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1.
Curr Treat Options Oncol ; 23(5): 688-702, 2022 05.
Article in English | MEDLINE | ID: covidwho-1763473

ABSTRACT

OPINION STATEMENT: The coronavirus disease-19 (COVID-19) pandemic has posed numerous challenges to the global healthcare system. Of particular gravity is adult and pediatric patients with hematologic malignancies who are among the most vulnerable groups of patients at risk of severe COVID-19 outcomes. In the early phases of the pandemic, several treatment modifications were proposed for patients with leukemia. Largely speaking, these were adopting less-intense therapies and more utilization of the outpatient setting. Over time, our understanding and management have become more nuanced. Furthermore, equipped with vaccinations to prevent COVID-19 infection and availability of treatments in the presence of COVID-19 infection, the recommendations on management of patients with leukemia have evolved. Patient's leukemia characteristics, possibility of targeted therapy, vaccination status, symptomatology, comorbidities, goal of anti-leukemic therapy, the intensity of therapy, the setting of treatment, as well as loco regional factors like dynamic incidence of COVID-19 in the community and hospital/ICU bed status are among many factors that influence the decisions. Furthermore, the oncology community has adopted delaying the anti-leukemia therapy for a limited time frame, if clinically possible, so as to still deliver most appropriate therapy while minimizing risks. Early adoption of growth factor support and conservative blood transfusion practices have helped as well. In this review, we discuss the impact of COVID-19 on outcomes and share considerations for treatments of leukemias. We describe the impact on both clinical care (from diagnosis to treatment) and research, and cover the literature on vaccines and treatments for COVID-19 in relation to leukemia.


Subject(s)
Antineoplastic Agents , COVID-19 , Hematologic Neoplasms , Leukemia , COVID-19/epidemiology , Child , Hematologic Neoplasms/therapy , Humans , Leukemia/epidemiology , Leukemia/therapy , Pandemics , SARS-CoV-2
3.
Leuk Lymphoma ; 62(14): 3516-3520, 2021 12.
Article in English | MEDLINE | ID: covidwho-1354196

ABSTRACT

Patients with acute leukemia (AL) have a high mortality rate from coronavirus disease 2019 (COVID-19). However, studies including patients with AL and COVID-19 are few. Fifty-one patients with AL and COVID-19 were included in our study. The mortality rate was 17/51 (29.4%). In all cases, death was associated with COVID-19 pneumonia. The major driver of outcome was the disease status (worse outcome was observed in newly diagnosed (OR, 6.00; 95% CI, 1.133 - 15.188) and patients with bone marrow aplasia (OR 4.148 [95% CI 1.133 - 15.188])). Higher mortality rate was associated with lower platelet count, prolonged PT, higher ISTH DIC score, CRP and LDH. Moreover, careful risk-benefit assessment regarding the continuation of anticancer therapy is required in patients receiving nonintensive and supportive therapy. Considering the high frequency of intrahospital viral transmission (50.98%), isolation of AL patients in single rooms, and permanent symptom monitoring and testing should be prioritized.


Subject(s)
COVID-19 , Leukemia , Humans , Leukemia/diagnosis , Leukemia/epidemiology , Leukemia/therapy , Risk Factors , SARS-CoV-2
4.
Curr Oncol Rep ; 23(10): 114, 2021 08 03.
Article in English | MEDLINE | ID: covidwho-1338274

ABSTRACT

PURPOSE OF REVIEW: The spread of the novel coronavirus SARS-CoV-2 and its associated disease, coronavirus disease of 2019 (COVID-19), has significantly derailed cancer care. Patients with leukemia are more likely to have severe infection and increased rates of mortality. There is paucity of information on how to modify care of leukemia patients in view of the COVID-19 risks and imposed restrictions. We review the available literature on the impact of COVID-19 on different types of leukemia patients and suggest general as well as disease-specific recommendations on care based on available evidence. RECENT FINDINGS: The COVID-19 infection impacts leukemia subtypes in variable ways and the standard treatments for leukemia have similarly, varying effects on the course of COVID-19 infection. Useful treatment strategies include deferring treatment when possible, use of less intensive regimens, outpatient targeted oral agents requiring minimal monitoring, and prioritization of curative or life-prolonging strategies. Reducing health care encounters, rational transfusion standards, just resource allocation, and pre-emptive advance care planning will serve the interests of leukemia patients. Ad hoc modifications based on expert opinions and extrapolations of previous well-designed studies are the way forward to navigate the crisis. This should be supplanted with more rigorous prospective evidence.


