Oncological Care During First Peruvian National Emergency COVID-19 Pandemic: A Multicentric Descriptive Study.

Purpose: The aim of this study is to evaluate the oncological care during the first state of national emergency due to the COVID-19 pandemic in several public cancer hospitals in Peru. Materials and Methods: A multicentric cross-sectional descriptive study was conducted by interviewing adult cancer patients diagnosed and treated between January 2019 and February 2020 from 18 hospitals. This study was carried out in September 2020, the last month of the first state of national emergency. Demographic and clinical characteristics were evaluated, including COVID-19 status and cancer treatment features. Results: A total of 1472 patients were included; the median age was 55 years (range 19-97). Most patients (85.8%, n = 1263) had solid neoplasia, 13.5% (n = 198) hematologic neoplasia, and 0.7% (n = 11) others. SARS-CoV-2 infection was confirmed in 8.6% (n = 126), 1.2% (n = 18) were probable, 1.6% (n = 24) suspected, and 88.6% (n = 1304) negative cases. Overall, 51.6% of patients (n = 759) had cancer treatment delays, 42.5% (n = 626) changed treatment delivery (endovenous to oral systemic therapy), and 12.6% (n = 185) of cases cancer therapy was discontinued. In total, 10.3% (n = 117) of patients whose disease was controlled or in remission, experienced progression of disease during the state of emergency. A total of 6.7% (n = 98) of patients died, of whom 73.5% (n = 72) died from disease progression; 18.4% (n = 18) from SARS-CoV-2 infection and 8.1% (n = 8) from undetermined causes. Patients with hematological malignancies [hazard ratio (HR): 5.11 (95% confidence interval (CI): 1.99-13.07)] and no response to therapy before the onset of the pandemic [5.01 (1.44-17.42)] had an increased risk of death among COVID-19 infected individuals, whereas advanced clinical stage [5.09 (2.37-10.95)] and discontinuation of treatment [3.66 (1.97-6.78)] were risk factors among non-COVID-19 patients. Conclusion: Our study suggests that the COVID-19 pandemic has an adverse impact on the outcomes of Peruvian cancer patients. In our cohort, cancer mortality was higher than COVID-19 disease mortality.

Recomendaciones clínicas para el manejo de pacientes oncológicos en el marco de la pandemia COVID-19 / Clinical Recommendations For The Management Of Cancer Patients In The Context Of The COVID-19 Pandemic

La enfermedad por la nueva cepa de Coronavirus (COVID-19) ha sido catalogada como una pandemia por la OMS. En el Perú, se decretó estado de emergencia nacional y aislamiento social obligatorio desde el 15 de marzo. Los sistemas de salud a nivel mundial han sufrido un gran impacto debido la infección por COVID-19, lo cual obligó a los sistemas de salud, sociedades y asociaciones médicas a diseñar estrategias de intervención priorizada para dar continuidad a la atención de los pacientes en áreas COVID-19 y áreas libres de COVID-19. El paciente con cáncer es catalogado como vulnerable y representa un factor de riesgo para complicaciones, como ingreso a unidad de cuidados intensivos, intubación y muerte temprana por infección por COVID-19. Es así como la Asociación de Médicos Ex-Residentes de Oncología Médica (AMEROM), ha realizado esfuerzos para poder realizar recomendaciones adaptables a nuestro sistema de salud, con la finalidad de dar continuidad a la atención priorizada de los pacientes con cáncer. Mediante la metodología modificada de consenso de expertos, bajo el sustento bibliográfico, se han generado recomendaciones en diferentes etapas de la pandemia, llegando a un consenso final con recomendaciones clínicas para el manejo de pacientes oncológicos en el marco de la pandemia COVID-19 en Perú, con el fin de brindar información útil para los profesionales de la salud. El presente artículo indica los procesos con los que se llegaron a los acuerdos para dictar las recomendaciones y generar el orden de prioridad adoptado por AMEROM.

The disease by the new coronavirus strain (COVID-19) has been classified as apandemic by the WHO. In Peru, a state of national emergency and compulsory socialisolation had been declared since 15 March. Global health systems have been greatlyimpacted by COVID-19, which forced health systems, societies and medicalassociations to design prioritized intervention strategies to provide continuity of patientcare in infected areas and COVID-19-free areas. A cancer patient is classified asvulnerable and represents a risk factor for complications due to COVID-19, such asadmission to the intensive care unit, intubation, and early death due to infection due toCOVID-19. This is how the Asociación de Médicos Ex Residentes de OncologíaMédica (AMEROM), has endeavored to give recommendations adaptable to our healthsystem, to continue with the prioritized care of cancer patients. Through the modifiedmethodology of expert consensus, based on the literature, recommendations have beengenerated at different stages of the pandemic, reaching a final consensus of clinicalrecommendations for the management of cancer patients in the framework of theCOVID-19 pandemic in Peru, to provide useful information to health professionals.This article indicates the processes by which agreements were reached to makerecommendations and generate the order of priority adopted by AMEROM.

EBV-positive diffuse large B-cell lymphoma in a human T-lymphotropic virus type 1 carrier.

The development of B-cell lymphomas has been seldom described in HTLV-1 carriers. We present the case of an elderly Peruvian HTLV-1 carrier who was diagnosed with EBV-positive diffuse large B-cell lymphoma. Despite an initial good response to therapy, patient died during treatment due to fatal Pneumocystis jirovecci pneumonia. EBV infection is characterized by B-cell lymphotropism and selective immunodeficiency. HTLV-1, on the other hand, induces T-cell dysfunction and B-cell proliferation. Finally, immunosenescence is characterized by T-cell dysregulation, decreased apoptosis and cytokine upregulation. In this elderly patient, the combination of EBV and HTLV-1 coinfection and immunosenescence may have played a role in the development of this aggressive diffuse large B-cell lymphoma. Furthermore, the immunodeficiency caused by the viral infections and chemotherapy may have played a role in developing life-threatening infectious complications.

ALK-positive diffuse large B-cell lymphoma: report of four cases and review of the literature.

BACKGROUND: Anaplastic lymphoma kinase-positive diffuse large B-cell lymphoma (ALK-DLBCL) is a rare lymphoma with several clinicopathological differences from ALK-positive anaplastic large cell lymphoma (ALCL). The latest WHO classification of lymphomas recognizes ALK-DLBCL as a separate entity. METHODS: A comprehensive comparison was made between the clinical and pathological features of the 4 cases reported and those found in an extensive literature search using MEDLINE through December 2008. RESULTS: In our series, three cases were adults and one was pediatric. Two cases had primary extranodal disease (multifocal bone and right nasal fossa). Stages were I (n = 1), II (n = 1), III (n = 1) and IV (n = 1). Two cases had increased LDH levels and three reported B symptoms. IPI scores were 0 (n = 1), 2 (n = 2) and 3 (n = 1). All cases exhibited plasmablastic morphology. By immunohistochemistry, cases were positive for cytoplasmic ALK, MUM1, CD45, and EMA; they marked negative for CD3, CD30 and CD20. Studies for EBV and HHV-8 were negative. The survival for the patients with stage I, II, III and IV were 13, 62, 72 and 11 months, respectively. CONCLUSION: ALK-DLBCL is a distinct variant of DLBCL with plasmacytic differentiation, which is characterized by a bimodal age incidence curve, primarily nodal involvement, plasmablastic morphology, lack of expression of CD20, aggressive behavior and poor response to standard therapies, although some cases can have prolonged survival as the cases reported in this study. ALK-DLBCL does not seem associated to immunosuppression or the presence of EBV or HHV8. Further prospective studies are needed to optimize therapies for this entity.