reported, in the patients with hematologic malignancies compared to the cohort of healthcare providers who developed Several papers have appeared, by individuals, groups of specialists or under the auspices of scientific societies, to offer an initial description of the clinical presentation of COVID-19 in patients with hematologic malignancies and to advocate for general recommendations of good clinical practice in this pandemic period, for both adult and pediatric patients (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). One interesting case report involved a SARS-CoV-2 infection in a 39-year-old patient with chronic lymphocytic leukemia (CLL) where the clinical and biochemical manifestations of COVID-19 were partly masked by the coexisting CLL (6).…”

Section: Introductionmentioning

confidence: 99%

“…Specific guidelines have been proposed for chimeric antigen receptor T-cell (CART) therapy (9), acute myeloid leukemia and myelodysplastic syndromes (10)(11)(12)(13)(14), infections (15), chronic myeloid leukemia (16), chronic lymphocytic leukemia (17), and use of BTK inhibitors (18), which may have the potential benefit of blunting the hyperinflammatory response to SARS-CoV-2, but also potentially increasing the risk of secondary infections or impaired humoral immunity (18).…”

Section: Introductionmentioning

confidence: 99%

Management of Patients With Hematologic Malignancies During the COVID-19 Pandemic: Practical Considerations and Lessons to Be Learned

Isidori¹,

Leval

Gergis

et al. 2020

Front. Oncol.

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The COVID-19 pandemic has created unprecedented hurdles to the delivery of care to patients with cancer. Patients with hematologic malignancies appear to have a greater risk of SARS-CoV-2 infection and severe disease due to myelosuppression and lymphopenia. The first challenge, therefore, is how to continue to deliver effective, curative therapy to vulnerable patients and at the same time avoid exposing them, and their health care teams (HCT), to SARS-CoV-2. An additional challenge is the timely completion of the diagnostic and staging studies required to formulate appropriate treatment plans. Deferred procedures and avoidance of multiple trips to the surgical, diagnostic, and laboratory suites require same day consolidation of all procedures. With laboratory medicine absorbed by the need to deploy large scale COVID-testing, the availability of routine molecular tests is affected. Finally, we are increasingly faced with the challenge of making complex treatment decisions in SARS-CoV-2 positive patients with aggressive but potentially curable blood cancers. When to treat, how to treat, when to wait, how long to wait, how to predict and manage toxicities, and how to avoid compromising cure rates remains unknown. We present an outline of the scientific, medical, and operational challenges posed by the COVID-19 pandemic at selected American and European institutions and offer our current view of the key elements of a response. While the peak of the pandemic may be past us, in the absence of a vaccine risks remain, and our alertness and response to future challenges need to be refined and consolidated.

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“…In addition, patients with haematological disorders have previously been found to be vulnerable to infection with other coronavirus types following stem cell transplantation 7 . Therefore, many haematological specialists have issued guidelines to suggest how treatment and follow‐up may be changed, reduced or deferred to ensure a minimum of immunosuppression and optimal shielding of patients 8‐14 …”

Section: Introductionmentioning

confidence: 99%

SARS‐CoV‐2 infection among patients with haematological disorders: Severity and one‐month outcome in 66 Danish patients in a nationwide cohort study

Glenthøj

Jakobsen

Sengeløv

et al. 2020

European J of Haematology

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Objectives Patients with haematological disorders may be particularly vulnerable to respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection; however, this is unknown. Methods We conducted a prospective, nationwide study including 66 patients in follow‐up at Danish haematology departments with a malignant or non‐malignant haematological disorder and with verified SARS‐CoV‐2 infection. Outcomes were intensive care unit (ICU) admission and one‐month survival rate. Results Mean age was 66.7 years, 60.6% were males, 90.9% had comorbidity, and 13.6% had a BMI ≥ 30. The most frequent diagnoses were chronic lymphocytic leukaemia/lymphoma (47.0%), multiple myeloma (16.7%) and acute leukaemia/myelodysplastic syndrome (AL/MDS) (12.1%). Treatment for the haematological disease was ongoing in 59.1% of cases. Neutropenia was present in 6.5%, lymphopenia in 46.6% and hypogammaglobulinaemia in 26.3%. The SARS‐CoV‐2 infection was mild in 50.0%, severe in 36.4% and critical in 13.6%. After one month, 21.2% had been admitted to ICU, and 24.2% died. Mortality was highest in older patients, patients with severe/critical SARS‐CoV‐2 infection, high comorbidity score or high performance status score, purine analogue treatment and with AL/MDS. Although older patients and patients with comorbidities had the highest mortality rates, mortality was considerable among all haematological patients. Conclusion Haematological patients with SARS‐CoV‐2 infection has a severe clinical course.

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Rewriting the rules for care of MDS and AML patients in the time of COVID-19

Cited by 16 publications

References 8 publications

COVID-19 in Patients with Hematologic Disorders Undergoing Therapy: Perspective of a Large Referral Hematology Center in Rome

COVID-19 in Patients with Hematologic Disorders Undergoing Therapy: Perspective of a Large Referral Hematology Center in Rome

Management of Patients With Hematologic Malignancies During the COVID-19 Pandemic: Practical Considerations and Lessons to Be Learned

SARS‐CoV‐2 infection among patients with haematological disorders: Severity and one‐month outcome in 66 Danish patients in a nationwide cohort study

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