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Stoleriu MG, Gerckens M, Ströh K, Kovács J, Samm N, Obereisenbuchner F, Hetrodt J, Schmidt FM, Reinmuth N, Heiß-Neumann M, Stacher-Priehse E, Koch I, Behr J, Ketscher C, Grützner U, Hatz R. Prevention of COVID-19 in Thoracic Surgery Patients: Lessons Learned during the First Pandemic Wave. Pneumologie 2021; 75:960-970. [PMID: 34261146 DOI: 10.1055/a-1526-9979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this retrospective study was to investigate the implementation of measures to prevent perioperative COVID-19 in thoracic surgery during the first wave of the COVID-19 pandemic 2020 allowing a continued surgical treatment of patients. METHODS The implemented preventive measures in patient management of the thoracic surgery department of the Asklepios Lung Clinic Munich-Gauting, Germany were retrospectively analyzed. Postoperative COVID-19 incidence before and after implementation of preventive measures was investigated. Patients admitted for thoracic surgical procedures between March and May 2020 were included in the study. Patient characteristics were analyzed. For the early detection of putative postoperative COVID-19 symptoms, typical post-discharge symptomatology of thoracic surgery patients was compared to non-surgical patients hospitalized for COVID-19. RESULTS Thirty-five surgical procedures and fifty-seven surgical procedures were performed before and after implementation of the preventive measures, respectively. Three patients undergoing thoracic surgery before implementation of preventive measures developed a COVID-19 pneumonia post-discharge. After implementation of preventive measures, no postoperative COVID-19 cases were identified. Fever, dyspnea, dry cough and diarrhea were significantly more prevalent in COVID-19 patients compared to normally recovering thoracic surgery patients, while anosmia, phlegm, low energy levels, body ache and nausea were similarly frequent in both groups. CONCLUSIONS Based on the lessons learned during the first pandemic wave, we here provide a blueprint for successful easily implementable preventive measures minimizing SARS-CoV-2 transmission to thoracic surgery patients perioperatively. While symptoms of COVID-19 and the normal postoperative course of thoracic surgery patients substantially overlap, we found dyspnea, fever, cough, and diarrhea significantly more prevalent in COVID-19 patients than in normally recovering thoracic surgery patients. These symptoms should trigger further diagnostic testing for postoperative COVID-19 in thoracic surgery patients.
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Affiliation(s)
- Mircea Gabriel Stoleriu
- Center for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich (LMU) and Asklepios Lung Clinic Munich-Gauting, Munich and Gauting, Germany.,Comprehensive Pneumology Center, Helmholtz Center Munich, Munich, Germany, Member of the German Lung Research Center
| | - Michael Gerckens
- Comprehensive Pneumology Center, Helmholtz Center Munich, Munich, Germany, Member of the German Lung Research Center.,Department of Internal Medicine V, Ludwig-Maximilians-University of Munich (LMU), Munich, Germany
| | - Katja Ströh
- Center for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich (LMU) and Asklepios Lung Clinic Munich-Gauting, Munich and Gauting, Germany
| | - Julia Kovács
- Center for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich (LMU) and Asklepios Lung Clinic Munich-Gauting, Munich and Gauting, Germany
| | - Nicole Samm
- Center for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich (LMU) and Asklepios Lung Clinic Munich-Gauting, Munich and Gauting, Germany
| | | | - Justin Hetrodt
- Department of Pneumology, Asklepios Lung Clinic Munich-Gauting, Gauting, Germany
| | | | - Niels Reinmuth
- Department of Pneumology, Asklepios Lung Clinic Munich-Gauting, Gauting, Germany
| | - Marion Heiß-Neumann
- Department of Pneumology, Asklepios Lung Clinic Munich-Gauting, Gauting, Germany
| | | | - Ina Koch
- Center for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich (LMU) and Asklepios Lung Clinic Munich-Gauting, Munich and Gauting, Germany.,Comprehensive Pneumology Center, Helmholtz Center Munich, Munich, Germany, Member of the German Lung Research Center
| | - Jürgen Behr
- Comprehensive Pneumology Center, Helmholtz Center Munich, Munich, Germany, Member of the German Lung Research Center.,Department of Pneumology, Asklepios Lung Clinic Munich-Gauting, Gauting, Germany.,Department of Internal Medicine V, Ludwig-Maximilians-University of Munich (LMU), Munich, Germany
| | - Christian Ketscher
- Center for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich (LMU) and Asklepios Lung Clinic Munich-Gauting, Munich and Gauting, Germany
| | - Uwe Grützner
- Center for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich (LMU) and Asklepios Lung Clinic Munich-Gauting, Munich and Gauting, Germany
| | - Rudolf Hatz