Subject(s)
COVID-19/epidemiology , Leukemia/therapy , COVID-19/prevention & control , COVID-19/therapy , Humans , Leukemia/classification , Leukemia/diagnosis , Leukemia/epidemiology , Patient Care , Risk Factors , SARS-CoV-2
6.
Hastings Cent Rep ; 51(1): 4-5, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1100859

ABSTRACT

The Covid-19 pandemic has created a clinical environment in which health care practitioners are experiencing moral distress in numerous and novel ways. In this narrative reflection, a pediatric palliative care physician explores how his hospital's strict visitation policy set the stage for moral distress when, in the early months of the pandemic, it prevented two parents from being together at the bedside of their dying child.


Subject(s)
COVID-19/epidemiology , Child, Hospitalized , Organizational Policy , Parents/psychology , Visitors to Patients , COVID-19/prevention & control , Child , Humans , Leukemia/therapy , Male
7.
Transplant Cell Ther ; 27(5): 438.e1-438.e6, 2021 05.
Article in English | MEDLINE | ID: covidwho-1083120

ABSTRACT

An evidence-based triage plan for cellular therapy distribution is critical in the face of emerging constraints on healthcare resources. We evaluated the impact of treatment delays related to COVID-19 on patients scheduled to undergo hematopoietic cell transplantation (HCT) or chimeric antigen receptor T-cell (CAR-T) therapy at our center. Data were collected in real time between March 19 and May 11, 2020, for patients who were delayed to cellular therapy. We evaluated the proportion of delayed patients who ultimately received cellular therapy, reasons for not proceeding to cellular therapy, and changes in disease and health status during delay. A total of 85 patients were delayed, including 42 patients planned for autologous HCT, 36 patients planned for allogeneic HCT, and 7 patients planned for CAR-T therapy. Fifty-six of these patients (66%) since received planned therapy. Five patients died during the delay. The most common reason for not proceeding to autologous HCT was good disease control in patients with plasma cell dyscrasias (75%). The most common reason for not proceeding to allogeneic HCT was progression of disease (42%). All patients with acute leukemia who progressed had measurable residual disease (MRD) at the time of delay, whereas no patient without MRD at the time of delay progressed. Six patients (86%) ultimately received CAR-T therapy, including 3 patients who progressed during the delay. For patients with high-risk disease such as acute leukemia, and particularly those with MRD at the time of planned HCT, treatment delay can result in devastating outcomes and should be avoided if at all possible.


Subject(s)
COVID-19 , Hematopoietic Stem Cell Transplantation , Immunotherapy, Adoptive , Pandemics , SARS-CoV-2 , Time-to-Treatment , Adult , Aged , Allografts , Amyloidosis/therapy , Anemia, Aplastic/therapy , COVID-19/complications , COVID-19/epidemiology , COVID-19/transmission , Civil Defense , Cross Infection/epidemiology , Cross Infection/prevention & control , Disease Progression , Evidence-Based Practice/organization & administration , Female , Hematopoietic Stem Cell Transplantation/statistics & numerical data , Humans , Infection Control/methods , Infectious Disease Transmission, Professional-to-Patient , Leukemia/mortality , Leukemia/pathology , Leukemia/therapy , Male , Middle Aged , Myelodysplastic-Myeloproliferative Diseases/mortality , Myelodysplastic-Myeloproliferative Diseases/therapy , Neoplasm, Residual , Neoplasms/mortality , Neoplasms/therapy , New York City/epidemiology , Resource Allocation , Time-to-Treatment/statistics & numerical data , Transplantation, Autologous , Triage/organization & administration , Young Adult
8.
J Pediatr Nurs ; 58: e74-e80, 2021.
Article in English | MEDLINE | ID: covidwho-1060226

