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1.
Br J Haematol ; 196(3): 559-565, 2022 02.
Article in English | MEDLINE | ID: covidwho-1462747

ABSTRACT

Limited information is available on the impact of the COVID-19 pandemic on the management of chronic myeloid leukaemia (CML). The Campus CML network collected retrospective information on 8 665 CML patients followed at 46 centres throughout Italy during the pandemic between February 2020 and January 2021. Within this cohort, we recorded 217 SARS-CoV-2-positive patients (2·5%). Most patients (57%) were diagnosed as having SARS-CoV-2 infection during the second peak of the pandemic (September 2020 to January 2021). The majority (35%) was aged between 50 and 65 years with a male prevalence (73%). Fifty-six percent of patients presented concomitant comorbidities. The median time from CML diagnosis to SARS-CoV-2 infection was six years (three months to 18 years). Twenty-one patients (9·6%) required hospitalization without the need of respiratory assistance, 18 (8·2%) were hospitalized for respiratory assistance, 8 (3·6%) were admitted to an intensive care unit, while 170 (78%) were only quarantined. Twenty-three percent of patients discontinued tyrosine kinase inhibitor (TKI) therapy during the infection. Twelve patients died due to COVID-19 with a mortality rate of 5·5% in the positive cohort and of 0·13% in the whole cohort. We could also document sequelae caused by the SARS-CoV-2 infection and an impact of the pandemic on the overall management of CML patients.


Subject(s)
COVID-19 , Leukemia, Myelogenous, Chronic, BCR-ABL Positive , Pandemics , SARS-CoV-2 , Aged , COVID-19/diagnosis , COVID-19/mortality , COVID-19/therapy , Disease-Free Survival , Female , Humans , Italy/epidemiology , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy , Male , Middle Aged , Retrospective Studies , Survival Rate
3.
Cancer Med ; 10(18): 6310-6316, 2021 09.
Article in English | MEDLINE | ID: covidwho-1378924

ABSTRACT

BACKGROUND: Patients with hematological malignancies are at an increased risk of SARS-CoV-2 disease (COVID-19) and adverse outcome. However, a low mortality rate has been reported in patients with chronic myeloid leukemia (CML). Preclinical evidence suggests that tyrosine kinase inhibitors (TKIs) may have a protective role against severe COVID-19. METHODS: We conducted a cross-sectional study of 564 consecutive patients with CML who were tested for anti-SARS-CoV-2 IgG/IgM antibodies at their first outpatient visit between May and early November 2020 in five hematologic centers representative of three Italian regions. RESULTS: The estimated serological prevalence of SARS-CoV-2 infection in patients with CML after the first pandemic wave was similar to that in the general population (about 2%), both at national and regional levels. CML patients with positive anti-SARS-CoV-2 serology were more frequently male (p = 0.027) and active workers (p = 0.012), while there was no significant association with TKI treatment type. Only 3 out of 11 IgG-positive patients had previously received a molecular diagnosis of COVID-19, while the remainders were asymptomatic or with mild symptoms. CONCLUSIONS: Our data confirm that the course of SARS-CoV-2 infection in patients with CML is generally mild and reassure about the safety of continuing TKIs during the COVID-19 pandemic. Furthermore, we suggest that patients with CML succeed to mount an antibody response after exposure to SARS-CoV-2, similar to the general population.


Subject(s)
COVID-19/immunology , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/virology , SARS-CoV-2/immunology , Adult , Aged , Aged, 80 and over , COVID-19 Serological Testing/methods , Cross-Sectional Studies , Female , Humans , Immunoglobulin G/immunology , Immunoglobulin M/immunology , Italy , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/immunology , Male , Middle Aged , Prevalence , Young Adult
4.
Blood ; 136(Supplement 1):42-42, 2020.
Article in English | PMC | ID: covidwho-1339017