- Center for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich (LMU) and Asklepios Lung Clinic Munich-Gauting, Munich and Gauting, Germany.,Comprehensive Pneumology Center, Helmholtz Center Munich, Munich, Germany, Member of the German Lung Research Center
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202
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Silversmit G, Verdoodt F, Van Damme N, De Schutter H, Van Eycken L. Excess Mortality in a Nationwide Cohort of Cancer Patients during the Initial Phase of the COVID-19 Pandemic in Belgium. Cancer Epidemiol Biomarkers Prev 2021; 30:1615-1619. [PMID: 34233917 DOI: 10.1158/1055-9965.epi-21-0230] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/27/2021] [Accepted: 06/15/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Most studies investigating the impact of coronavirus infectious disease-19 (COVID-19) on mortality among patients with cancer were performed in a hospital setting, and the evidence is thus based on a selected and frail subset of patients. This study evaluates the excess mortality during the first wave of COVID-19 in a nationwide, prevalent cancer cohort in Belgium. METHODS Mortality was studied among almost 240,000 patients with cancer diagnosed between 2013 and 2018 and alive on January 1, 2020. The observed number of deaths in the months January to June 2020 was compared with the expected number of deaths applying the monthly mortality rates observed in the cancer cohort during the previous years. A comparison using the excess mortality rates from the general population was performed. RESULTS An excess number of deaths of about 400 was observed in the month of April, coinciding with a peak of COVID-19 diagnoses in Belgium and corresponding to a 33% rise in mortality. A comparable number of excess deaths was estimated if the COVID-19 excess mortality rates from the general Belgian population were applied to the cancer cohort, stratified by age and sex. CONCLUSIONS A considerable excess mortality in the Belgian cancer cohort was observed during the initial peak of COVID-19 in Belgium. The pattern of excess mortality was, however, not markedly different from that observed in the general population. IMPACT These results suggest that the susceptibility of prevalent cancer patients to COVID-19-induced mortality during the first wave of the pandemic was comparable with the general population.
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203
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O'Hare AM, Berry K, Fan VS, Crothers K, Eastment MC, Dominitz JA, Shah JA, Green P, Locke E, Ioannou GN. Age differences in the association of comorbid burden with adverse outcomes in SARS-CoV-2. BMC Geriatr 2021; 21:415. [PMID: 34229623 PMCID: PMC8258273 DOI: 10.1186/s12877-021-02340-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 06/06/2021] [Indexed: 01/08/2023] Open
Abstract
Background Older age and comorbid burden are both associated with adverse outcomes in SARS-CoV-2, but it is not known whether the association between comorbid burden and adverse outcomes differs in older and younger adults. Objective To compare the relationship between comorbid burden and adverse outcomes in adults with SARS-CoV-2 of different ages (18–64, 65–79 and ≥ 80 years). Design, setting, and participants Observational longitudinal cohort study of 170,528 patients who tested positive for SARS-CoV-2 in the US Department of Veterans Affairs (VA) Health Care System between 2/28/20 and 12/31/2020 who were followed through 01/31/2021. Measurements Charlson Comorbidity Index (CCI); Incidence of hospitalization, intensive care unit (ICU) admission, mechanical ventilation, and death within 30 days of a positive SARS-CoV-2 test. Results The cumulative 30-day incidence of death was 0.8% in cohort members < 65 years, 7.1% in those aged 65–79 years and 20.6% in those aged ≥80 years. The respective 30-day incidences of hospitalization were 8.2, 21.7 and 29.5%, of ICU admission were 2.7, 8.6, and 11% and of mechanical ventilation were 1, 3.9 and 3.2%. Median CCI (interquartile range) ranged from 0.0 (0.0, 2.0) in the youngest, to 4 (2.0, 7.0) in the oldest age group. The adjusted association of CCI with all outcomes was attenuated at older ages such that the threshold level of CCI above which the risk for each outcome exceeded the reference group (1st quartile) was lower in younger than in older cohort members (p < 0.001 for all age group interactions). Limitations The CCI is calculated based on diagnostic codes, which may not provide an accurate assessment of comorbid burden. Conclusions Age differences in the distribution and prognostic significance of overall comorbid burden could inform clinical management, vaccination prioritization and population health during the pandemic and argue for more work to understand the role of age and comorbidity in shaping the care of hospitalized patients with SARS-CoV-2. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02340-5.