ABSTRACT

PURPOSE: This study aimed to investigate the experiences of parents who care for children diagnosed with leukaemia. This paper is focused solely on reporting the interview findings from participating mothers regarding the challenges of caring for children with leukaemia in the context of the COVID-19. DESIGN AND METHODS: The study took place in a Jordanian hospital where a descriptive qualitative design approach was applied on one oncology floor and an oncology clinic. Semi-structured interviews were conducted with mothers of children aged 1-12 with acute lymphoblastic leukaemia (ALL). Inductive thematic analysis approach was undertaken. Written consent was obtained from all participants. RESULTS: Fifteen interviews were conducted with fifteen mothers. Four major themes reflect the different challenges parents and children face during the COVID-19 pandemic: children refusing to wear masks, social isolation, family relationship and financial concerns. CONCLUSIONS: The findings of the current study present important data for health care professionals to help them understand the challenges faced by parents and children with leukaemia, especially during the COVID-19 pandemic. PRACTICAL IMPLICATIONS: This study suggests activating emotional support teams in hospitals. These teams can actively help mothers express their concerns and worries which might otherwise foster self-blame, guilt and isolation.


Subject(s)
COVID-19 , Leukemia , Child , Female , Humans , Leukemia/therapy , Mothers , Pandemics , Qualitative Research , SARS-CoV-2
9.
Lancet Haematol ; 7(10): e737-e745, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-712017

ABSTRACT

BACKGROUND: Several small studies on patients with COVID-19 and haematological malignancies are available showing a high mortality in this population. The Italian Hematology Alliance on COVID-19 aimed to collect data from adult patients with haematological malignancies who required hospitalisation for COVID-19. METHODS: This multicentre, retrospective, cohort study included adult patients (aged ≥18 years) with diagnosis of a WHO-defined haematological malignancy admitted to 66 Italian hospitals between Feb 25 and May 18, 2020, with laboratory-confirmed and symptomatic COVID-19. Data cutoff for this analysis was June 22, 2020. The primary outcome was mortality and evaluation of potential predictive parameters of mortality. We calculated standardised mortality ratios between observed death in the study cohort and expected death by applying stratum-specific mortality rates of the Italian population with COVID-19 and an Italian cohort of 31 993 patients with haematological malignancies without COVID-19 (data up to March 1, 2019). Multivariable Cox proportional hazards model was used to identify factors associated with overall survival. This study is registered with ClinicalTrials.gov, NCT04352556, and the prospective part of the study is ongoing. FINDINGS: We enrolled 536 patients with a median follow-up of 20 days (IQR 10-34) at data cutoff, 85 (16%) of whom were managed as outpatients. 440 (98%) of 451 hospitalised patients completed their hospital course (were either discharged alive or died). 198 (37%) of 536 patients died. When compared with the general Italian population with COVID-19, the standardised mortality ratio was 2·04 (95% CI 1·77-2·34) in our whole study cohort and 3·72 (2·86-4·64) in individuals younger than 70 years. When compared with the non-COVID-19 cohort with haematological malignancies, the standardised mortality ratio was 41·3 (38·1-44·9). Older age (hazard ratio 1·03, 95% CI 1·01-1·05); progressive disease status (2·10, 1·41-3·12); diagnosis of acute myeloid leukaemia (3·49, 1·56-7·81), indolent non-Hodgin lymphoma (2·19, 1·07-4·48), aggressive non-Hodgkin lymphoma (2·56, 1·34-4·89), or plasma cell neoplasms (2·48, 1·31-4·69), and severe or critical COVID-19 (4·08, 2·73-6·09) were associated with worse overall survival. INTERPRETATION: This study adds to the evidence that patients with haematological malignancies have worse outcomes than both the general population with COVID-19 and patients with haematological malignancies without COVID-19. The high mortality among patients with haematological malignancies hospitalised with COVID-19 highlights the need for aggressive infection prevention strategies, at least until effective vaccination or treatment strategies are available. FUNDING: Associazione italiana contro le leucemie, linfomi e mieloma-Varese Onlus.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Hematologic Neoplasms/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Adult , Aged , Aged, 80 and over , COVID-19 , Comorbidity , Coronavirus Infections/drug therapy , Female , Follow-Up Studies , Hematologic Neoplasms/therapy , Humans , Inpatients , Italy/epidemiology , Leukemia/epidemiology , Leukemia/therapy , Lymphoma, Non-Hodgkin/epidemiology , Lymphoma, Non-Hodgkin/therapy , Male , Middle Aged , Myeloproliferative Disorders/epidemiology , Myeloproliferative Disorders/therapy , Neoplasms, Plasma Cell/epidemiology , Neoplasms, Plasma Cell/therapy , Retrospective Studies , Risk Factors , SARS-CoV-2 , Young Adult
12.
Lancet Haematol ; 7(8): e601-e612, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-609322