ABSTRACT

Background. Clinical course of the novel Coronavirus (SARS-CoV-2) Disease 2019 (COVID-19) is extremely heterogeneous, and infected individuals may be asymptomatic or develop acute respiratory manifestations. Elderly people and patients with pre-existing comorbidities, including malignancies, may be at higher risk due to their immunological impairment. On the other hand, still limited evidence suggests that some target drugs used to treat hematological cancers, including tyrosine kinase inhibitors (TKI), may have a direct antiviral action or an indirect immunomodulatory effect on the abnormal inflammatory host response to SARS-CoV-2.Aims. To describe the prevalence of symptomatic and asymptomatic SARS-CoV-2 infection in a cohort of chronic myeloid leukemia (CML) patients.Methods.This is an ongoing prospective study ideated and conducted in the Centers of the regional network Rete Ematologica Veneta (REV). According to the Italian Ministry of Health data as of Jul 22, 2020, prevalence of SARS-CoV-2 infection in Veneto, as documented by molecular test on pharyngeal swab, was 0.4%. For comparison, two other centers from Regions with lower prevalence (Lazio and Friuli-Venezia Giulia) were included. All consecutive CML patients coming to the participating Centers were offered to participate to the study, which was approved by local IRBs. Patients in Treatment Free Remission (TFR) phase (i.e. not taking TKI at the time of pandemic) were included as a control group. After collecting information about risk factors for COVID-19 (travels, work exposure, cohabitation with infected subjects) and respiratory or general symptoms experienced from mid Feb 2020, patients were tested for anti-SARS-CoV-2 IgM and/or IgG antibodies through a immunochromatographic qualitative assay (COVID-19 IgG/IgM Rapid Test Cassette, Menarini Diagnostics, IT;sensitivity IgG 97.2%, IgM 87.9%, specificity IgG/IgM 100%). Patients with positive results underwent a pharyngeal swab for molecular detection of the virus.Results. From May 18 to Jul 29, 2020 a total of 339 patients were enrolled (238 from REV centers and 101 from other centers). Males were 183 (54%), median age was 63.2 (range 26.5-93) years. Median time from CML diagnosis was 8 (range 0.1-29.6) years. The majority of patients were in frontline TKI treatment (n=174, 51.3%), and the remaining were in 2ndline (n=80, 23.6%), 3rdor further line of treatment (n=35, 10.3%), or in TFR (n=50, 14.7%). The type of TKI currently assumed was imatinib (n=134, 39.5%), nilotinib (n=63, 18.6%), dasatinib (n=52, 15.4%), bosutinib (n= 24, 7.1%), ponatinib (n=14, 4.1%) or experimental (n=2, 0.6%). The majority of patients was in major (n=79, 23.3%) or deep molecular response (n=204, 60.2%).Thirteen and 3 patients declared close contact with COVID-19 infected individuals at work and/or at home, respectively. The frequency of newly onset or worsening symptoms during the last months was as follows: anosmia (2.4%), ageusia (2.1%), cough (4.7%), pharyngitis (2.6%), dyspnea (2.4%), fever (3.2%), headache (7.7%), asthenia (13.6%), arthralgia (14.9%), dizziness (6.5%), nausea/vomiting (2.7%), and diarrhea (4.4%).Five patients out of the 238 in the REV cohort (2.1%) had a positive IgG test, and two of them were also IgM-positive. All resulted negative at swab performed after the serological assay. They were 4 males and 1 female, aged between 53 and 72 years. One of them, in treatment with nilotinib, had a symptomatic infection in early March, confirmed at that time by molecular tests, and reported close contact with infected subjects both at work and at home. All the other patients (2 in treatment with imatinib, 1 with nilotinib and 1 with bosutinib) reported no or only mild symptoms and had not performed diagnostic tests for SARS-CoV-2 before. Anosmia, ageusia and fever were the only symptoms significantly associated with anti-SARS-CoV-2 IgG positive test (p<0.001). All the patients from the other two Regions and all the patients in TFR had a negative IgG/IgM test.Conclusions. We reported for the first time the serol gical prevalence of SARS-CoV-2 infection in CML patients. Serological studies in the general Italian population are ongoing and will be used to make comparisons with our cohort. Prospective enrollment in the present study is ongoing and updated results will be presented at the Meeting.Acknowledgment. This work was supported by Fondazione Cariverona (ENACT Project).

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