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1.
Blood ; 136(Supplement 1):25-25, 2020.
Article in English | PMC | ID: covidwho-1339026

ABSTRACT

IntroductionOutcomes of patients with hematological cancers and Corona Virus Disease-19 (COVID-19) have been dismal with high rates of hospitalization, admission to intensive care unit and high mortality of up to 20% compared to general population, more so pronounced among black and ethnic minorities. There is hardly any data on outcomes of patients with lymphoma and concurrent COVID-19 from eastern mediterranean region. From eastern mediterranean area no similar studies have been reported so far.MethodsHere we describe outcomes of eleven consecutive patients who had history malignant lymphoma (either treated or currently on treatment) and now had developed COVID-19 infection, recently admitted at our tertiary care center between April and July 2020 with minimum of 10 days follow up.ResultsTotal of eleven (n=11) patients were identified with COVID-19 who also had diagnosis of malignant lymphoma. There were 5 males and 6 females and median age was 31 years (Range 19-59). Diagnoses included five cases of diffuse large b cell lymphoma, two cases of primary central nervous system lymphoma, three cases of classical Hodgkin lymphoma, one case of low grade non Hodgkin lymphoma. Two cases were newly diagnosed and had not received any treatment while six patients were on active treatment and three patients had received treatment more than six months prior. Three patients were on Rituximab based therapy at the time of infection and two patients had prior autologous stem cell transplant. Seven patients had mild COVID-19 while four had severe form of disease. All patients were on supportive care and treatment included various options including chloroquine, antibiotics, convalescent plasma, interferon, enoxaparin, Tocilizumab depending on treating physician's discretion. Four patients had home isolation and recovered fully, while seven patients needed hospitalization of which three made full recovery while three needed admissions to intensive care unit (ICU) due to severe COVID-19. Out of three patients in ICU, two needed noninvasive ventilation, one needed mechanical ventilation. At the time analysis one ICU patient made complete recovery and discharged home while two others are still in hospital. After a median follow up of 37 days (range 10-87), no mortality has been recorded so far. Out of four patients with severe COVID-19, one was newly diagnosed and treatment naïve, and one was in remission for more than a year, the remaining two were on active rituximab based chemotherapy for lymphoma. However, 3 out of 4 patients had cleared COVID-19 by polymerase chain reaction testing.ConclusionsOur results suggest that COVID-19 causes significant morbidity in patients with lymphoma like other studies, however there has been no mortality so far in our cohort with relatively long follow up, although some patients are still admitted at the time of analysis. One of the reason for lower mortality could be younger age group. Our study also suggests that over two thirds of the patients had only mild disease out of which majority of them were on some sort of therapy or had undergone recent transplant, making us wonder if recent immunochemotherapy may have some protective effect against cytokine storm or severe COVID-19 by having dampening role on immune system. Half of the patients who had severe disease were not on any therapy while the other two who were on active therapy, although still inpatients, had cleared the virus interestingly. Further studies needed to examine this further, our results from this ethnic community are encouraging.

2.
Blood ; 136(Supplement 1):3-3, 2020.
Article in English | PMC | ID: covidwho-1339025

ABSTRACT

IntroductionOutcomes of patients with hematological cancers and coronavirus disease 2019 (COVID-19) have been reported to be poor with high rates of hospitalization, mechanical ventilation with high case fatality rates, mortality being around 10% or higher. The mortality had been particularly higher among blacks and ethnic minority individuals. There is paucity of data on the outcomes of patients with autologous stem cell transplant and concurrent COVID-19 infections, especially from eastern mediterranean region, no similar studies have been reported so far.MethodsHere we describe outcomes of five consecutive patients of middle eastern ethnic origin who had a history of autologous stem cell transplant and developed COVID-19 infection, who were admitted at our tertiary care center between April and June 2020 with a minimum of 10 days follow-up.ResultsA total of five patients were identified who had undergone autologous stem cell transplantation and had developed COVID-19 infection. There were 3 males and 2 females and the median age was 43 years (range 18-59). Indications for transplant were myeloma (n=3), relapsed Hodgkin lymphoma (n=1), and relapsed diffuse large b cell lymphoma (n=1). Three of five patients had other comorbidities. Median time from transplant was 9 months (range 3-33 months). Four of five patients were on active treatment or maintenance at the time of infection. One patient was on brentuximab, and three were on lenalidomide based therapy. Only one of the five patients had active disease at the time of infection while the rest were in remission. None of the patients had severe disease and four were discharged to home isolation and made full recovery, and one needed admission requiring minimal oxygen and eventually made full recovery. At a median follow up of 70 days (range 12-90) all patients were doing well with no sequelae.ConclusionOur study, albeit small, shows excellent outcomes among patients of middle eastern ethnic origin with hematological cancers who had undergone autologous stem cell transplantation and had developed COVID-19 infection, unlike other studies that have shown high mortality among patients with hematological cancers. However, our cohort is relatively younger, most of them were in remission at the time of infection which may have had a protective effect. At the same time, the majority had transplant within the last nine months and four-fifths of the patients were on some sort of immunosuppressive therapy whilst developing COVID-19 infection. It is possible that a dampened immune system due to transplant and recent therapy might have had a protective effect against cytokine storm or severe COVID-19, in our view. More studies are needed to examine this aspect further, however, these results are encouraging.

4.
Bone Marrow Transplant ; 56(9): 2144-2151, 2021 09.
Article in English | MEDLINE | ID: covidwho-1205432

ABSTRACT

The coronavirus disease-2019 (COVID-19) caused by SARS Coronavirus 2 (SARS-CoV-2) is a potentially lethal infection. Cancer patients, and specifically hematopoietic cell transplant (HCT) recipients are severely immunocompromised and may be at a higher risk of a complicated course with this infection. We aimed to study the COVID-19 outcomes and severity in post HCT patients. We retrospectively reviewed post-HCT patients diagnosed with COVID-19 between March 15, 2020, and December 1, 2020 at 10 transplant centers across the Middle East. We identified 91 patients with confirmed SARS-CoV-2 infection across 10 transplant centers. The median age upon presentation with COVID-19 was 35. Fifty two patients were post allo-HCT while the remaining 39 patients were post auto-HCT. The median time from transplant was 14.9 months. Mortality rate was 4.4%. Hospital admission rate was 53%. ICU admission rate was 14%. Mechanical ventilation rate was 10%. Oxygen supplementation rate was 18%. Time from HCT to COVID-19 >6 months was associated with lower admission rates and lower rates of the "severity" composite endpoint. Antibody responses was seen 67% of evaluable patients. In this series of HCT recipients, we report overall favorable clinical outcomes for patients with COVID-19 and provide preliminary insights into the clinical course of this disease in this specific population.


Subject(s)
COVID-19 , Hematopoietic Stem Cell Transplantation , Humans , Retrospective Studies , SARS-CoV-2 , Transplant Recipients
6.
Saudi J Med Med Sci ; 8(3): 227-238, 2020.
Article in English | MEDLINE | ID: covidwho-782280

ABSTRACT

The Saudi Lymphoma Group had previously published recommendations on the management of the major subtypes of lymphoma. However, the effect the currently ongoing coronavirus disease 2019 (COVID-19) pandemic has on the management of patients with lymphoma has been paramount. Therefore, the Saudi Lymphoma Group has decided to provide clinical practice guidelines for the diagnosis, management and follow-up of patients with various types of lymphoma during the COVID-19 pandemic.

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