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4.
Hematology ; 26(1): 870-873, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1493499

ABSTRACT

BACKGROUND: COVID-19 viral pandemic caused many mortalities in cancer patients especially those with hematological malignancies. The immunological response to COVID-19 infection is responsible for the outcome of cases whether mild, severe or critical. CASE PRESENTATION: Two cases presented with moderate COVID-19 viral infection, concomitant with acute myeloid leukemia and T acute lymphoblastic leukemia, respectively. Surprisingly, after the administration of COVID-19 supportive therapy, the cases showed disease remission after a follow-up period of 12 and 5 months, respectively. Additionally, the blast cells dropped to only 3% and 0% in the bone marrow aspirates of those two cases, respectively, after it was 30% in both cases at diagnosis. CONCLUSION: The immune response that emerged against COVID-19 infection could potentially produce anti-tumor immunity in some patients, or the virus may act as an oncolytic virus. However, further investigations are required to explain this phenomenon, which may help in finding a possible new targeted therapy for these cases.


Subject(s)
COVID-19/complications , Leukemia, Myeloid, Acute/complications , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Adult , COVID-19/therapy , Disease Management , Female , Humans , Leukemia, Myeloid, Acute/therapy , Male , Middle Aged , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy , Remission Induction , SARS-CoV-2/drug effects , SARS-CoV-2/isolation & purification
5.
Pediatr Transplant ; 26(2): e14179, 2022 03.
Article in English | MEDLINE | ID: covidwho-1488242

ABSTRACT

BACKGROUND: The SARS-CoV-2 pandemic brought challenges to all areas of medicine. In pediatric bone marrow transplant (BMT), one of the biggest challenges was determining how and when to transplant patients infected with SARS-CoV-2 while mitigating the risks of COVID-related complications. METHODS: Our joint adult and pediatric BMT program developed protocols for performing BMT during the pandemic, including guidelines for screening and isolation. For patients who tested positive for SARS-CoV-2, the general recommendation was to delay BMT for at least 14 days from the start of infection and until symptoms improved and the patient twice tested negative by polymerase chain reaction (PCR). However, delaying BMT in patients with malignancy increases the risk of relapse. RESULTS: We opted to transplant two SARS-CoV-2 persistently PCR positive patients with leukemia at high risk of relapse. One patient passed away early post-BMT of a transplant-related complication. The other patient is currently in remission and doing well. CONCLUSION: These cases demonstrate that when the risk associated with delaying BMT is high, it may be reasonable to proceed to transplant in pediatric leukemia patients infected with SARS-CoV-2.


Subject(s)
COVID-19/complications , Hematopoietic Stem Cell Transplantation/methods , Leukemia, B-Cell/therapy , Leukemia, Myeloid, Acute/therapy , Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/therapy , Adolescent , COVID-19/diagnosis , Fatal Outcome , Female , Humans , Infant , Leukemia, B-Cell/complications , Leukemia, Myeloid, Acute/complications , Male , Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/complications , Time-to-Treatment
6.
In Vivo ; 35(5): 2951-2955, 2021.
Article in English | MEDLINE | ID: covidwho-1436484

ABSTRACT

BACKGROUND/AIM: We present the case of a 19-year-old male patient diagnosed concomitantly with extensive thromboses (including two intra-cardiac masses and Budd-Chiari syndrome), as well as acute myeloid leukemia. This necessitated prompt deployment of a monitoring and treatment strategy which included twice-daily blood count assessment, multiple platelet transfusions and anti-coagulation therapy with dose-adjustment per blood count during both induction and consolidation chemotherapy. Multiple factors are believed to contribute to the development of thrombosis in acute leukemia such as diffuse intravascular coagulation, cytokine release and chemotherapy. CASE REPORT: Our patient presented early on in the COVID-19 pandemic, delaying his seeking out medical treatment and we suspect this to have contributed to his 'catastrophic' thrombotic presentation. Well-structured guidelines to help clinicians manage these patients are lacking, and most data are from retrospective analyses or case reports. Our patient continued full-dose anticoagulant therapy until successfully undergoing allogeneic stem cell transplant. The thrombi eventually diminished in size, and the patient was not diagnosed with any further thrombotic events. CONCLUSION: Our case highlights the feasibility of intensive monitoring and provision of platelet transfusion as necessary in order to safely administer low molecular weight heparin from the outset of chemotherapy.