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Affiliation(s)
- A M O'Hare
- Division of Nephrology, Veterans Affairs Puget Sound Healthcare System and University of Washington, 1660 South Columbian Way, Seattle, WA, 98108, USA. .,Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.
| | - K Berry
- Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - V S Fan
- Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.,Division of Pulmonary and Critical Care, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, WA, USA
| | - K Crothers
- Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.,Division of Pulmonary and Critical Care, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, WA, USA
| | - M C Eastment
- Division of Allergy and Infectious Disease, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, WA, USA
| | - J A Dominitz
- Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.,Division of Gastroenterology, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, WA, USA
| | - J A Shah
- Division of Allergy and Infectious Disease, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, WA, USA
| | - P Green
- Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - E Locke
- Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - G N Ioannou
- Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.,Division of Gastroenterology, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, WA, USA
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204
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Zhu Z, Zheng Z, Liu J. Comparison of COVID-19 and Lung Cancer via Reactive Oxygen Species Signaling. Front Oncol 2021; 11:708263. [PMID: 34277453 PMCID: PMC8283805 DOI: 10.3389/fonc.2021.708263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/10/2021] [Indexed: 12/17/2022] Open
Abstract
COVID-19 and lung cancer are two severe pulmonary diseases that cause millions of deaths globally each year. Understanding the dysregulated signaling pathways between them can benefit treating the related patients. Recent studies suggest the critical role of reactive oxygen species (ROS) in both diseases, indicating an interplay between them. Here we reviewed references showing that ROS and ROS-associated signaling pathways, specifically via NRF2, HIF-1, and Nf-κB pathways, may bridge mutual impact between COVID-19 and lung cancer. As expected, typical ROS-associated inflammation pathways (HIF-1 and Nf-κB) are activated in both diseases. The activation of both pathways in immune cells leads to an overloading immune response and exacerbates inflammation in COVID-19. In lung cancer, HIF-1 activation facilitates immune escape, while Nf-κB activation in T cells suppresses tumor growth. However, the altered NRF2 pathway show opposite trends between them, NRF2 pathways exert immunosuppressive effects in both diseases, as it represses the immune response in COVID-19 patients while facilitates the immune escape of tumor cells. Furthermore, we summarized the therapeutic targets (e.g., phytochemicals) on these ROS pathways. In sum, our review focus on the understanding of ROS Signaling in COVID-19 and lung cancer, showing that modulating ROS signaling pathways may alleviate the potentially mutual impacts between COVID-19 and lung cancer patients.
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Affiliation(s)
- Zilan Zhu
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China.,Zhejiang University-University of Edinburgh Institute (ZJU-UoE Institute), Zhejiang University School of Medicine, Zhejiang University, Haining, China
| | - Ziyi Zheng
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China.,Zhejiang University-University of Edinburgh Institute (ZJU-UoE Institute), Zhejiang University School of Medicine, Zhejiang University, Haining, China
| | - Jian Liu
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China.,Zhejiang University-University of Edinburgh Institute (ZJU-UoE Institute), Zhejiang University School of Medicine, Zhejiang University, Haining, China
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205
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Mahat RK, Panda S, Rathore V, Swain S, Yadav L, Sah SP. The dynamics of inflammatory markers in coronavirus disease-2019 (COVID-19) patients: A systematic review and meta-analysis. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021; 11:100727. [PMID: 33778183 PMCID: PMC7979575 DOI: 10.1016/j.cegh.2021.100727] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/04/2021] [Accepted: 03/11/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Coronavirus disease-2019 (COVID-19) is a global pandemic and high mortality rate among severe or critical COVID-19 is linked with SARS-CoV-2 infection-induced hyperinflammation of the innate and adaptive immune systems and the resulting cytokine storm. This paper attempts to conduct a systematic review and meta-analysis of published articles, to evaluate the association of inflammatory parameters with the severity and mortality in COVID-19 patients. METHODS A comprehensive systematic literature search of medical electronic databases including Pubmed/Medline, Europe PMC, and Google Scholar was performed for relevant data published from January 1, 2020 to June 26, 2020. Observational studies reporting clear extractable data on inflammatory parameters in laboratory-confirmed COVID-19 patients were included. Screening of articles, data extraction and quality assessment were carried out by two authors independently. Standardized mean difference (SMD)/mean difference (MD/WMD) and 95% confidence intervals (CIs) were calculated using random or fixed-effects models. RESULTS A total of 83 studies were included in the meta-analysis. Of which, 54 studies were grouped by severity, 25 studies were grouped by mortality, and 04 studies were grouped by both severity and mortality. Random effect model results demonstrated that patients with severe COVID-19 group had significantly higher levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin (PCT), interleukin-6 (IL-6), interleukin-10 (IL-10), interleukin-2R (IL-2R), serum amyloid A (SAA) and neutrophil-to-lymphocyte ratio (NLR) compared to those in the non-severe group. Similarly, the fixed-effect model revealed significant higher ferritin level in the severe group when compared with the non-severe group. Furthermore, the random effect model results demonstrated that the non-survivor group had significantly higher levels of CRP, PCT, IL-6, ferritin, and NLR when compared with the survivor group. CONCLUSION In conclusion, the measurement of these inflammatory parameters could help the physicians to rapidly identify severe COVID-19 patients, hence facilitating the early initiation of effective treatment. PROSPERO REGISTRATION NUMBER CRD42020193169.