ABSTRACT

The ongoing COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 is a global public health crisis. Multiple observations indicate poorer post-infection outcomes for patients with cancer than for the general population. Herein, we highlight the challenges in caring for patients with acute leukaemias and myeloid neoplasms amid the COVID-19 pandemic. We summarise key changes related to service allocation, clinical and supportive care, clinical trial participation, and ethical considerations regarding the use of lifesaving measures for these patients. We recognise that these recommendations might be more applicable to high-income countries and might not be generalisable because of regional differences in health-care infrastructure, individual circumstances, and a complex and highly fluid health-care environment. Despite these limitations, we aim to provide a general framework for the care of patients with acute leukaemias and myeloid neoplasms during the COVID-19 pandemic on the basis of recommendations from international experts.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/complications , Infection Control/standards , Leukemia/therapy , Myeloproliferative Disorders/therapy , Pneumonia, Viral/complications , Practice Guidelines as Topic/standards , Adult , COVID-19 , Coronavirus Infections/transmission , Coronavirus Infections/virology , Disease Management , Expert Testimony , Humans , Leukemia/virology , Myeloproliferative Disorders/virology , Pandemics , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Resource Allocation , SARS-CoV-2
15.
Pediatr Infect Dis J ; 39(7): e142-e145, 2020 07.
Article in English | MEDLINE | ID: covidwho-261323

ABSTRACT

We report the first case of coronavirus disease 2019 (COVID-19) comorbid with leukemia in a patient hospitalized in Beijing, China. The patient showed a prolonged manifestation of symptoms and a protracted diagnosis period of COVID-19. It is necessary to extend isolation time, increase the number of nucleic acid detections and conduct early symptomatic treatment for children with both COVID-19 and additional health problems.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/blood , Leukemia/virology , Pneumonia, Viral/blood , Beijing/epidemiology , COVID-19 , Child, Preschool , China/epidemiology , Coronavirus Infections/pathology , Coronavirus Infections/virology , Humans , Leukemia/diagnosis , Leukemia/therapy , Male , Pandemics , Pneumonia, Viral/pathology , Pneumonia, Viral/virology , SARS-CoV-2
16.
Acta Haematol ; 144(2): 132-145, 2021.
Article in English | MEDLINE | ID: covidwho-237075

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic poses several challenges to the management of patients with leukemia. The biology of each leukemia and its corresponding treatment with conventional intensive chemotherapy, with or without targeted therapies (venetoclax, FLT3 inhibitors, IDH1/2 inhibitors, Bruton's tyrosine kinase inhibitors), introduce additional layers of complexity during COVID-19 high-risk periods. The knowledge about COVID-19 is accumulating rapidly. An important distinction is the prevalence of "exposure" versus "clinical infectivity," which determine the risk versus benefit of modifying potentially highly curative therapies in leukemia. At present, the rate of clinical infection is <1-2% worldwide. With a mortality rate of 1-5% in CO-VID-19 patients in the general population and potentially of >30% in patients with cancer, careful consideration should be given to the risk of COVID-19 in leukemia. Instead of reducing patient access to specialized cancer centers and modifying therapies to ones with unproven curative benefit, there is more rationale for less intensive, yet effective therapies that may require fewer clinic visits or hospitalizations. Here, we offer recommendations on the optimization of leukemia management during high-risk COVID-19 periods.


Subject(s)
COVID-19/complications , Leukemia/complications , Leukemia/therapy , SARS-CoV-2 , Acute Disease , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , COVID-19/epidemiology , COVID-19/prevention & control , Chronic Disease , Humans , Myelodysplastic Syndromes/complications , Myelodysplastic Syndromes/therapy , Myeloproliferative Disorders/complications , Myeloproliferative Disorders/therapy , Pandemics , Risk Factors
17.
Biol Blood Marrow Transplant ; 26(7): 1312-1317, 2020 07.
Article in English | MEDLINE | ID: covidwho-208523