Subject(s)
COVID-19 , Leukemia, Myeloid, Acute , Thrombosis , Adult , Humans , Leukemia, Myeloid, Acute/complications , Leukemia, Myeloid, Acute/diagnosis , Male , Pandemics , Retrospective Studies , SARS-CoV-2 , Thrombosis/diagnosis , Thrombosis/etiology , Young Adult
7.
Leuk Lymphoma ; 62(8): 1940-1948, 2021 08.
Article in English | MEDLINE | ID: covidwho-1284804

ABSTRACT

Patients with hematological malignancies are at risk for poor outcomes when diagnosed with coronavirus disease 2019 (COVID-19). It remains unclear whether cytopenias and specific leukemia subtypes play a role in the clinical course of COVID-19 infection. Here, we report outcomes and their clinical/laboratory predictors for 65 patients with acute and chronic leukemias diagnosed with COVID-19 between 8 March 2020 and 19 May 2020 at Memorial Sloan Kettering Cancer Center in New York City. Most patients had CLL (38%) or AML (26%). A total of 14 (22%) patients required high flow nasal cannula or were intubated for mechanical ventilation and 11 patients (17%) died. A diagnosis of AML (OR 4.7, p=.028), active treatment within the last 3 months (OR 5.22, p=.047), neutropenia within seven days prior and up to 28 days after SARS-CoV-2 diagnosis (11.75, p=.001) and ≥3 comorbidities (OR 6.55, p=.019) were associated with increased odds of death.


Subject(s)
COVID-19 , Leukemia, Myeloid, Acute , Neutropenia , Adult , COVID-19 Testing , Humans , Leukemia, Myeloid, Acute/complications , Leukemia, Myeloid, Acute/epidemiology , Leukemia, Myeloid, Acute/therapy , Neutropenia/epidemiology , Neutropenia/etiology , Risk Factors , SARS-CoV-2
8.
Blood Cancer J ; 11(6): 115, 2021 06 16.
Article in English | MEDLINE | ID: covidwho-1275905
9.
J Pediatr Hematol Oncol ; 44(2): e532-e536, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1270768

ABSTRACT

A 15-year-old male presented with fatigue and weight loss for 1 month, petechiae and bruising for 2 weeks. He was diagnosed with concurrent new acute myeloid leukemia and coronavirus disease 2019. He was febrile and chest computed tomography scan showed ground glass opacities. Fever resolved after 4 days. Polymerase chain reaction test for coronavirus disease 2019 became negative after 2 days. Induction chemotherapy was initiated on day 8 and was complicated by multisystem inflammatory syndrome in children. The multisystem inflammatory syndrome in children was managed with symptomatic treatment and continued chemotherapy. Patient recovered and end of induction bone marrow showed remission of the leukemia.


Subject(s)
COVID-19/complications , Induction Chemotherapy/methods , Leukemia, Myeloid, Acute/complications , SARS-CoV-2/isolation & purification , Systemic Inflammatory Response Syndrome/pathology , Adolescent , COVID-19/drug therapy , COVID-19/pathology , COVID-19/virology , Humans , Leukemia, Myeloid, Acute/drug therapy , Leukemia, Myeloid, Acute/pathology , Leukemia, Myeloid, Acute/virology , Male , Remission Induction , Systemic Inflammatory Response Syndrome/drug therapy , Systemic Inflammatory Response Syndrome/virology
12.
A A Pract ; 15(4): e01432, 2021 Mar 30.
Article in English | MEDLINE | ID: covidwho-1158241

ABSTRACT

The role of concurrent illness in coronavirus disease 2019 (COVID-19) is unknown. Patients with leukemia may display altered thromboinflammatory responses. We report a 53-year-old man presenting with acute leukemia and COVID-19 who developed thrombotic complications and acute respiratory distress syndrome. Multiple analyses, including rotational thromboelastometry and flow cytometry on blood and bronchoalveolar lavage, are reported to characterize coagulation and immune profiles. The patient developed chemotherapy-induced neutropenia that may have protected his lungs from granulocyte-driven hyperinflammatory acute lung injury. However, neutropenia also alters viral clearing, potentially enabling ongoing viral propagation. This case depicts a precarious equilibrium between leukemia and COVID-19.