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Affiliation(s)
- Roshan Kumar Mahat
- Department of Biochemistry, Pandit Raghunath Murmu Medical College and Hospital, Baripada, Mayurbhanj, Odisha, 757107, India
| | - Suchismita Panda
- Department of Biochemistry, Pandit Raghunath Murmu Medical College and Hospital, Baripada, Mayurbhanj, Odisha, 757107, India
| | - Vedika Rathore
- Department of Biochemistry, Shyam Shah Medical College, Rewa, Madhya Pradesh, 486001, India
| | - Sharmistha Swain
- Department of Biochemistry, Pandit Raghunath Murmu Medical College and Hospital, Baripada, Mayurbhanj, Odisha, 757107, India
| | - Lalendra Yadav
- Department of Pharmacology, Teerthanker Mahaveer Medical College and Research Center, Moradabad, Uttar Pradesh, 244001, India
| | - Sumesh Prasad Sah
- Department of Biochemistry, Muzaffarnagar Medical College, Muzaffarnagar, Uttar Pradesh, 251203, India
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206
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Pan S, Jiang J, Chen Z, Yang L. Management and Thinking on the Treatment of Cancer Patients During the COVID-19. Front Mol Biosci 2021; 8:673360. [PMID: 34277701 PMCID: PMC8282485 DOI: 10.3389/fmolb.2021.673360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/20/2021] [Indexed: 12/19/2022] Open
Abstract
Coronavirus disease-2019 (COVID-19) has spread rapidly around the world and has become a public health emergency of international concern. The weekly epidemiological report issued by the WHO pointed out that new coronavirus variants have appeared in 131 countries and regions, which demonstrates that the current epidemic situation is still severe. As of now, the severe acute respiratory syndrome coronavirus (SARS-CoV-2) has been widespread worldwide for more than one year and poses a serious threat to the health of vulnerable groups such as those with malignancies, the elderly, and the immunocompromised. Compared with the general population, cancer patients with COVID-19 infection are more likely to have serious clinical adverse events, leading to higher mortality. There is no doubt that during the COVID-19 epidemic, whether it is with regards to how to prevent infection or how to continue anti-tumor treatment, cancer patients are in a difficult situation. Meanwhile, an international patient with malignant Hodgkin's lymphoma who was cured after being infected with the new coronavirus surprised us, and it inspires more scientists to explore the relationship between infection, immunity, and tumors. Relevantly, through multi-disciplinary discussion, scientists put forward more new perspectives on the treatment of future tumors and the management of SARS-CoV-2 diseases. In this review, the impact of COVID-19 on cancer patients is discussed in detail and the recommendations for the diagnosis, treatment and management of cancer patients will be put forward under the challenge of the COVID-19 epidemic. Furthermore, the safety and effectiveness of the SARS-CoV-2 vaccine will be discussed, and we will also put forward our insights on cancer immunity.
