Screening Strategies for COVID-19 in Patients With Hematologic Malignancies

Abstract

COVID-19 has been declared a pandemic by the world health organization. Patients with cancer, and particularly hematologic malignancies may be at higher risk for severe complications due to their malignancy, immune dysregulation, therapy, and associated comorbidities. The oncology community has been proactive in issuing practice guidelines to help optimize management, and limit infection risk and complications from SARS-COV-2. Although hematologic malignancies account for only 10% of all cancers, their management is particularly complex, especially in the time of COVID-19. Screening or early detection of COVID-19 are central for preventative/mitigation strategy, which is the best current strategy in our battle against COVID-19. Herein, we provide an overview of COVID-19 screening strategies and highlight the unique aspects of treating patients with hematologic malignancies.

The management of hematologic malignancies during the COVID-19 pandemic

“…In this situation, it is necessary to repeat the RT-PCR test, but the optimal time interval between the first and second tests remains unclear [57]. Even if recommendations regarding screening chest CT in hematological patients have not been issued [58], we believe that this approach is of particular importance in this clinical situation [49,50]. CT imaging of the chest in patients with COVID-19-associated pneumonia usually reveals groundglass opacification, possibly with consolidation.…”

Should we screen patients with hematologic malignancies for COVID‐19?

“…hypogammaglobulinemia. [17][18][19] In patients with CLL, the secretion of TGFβ and high IL2 levels are responsible for B-cell proliferation inhibition and T-helper cell downregulation, respectively, partly explaining the resulting various immune deficiencies. 18 In multiple myeloma, The past experiences with previous coronaviruses show controversial outcomes that limit clear conclusions.…”

“…It is widely available, easily performed, and allows a fast diagnosis. 19 Radiologically suggestive features include patchy ground-glass opacities in the two lower lobes bilaterally. 46 Although the available evidence supports a higher sensitivity for chest CT scan over RT-PCR, the American College of Radiology advised against the use of chest CT scan for screening and diagnostic purposes of COVID-19.…”

“…We have previously proposed, in addition to other international societies, a screening strategy for COVID-19 according to a risk-level-based on management. 19 Unfortunately, solid scientific data are lacking on how to screen patients for COVID-19 with all the discussed limitations of RT-PCR and serologic testing. Whereas the international hematology community has shared and discussed expert opinions that provide the roadmap in the short term, the oncology community should close the large knowledge gap in screening for COVID-19 to enable evidencebased algorithms and ensure the safe management of patients with hematologic malignancies.…”

“…The pathophysiology of acquired immunodeficiency in lymphoproliferative disorders is in part inherent to the disease itself. Hematologic malignancies are accompanied by dysfunction in both cellular and humoral immunity, with B cell, T cell, NK cells, and dendritic‐cell function, neutropenia due to marrow infiltration, and hypogammaglobulinemia 17‐19 . In patients with CLL, the secretion of TGFβ and high IL2 levels are responsible for B‐cell proliferation inhibition and T‐helper cell downregulation, respectively, partly explaining the resulting various immune deficiencies 18 .…”