Subject(s)
Acute Lung Injury/complications , Blood Coagulation Disorders/complications , Blood Coagulation Disorders/pathology , COVID-19/complications , COVID-19/pathology , Leukemia, Myeloid, Acute/complications , Acute Lung Injury/diagnosis , Acute Lung Injury/pathology , Blood Coagulation Disorders/diagnosis , Bronchoalveolar Lavage , COVID-19/diagnosis , Flow Cytometry , Humans , Leukemia, Myeloid, Acute/diagnosis , Leukemia, Myeloid, Acute/pathology , Male , Middle Aged , Neutropenia/complications , Neutropenia/diagnosis , Neutropenia/pathology , SARS-CoV-2 , Thrombelastography , Virulence Factors
13.
Mycopathologia ; 185(6): 1077-1084, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1064562

ABSTRACT

Although patients with severe immunodeficiency and hematological malignancies has been considered at highest risk for invasive fungal infection, patients with severe pneumonia due to influenza, and severe acute respiratory syndrome coronavirus (SARS-CoV) are also at a higher risk of developing invasive pulmonary aspergillosis (IPA). Recently, reports of IPA have also emerged among SARS-CoV-2 infected patients admitted to intensive care units (ICUs). Here, we report a fatal case of probable IPA in an acute myeloid leukemia patient co-infected with SARS-CoV-2 and complicated by acute respiratory distress syndrome (ARDS). Probable IPA is supported by multiple pulmonary nodules with ground glass opacities which indicate halo sign and positive serum galactomannan results. Screening studies are needed to evaluate the prevalence of IPA in immunocompromised patients infected with SARS-CoV-2. Consequently, testing for the presence of Aspergillus in lower respiratory secretions and galactomannan in consecutive serum samples of COVID-19 patients with timely and targeted antifungal therapy based on early clinical suspicion of IPA are highly recommended.


Subject(s)
COVID-19/complications , COVID-19/mortality , Invasive Pulmonary Aspergillosis/etiology , Invasive Pulmonary Aspergillosis/mortality , Leukemia, Myeloid, Acute/complications , Leukemia, Myeloid, Acute/mortality , SARS-CoV-2/pathogenicity , Adult , COVID-19/blood , Fatal Outcome , Female , Galactose/analogs & derivatives , Humans , Iran , Leukemia, Myeloid, Acute/blood , Mannans/blood
15.
Blood Rev ; 47: 100775, 2021 05.
Article in English | MEDLINE | ID: covidwho-917231

ABSTRACT

Scientific data is limited on the risks, adverse outcomes and racial disparities for COVID-19 illness in individuals with hematologic malignancies in the United States. To fill this void, we screened and analyzed a nation-wide database of patient electronic health records (EHRs) of 73 million patients in the US (up to September 1st) for COVID-19 and eight major types of hematologic malignancies. Patients with hematologic malignancies had increased odds of COVID-19 infection compared with patients without hematologic malignancies for both all-time diagnosis (malignancy diagnosed in the past year or prior) (adjusted Odds ratio or AOR: 2.27 [2.17-2.36], p < 0.001) and recent diagnosis (malignancy diagnosed in the past year) (AOR:11.91 [11.31-12.53], p < 0.001), with strongest effect for recently diagnosed acute lymphoid leukemia (AOR: 31.03 [25.87-37.27], p < 0.001), essential thrombocythemia (AOR: 20.65 [19.10-22.32], p < 0.001), acute myeloid leukemia (AOR: 18.94 [15.79-22.73], p < 0.001), multiple myeloma (AOR: 14.21 [12.72-15.89], p < 0.001). Among patients with hematologic malignancies, African Americans had higher odds of COVID-19 infection than Caucasians with largest racial disparity for multiple myeloma (AOR: 4.23 [3.21-5.56], p < 0.001). Patients with recently diagnosed hematologic malignancies had worse outcomes (hospitalization: 51.9%, death: 14.8%) than COVID-19 patients without hematologic malignancies (hospitalization: 23.5%, death: 5.1%) (p < 0.001) and hematologic malignancy patients without COVID-19 (hospitalization: 15.0%, death: 4.1%) (p < 0.001).


Subject(s)
COVID-19/epidemiology , Hematologic Neoplasms/complications , Adolescent , Adult , Aged , Female , Health Status Disparities , Hematologic Neoplasms/epidemiology , Hospitalization , Humans , Leukemia, Myeloid, Acute/complications , Leukemia, Myeloid, Acute/epidemiology , Male , Middle Aged , Multiple Myeloma/complications , Multiple Myeloma/epidemiology , Odds Ratio , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Precursor Cell Lymphoblastic Leukemia-Lymphoma/epidemiology , Risk Factors , SARS-CoV-2/isolation & purification , United States/epidemiology , Young Adult
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