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Affiliation(s)
- Shuangyue Pan
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
- Center of Oncology, Department of Medical Oncology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China
| | - Jiahong Jiang
- Center of Oncology, Department of Medical Oncology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China
| | - Zheling Chen
- Center of Oncology, Department of Medical Oncology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China
| | - Liu Yang
- Center of Oncology, Department of Medical Oncology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China
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207
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Tagliamento M, Agostinetto E, Bruzzone M, Ceppi M, Saini KS, de Azambuja E, Punie K, Westphalen CB, Morgan G, Pronzato P, Del Mastro L, Poggio F, Lambertini M. Mortality in adult patients with solid or hematological malignancies and SARS-CoV-2 infection with a specific focus on lung and breast cancers: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2021; 163:103365. [PMID: 34052423 PMCID: PMC8156831 DOI: 10.1016/j.critrevonc.2021.103365] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/27/2021] [Accepted: 05/03/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND A systematic review and meta-analysis was performed to estimate mortality in adult patients with solid or hematological malignancies and SARS-CoV-2 infection. METHODS A systematic search of PubMed, up to 31 January 2021, identified publications reporting the case-fatality rate (CFR) among adult patients with solid or hematological malignancies and SARS-CoV-2 infection. The CFR, defined as the rate of death in this population, was assessed with a random effect model; 95% confidence intervals (CI) were calculated. RESULTS Among 135 selected studies (N = 33,879 patients), the CFR was 25.4% (95% CI 22.9%-28.2%). At a sensitivity analysis including studies with at least 100 patients, the CFR was 21.9% (95% CI 19.1%-25.1%). Among COVID-19 patients with lung (N = 1,135) and breast (N = 1,296) cancers, CFR were 32.4% (95% CI 26.5%-39.6%) and 14.2% (95% CI 9.3%-21.8%), respectively. CONCLUSIONS Patients with solid or hematological malignancies and SARS-CoV-2 infection have a high probability of mortality, with comparatively higher and lower CFRs in patients with lung and breast cancers, respectively.
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Affiliation(s)
- Marco Tagliamento
- Department of Medical Oncology, Medical Oncology 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine and Medical Specialties (DiMI), University of Genova, Genova, Italy
| | - Elisa Agostinetto
- Department of Internal Medicine, Institut Jules Bordet and Université Libre de Bruxelles (ULB), Brussels, Belgium; Humanitas Clinical and Research Center - IRCCS, Humanitas Cancer Center, Rozzano, Milan, Italy
| | - Marco Bruzzone
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Marcello Ceppi
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Evandro de Azambuja
- Department of Internal Medicine, Institut Jules Bordet and Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Kevin Punie
- Department of General Medical Oncology and Multidisciplinary Breast Centre, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - C Benedikt Westphalen
- Comprehensive Cancer Center Munich & Department of Medicine III, University Hospital, LMU Munich, Germany
| | - Gilberto Morgan
- Department of Medical and Radiation Oncology, Skåne University Hospital, Lund, Sweden
| | - Paolo Pronzato
- Department of Medical Oncology, Medical Oncology 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Lucia Del Mastro
- Department of Internal Medicine and Medical Specialties (DiMI), University of Genova, Genova, Italy; Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Francesca Poggio
- Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), University of Genova, Genova, Italy; Department of Medical Oncology, UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
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208
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Kiani A, Roesch R, Wendtner CM, Kullmann F, Kubin T, Südhoff T, Augustin M, Schaich M, Müller‐Naendrup C, Illerhaus G, Hartmann F, Hebart H, Seggewiss‐Bernhardt R, Bentz M, Späth‐Schwalbe E, Reimer P, Kaiser U, Kapp M, Graeven U, Chemnitz J, Baesecke J, Lambertz H, Naumann R. Preinfection laboratory parameters may predict COVID-19 severity in tumor patients. Cancer Med 2021; 10:4424-4436. [PMID: 34121360 PMCID: PMC8267142 DOI: 10.1002/cam4.4023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/13/2021] [Accepted: 04/16/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Infection with SARS-CoV-2 leads to COVID-19, the course of which is highly variable and depends on numerous patient-specific risk factors. Patients with tumor diseases are considered to be more susceptible to severe COVID-19; however, they also represent a heterogeneous group of individuals with variable risk. Identifying specific risk factors for a severe course of COVID-19 in patients with cancer is of great importance. METHODS Patients diagnosed with solid tumors or hematological malignancies and PCR-confirmed SARS-CoV-2 infection were included into the multicentric ADHOK (Arbeitsgemeinschaft der Hämatologen und Onkologen im Krankenhaus e.V.) coronavirus tumor registry. Detailed information about the patients' cancer disease, treatment, and laboratory parameters prior to infection, was collected retrospectively. The outcome of the SARS-CoV-2 infection was graded according to the WHO. RESULTS A total of 195 patients (68% with solid neoplasms and 32% with hematological malignancies) were included in the registry. Overall, the course of the SARS-CoV-2 infection varied greatly, as 69% of all patients were either asymptomatic or encountered a mild to moderate course, while 23% of the cohort died from COVID-19. In multivariable analysis, preinfection laboratory parameters (determined at least 10 days and a median of 21 days before the first documentation of SARS-CoV-2 infection) significantly correlated with severe course of the disease. Out of these, the absolute neutrophil count prior to infection showed the strongest association with COVID-19-related death. CONCLUSION The course of COVID-19 in patients with tumor diseases is highly variable. Preinfection laboratory parameters may aid to identify patients at risk for severe COVID-19 at an early stage prior to infection with the virus. German Clinical Trials Register identification: DRKS00023012.
