ABSTRACT
BACKGROUND: The pulmonary changes in COVID-19 are associated with cytokine release syndrome that could be treated with JAK inhibitors through the blockade of type I interferon and IL-6, IL-1, TNF and GM-CSF. CLINICAL CASE: A 32-year-old female with previous iron-deficiency anemia. She presented cough, tachypnea, fever, diarrhea and low oxygen saturation to 86% by pulse oximeter. PCR for SARS-CoV-2 was reported positive and bilateral pneumonia was seen on CT-scan. Diagnosis of COVID-19 pneumonia was confirmed. At diagnosis with erythrocyte sedimentation rate (ESR) 33 mm/hour, CRP 8.4 mg/dL, LDH 317 U/L, DD 412 ng/mL, lymphocytes 0.8 x 103/uL, hemoglobin 7.4 g/dL with rest of bloodcount being normal. Ruxolitinib at 5 mg BID for 14 days was given. The patient was discharged after 7 days of hospital-length without supplemental oxygen and improvement in CT-scan and proinflammatory values: ESR 18 mm/hour, CPR 0.7 mg/mL, LDH 187 U/L, DD 308 ng/dL, lymphocytes 1.8 x 103/uL, hemoglobin 11.4 g/dL. CONCLUSIONS: Ruxolitinib proved to be a safe and efficient treatment for SARS-CoV-2 pneumonia with limitation of the cytokine release syndrome demonstrated by clinical evolution and proinflammatory markers. © 2020 Comunicaciones Cientificas Mexicanas S.A. de C.V.. All rights reserved.
ABSTRACT
The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has already affected 180 countries. Older patients and patients with cancer or immunosuppression are at greater risk of severe forms of the disease. Patients with acute leukemia are challenging to manage during the pandemic. Recommendations for the management of these patients are based on expert opinion. This is a population in which polymerase chain reaction tests for SARS-CoV-2 must be performed routinely and cytotoxic chemotherapy should be deferred as far as possible in positive patients. On the other hand, some of the frequently used drugs such as corticosteroids, rituximab or asparaginase, can potentially complicate the course of COVID-19, so consideration should be given to deferring or adjusting them in higher-risk populations. In the same way, considering the particularities of each center, in certain cases it may be reasonable to give preference to outpatient regimens that also allow us to decrease the transfusion requirement. Finally, many of the patients with acute leukemia are candidates to receive allogeneic hematopoietic stem cell transplantation (alloHSCT). The limitation of the spaces in intensive care units must be considered, as well as the degree of immunosuppression derived from the transplant. The recommendation is not to defer alloHOCT in patients with an increased risk of relapse. Later, we will learn about the consequences on of the modifications in treatment on leukemia derived from the pandemic.