ABSTRACT

The COVID-19 pandemic has created significant barriers to timely donor evaluation, cell collection, and graft transport for allogeneic hematopoietic stem cell transplantation (allo-HCT). To ensure availability of donor cells on the scheduled date of infusion, many sites now collect cryopreserved grafts before the start of pretransplantation conditioning. Post-transplantation cyclophosphamide (ptCY) is an increasingly used approach for graft-versus-host disease (GVHD) prophylaxis, but the impact of graft cryopreservation on the outcomes of allo-HCT using ptCY is not known. Using the Center for International Blood and Marrow Transplant Research (CIBMTR) database, we compared the outcomes of HCT using cryopreserved versus fresh grafts in patients undergoing HCT for hematologic malignancy with ptCY. We analyzed 274 patients with hematologic malignancy undergoing allo-HCT between 2013 and 2018 with cryopreserved grafts and ptCY. Eighteen patients received bone marrow grafts and 256 received peripheral blood stem cell grafts. These patients were matched for age, graft type, disease risk index (DRI), and propensity score with 1080 patients who underwent allo-HCT with fresh grafts. The propensity score, which is an assessment of the likelihood of receiving a fresh graft versus a cryopreserved graft, was calculated using logistic regression to account for the following: disease histology, Karnofsky Performance Score (KPS), HCT Comorbidity Index, conditioning regimen intensity, donor type, and recipient race. The primary endpoint was overall survival (OS). Secondary endpoints included acute and chronic graft-versus-host disease (GVHD), non-relapse mortality (NRM), relapse/progression and disease-free survival (DFS). Because of multiple comparisons, only P values <.01 were considered statistically significant. The 2 cohorts (cryopreserved and fresh) were similar in terms of patient age, KPS, diagnosis, DRI, HCT-CI, donor/graft source, and conditioning intensity. One-year probabilities of OS were 71.1% (95% confidence interval [CI], 68.3% to 73.8%) with fresh grafts and 70.3% (95% CI, 64.6% to 75.7%) with cryopreserved grafts (P = .81). Corresponding probabilities of OS at 2 years were 60.6% (95% CI, 57.3% to 63.8%) and 58.7% (95% CI, 51.9% to 65.4%) (P = .62). In matched-pair regression analysis, graft cryopreservation was not associated with a significantly higher risk of mortality (hazard ratio [HR] for cryopreserved versus fresh, 1.05; 95% CI, .86 to 1.29; P = .60). Similarly, rates of neutrophil recovery (HR, .91; 95% CI, .80 to 1.02; P = .12), platelet recovery (HR, .88; 95% CI, .78 to 1.00; P = .05), grade III-IV acute GVHD (HR, .78; 95% CI, .50 to 1.22; P = .27), NRM (HR, 1.16; 95% CI, .86 to 1.55; P = .32) and relapse/progression (HR, 1.21; 95% CI, .97 to 1.50; P = .09) were similar with cryopreserved grafts versus fresh grafts. There were somewhat lower rates of chronic GVHD (HR, 78; 95% CI, .61 to .99; P = .04) and DFS (HR for treatment failure, 1.19; 95% CI, 1.01 to 1.29; P = .04) with graft cryopreservation that were of marginal statistical significance after adjusting for multiple comparisons. Overall, our data indicate that graft cryopreservation does not significantly delay hematopoietic recovery, increase the risk of acute GVHD or NRM, or decrease OS after allo-HCT using ptCY.


Subject(s)
Bone Marrow Transplantation/methods , Coronavirus Infections/epidemiology , Cryopreservation/methods , Graft vs Host Disease/prevention & control , Hematopoietic Stem Cell Transplantation/methods , Leukemia/therapy , Lymphoma/therapy , Myelodysplastic Syndromes/therapy , Pneumonia, Viral/epidemiology , Adult , Aged , Aged, 80 and over , COVID-19 , Cohort Studies , Cyclophosphamide/therapeutic use , Female , Graft vs Host Disease/immunology , Graft vs Host Disease/mortality , Graft vs Host Disease/pathology , Histocompatibility Testing , Humans , Leukemia/immunology , Leukemia/mortality , Leukemia/pathology , Lymphoma/immunology , Lymphoma/mortality , Lymphoma/pathology , Male , Middle Aged , Myelodysplastic Syndromes/immunology , Myelodysplastic Syndromes/mortality , Myelodysplastic Syndromes/pathology , Pandemics , Siblings , Survival Analysis , Transplantation Conditioning/methods , Transplantation, Homologous , United States/epidemiology , Unrelated Donors/supply & distribution
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