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Affiliation(s)
- Alexander Kiani
- Medizinische Klinik IVKlinikum Bayreuth GmbHBayreuthGermany
- Comprehensive Cancer Center Erlangen‐EMN (CCC ER‐EMN)ErlangenGermany
| | | | - Clemens M. Wendtner
- Klinik für Hämatologie, Onkologie, Immunologie, Palliativmedizin, Infektiologie und TropenmedizinMünchen Klinik SchwabingMunchenGermany
| | | | - Thomas Kubin
- Klinik für Hämatologie & OnkologieKlinikum TraunsteinTraunsteinGermany
| | | | | | - Markus Schaich
- Klinik für Hämatologie, Onkologie und PalliativmedizinRems‐Murr‐Klinikum WinnendenWinnendenGermany
| | - Clemens Müller‐Naendrup
- Onkologische und Hämatologische Schwerpunktpraxis im Medizinischen Versorgungszentrum IIOlpeGermany
| | - Gerald Illerhaus
- Klinik für Hämatologie, Onkologie und PalliativmedizinKlinikum StuttgartStuttgartGermany
| | - Frank Hartmann
- Klinik für Hämatologie und OnkologieKlinikum LippeLemgoGermany
| | - Holger Hebart
- Zentrum für Innere MedizinStauferklinikumMutlangenGermany
| | | | - Martin Bentz
- Medizinische Klinik IIIStädtisches Klinikum KarlsruheKarlsruheGermany
| | - Ernst Späth‐Schwalbe
- Klinik für Innere Medizin ‐ Hämatologie, Onkologie und PalliativmedizinVivantes Klinikum Berlin SpandauBerlinGermany
| | - Peter Reimer
- Klinik für Hämatologie, Internistische Onkologie & StammzelltransplantationEvangelisches Krankenhaus Essen‐WerdenEssenGermany
| | - Ulrich Kaiser
- Klinik für Hämatologie, Onkologie und ImmunologieSt. Bernward Krankenhaus GmbHHildesheimGermany
| | - Markus Kapp
- Klinik für Gastroenterologie, Hepatologie, Infektiologie, Hämatologie und Internistische OnkologieSana Klinikum HofHofGermany
| | - Ullrich Graeven
- Klinik für Hämatologie, Onkologie und GastroenterologieKliniken Maria Hilf GmbHMönchengladbachGermany
| | - Jens‐Marcus Chemnitz
- Klinik für Innere Medizin ‐ Hämatologie/Onkologie, PalliativmedizinEv. Stift St. MartinKoblenzGermany
| | - Jörg Baesecke
- Klinik für Hämatologie, Onkologie, PalliativmedizinSt. Josefs‐Hospital CloppenburgCloppenburgGermany
| | - Helmut Lambertz
- Fachabteilung Onkologie, Hämatologie & PalliativmedizinKlinikum Garmisch‐PatenkirchenGarmisch‐PartenkirchenGermany
| | - Ralph Naumann
- Klinik für Hämatologie, Medizinische Onkologie und PalliativmedizinMarien Kliniken SiegenSiegenGermany
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209
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Ioannou GN, Liang PS, Locke E, Green P, Berry K, O’Hare AM, Shah JA, Crothers K, Eastment MC, Fan VS, Dominitz JA. Cirrhosis and Severe Acute Respiratory Syndrome Coronavirus 2 Infection in US Veterans: Risk of Infection, Hospitalization, Ventilation, and Mortality. Hepatology 2021; 74:322-335. [PMID: 33219546 PMCID: PMC7753324 DOI: 10.1002/hep.31649] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/29/2020] [Accepted: 11/17/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Whether patients with cirrhosis have increased risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the extent to which infection and cirrhosis increase the risk of adverse patient outcomes remain unclear. APPROACH AND RESULTS We identified 88,747 patients tested for SARS-CoV-2 between March 1, 2020, and May 14, 2020, in the Veterans Affairs (VA) national health care system, including 75,315 with no cirrhosis-SARS-CoV-2-negative (C0-S0), 9,826 with no cirrhosis-SARS-CoV-2-positive (C0-S1), 3,301 with cirrhosis-SARS-CoV-2-negative (C1-S0), and 305 with cirrhosis-SARS-CoV-2-positive (C1-S1). Patients were followed through June 22, 2020. Hospitalization, mechanical ventilation, and death were modeled in time-to-event analyses using Cox proportional hazards regression. Patients with cirrhosis were less likely to test positive than patients without cirrhosis (8.5% vs. 11.5%; adjusted odds ratio, 0.83; 95% CI, 0.69-0.99). Thirty-day mortality and ventilation rates increased progressively from C0-S0 (2.3% and 1.6%) to C1-S0 (5.2% and 3.6%) to C0-S1 (10.6% and 6.5%) and to C1-S1 (17.1% and 13.0%). Among patients with cirrhosis, those who tested positive for SARS-CoV-2 were 4.1 times more likely to undergo mechanical ventilation (adjusted hazard ratio [aHR], 4.12; 95% CI, 2.79-6.10) and 3.5 times more likely to die (aHR, 3.54; 95% CI, 2.55-4.90) than those who tested negative. Among patients with SARS-CoV-2 infection, those with cirrhosis were more likely to be hospitalized (aHR, 1.37; 95% CI, 1.12-1.66), undergo ventilation (aHR, 1.61; 95% CI, 1.05-2.46) or die (aHR, 1.65; 95% CI, 1.18-2.30) than patients without cirrhosis. Among patients with cirrhosis and SARS-CoV-2 infection, the most important predictors of mortality were advanced age, cirrhosis decompensation, and high Model for End-Stage Liver Disease score. CONCLUSIONS SARS-CoV-2 infection was associated with a 3.5-fold increase in mortality in patients with cirrhosis. Cirrhosis was associated with a 1.7-fold increase in mortality in patients with SARS-CoV-2 infection.
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Affiliation(s)
- George N. Ioannou
- Division of GastroenterologyVeterans Affairs Puget Sound Healthcare System and University of WashingtonSeattleWA
| | - Peter S. Liang
- Division of GastroenterologyVeterans Affairs New York Harbor Health Care System and NYU Langone HealthNew YorkNY
| | - Emily Locke
- Research and DevelopmentVeterans Affairs Puget Sound Health Care SystemSeattleWA
| | - Pamela Green
- Research and DevelopmentVeterans Affairs Puget Sound Health Care SystemSeattleWA
| | - Kristin Berry
- Research and DevelopmentVeterans Affairs Puget Sound Health Care SystemSeattleWA
| | - Ann M. O’Hare
- Division of NephrologyVeterans Affairs Puget Sound Healthcare System and University of WashingtonSeattleWA
| | - Javeed A. Shah
- Division of Allergy and Infectious DiseaseVeterans Affairs Puget Sound Healthcare System and University of WashingtonSeattleWA
| | - Kristina Crothers
- Division of Pulmonary and Critical CareVeterans Affairs Puget Sound Healthcare System and University of WashingtonSeattleWA
| | - McKenna C. Eastment
- Division of Allergy and Infectious DiseaseVeterans Affairs Puget Sound Healthcare System and University of WashingtonSeattleWA
| | - Vincent S. Fan
- Division of Pulmonary and Critical CareVeterans Affairs Puget Sound Healthcare System and University of WashingtonSeattleWA
| | - Jason A. Dominitz
- Division of GastroenterologyVeterans Affairs Puget Sound Healthcare System and University of WashingtonSeattleWA
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210
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Naumov V, Putin E, Pushkov S, Kozlova E, Romantsov K, Kalashnikov A, Galkin F, Tihonova N, Shneyderman A, Galkin E, Zinkevich A, Cope SM, Sethuraman R, Oprea TI, Pearson AT, Tay S, Agrawal N, Dubovenko A, Vanhaelen Q, Ozerov I, Aliper A, Izumchenko E, Zhavoronkov A. COVIDomic: A multi-modal cloud-based platform for identification of risk factors associated with COVID-19 severity. PLoS Comput Biol 2021; 17:e1009183. [PMID: 34260589 PMCID: PMC8312936 DOI: 10.1371/journal.pcbi.1009183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 07/26/2021] [Accepted: 06/14/2021] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is an acute infection of the respiratory tract that emerged in December 2019 in Wuhan, China. It was quickly established that both the symptoms and the disease severity may vary from one case to another and several strains of SARS-CoV-2 have been identified. To gain a better understanding of the wide variety of SARS-CoV-2 strains and their associated symptoms, thousands of SARS-CoV-2 genomes have been sequenced in dozens of countries. In this article, we introduce COVIDomic, a multi-omics online platform designed to facilitate the analysis and interpretation of the large amount of health data collected from patients with COVID-19. The COVIDomic platform provides a comprehensive set of bioinformatic tools for the multi-modal metatranscriptomic data analysis of COVID-19 patients to determine the origin of the coronavirus strain and the expected severity of the disease. An integrative analytical workflow, which includes microbial pathogens community analysis, COVID-19 genetic epidemiology and patient stratification, allows to analyze the presence of the most common microbial organisms, their antibiotic resistance, the severity of the infection and the set of the most probable geographical locations from which the studied strain could have originated. The online platform integrates a user friendly interface which allows easy visualization of the results. We envision this tool will not only have immediate implications for management of the ongoing COVID-19 pandemic, but will also improve our readiness to respond to other infectious outbreaks.
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Affiliation(s)
- Vladimir Naumov
- Insilico Medicine Hong Kong Ltd, Pak Shek Kok, New Territories, Hong Kong
| | - Evgeny Putin
- Insilico Medicine Hong Kong Ltd, Pak Shek Kok, New Territories, Hong Kong
| | - Stefan Pushkov
- Insilico Medicine Hong Kong Ltd, Pak Shek Kok, New Territories, Hong Kong
| | - Ekaterina Kozlova
- Insilico Medicine Hong Kong Ltd, Pak Shek Kok, New Territories, Hong Kong
| | | | | | - Fedor Galkin
- Insilico Medicine Hong Kong Ltd, Pak Shek Kok, New Territories, Hong Kong
| | - Nina Tihonova
- Insilico Medicine Hong Kong Ltd, Pak Shek Kok, New Territories, Hong Kong
- School of Biology, Lomonosov Moscow State University, Moscow, Russia
| | | | - Egor Galkin
- Insilico Medicine Hong Kong Ltd, Pak Shek Kok, New Territories, Hong Kong
| | - Arsenii Zinkevich
- Insilico Medicine Hong Kong Ltd, Pak Shek Kok, New Territories, Hong Kong
| | - Stephanie M. Cope
- Intel Corporation, Santa Clara, California, United States of America
| | | | - Tudor I. Oprea
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States of America
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, United States of America
- Autophagy Inflammation and Metabolism Center of Biomedical Research Excellence, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States of America
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Faculty of Health and Medical Sciences, Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, Copenhagen, Denmark
| | - Alexander T. Pearson
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, Ilinois, United States of America
| | - Savas Tay
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, Ilinois, United States of America
| | - Nishant Agrawal
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, Ilinois, United States of America
| | - Alexey Dubovenko
- Insilico Medicine Hong Kong Ltd, Pak Shek Kok, New Territories, Hong Kong
| | - Quentin Vanhaelen
- Insilico Medicine Hong Kong Ltd, Pak Shek Kok, New Territories, Hong Kong
| | - Ivan Ozerov
- Insilico Medicine Hong Kong Ltd, Pak Shek Kok, New Territories, Hong Kong
| | - Alex Aliper
- Insilico Medicine Hong Kong Ltd, Pak Shek Kok, New Territories, Hong Kong
| | - Evgeny Izumchenko
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, Ilinois, United States of America
| | - Alex Zhavoronkov
- Insilico Medicine Hong Kong Ltd, Pak Shek Kok, New Territories, Hong Kong
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211
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Yuan K, Agarwal S, Chakraborty A, Condon DF, Patel H, Zhang S, Huang F, Mello SA, Kirk OI, Vasquez R, de Jesus Perez VA. Lung Pericytes in Pulmonary Vascular Physiology and Pathophysiology. Compr Physiol 2021; 11:2227-2247. [PMID: 34190345 PMCID: PMC10507675 DOI: 10.1002/cphy.c200027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pericytes are mesenchymal-derived mural cells localized within the basement membrane of pulmonary and systemic capillaries. Besides structural support, pericytes control vascular tone, produce extracellular matrix components, and cytokines responsible for promoting vascular homeostasis and angiogenesis. However, pericytes can also contribute to vascular pathology through the production of pro-inflammatory and pro-fibrotic cytokines, differentiation into myofibroblast-like cells, destruction of the extracellular matrix, and dissociation from the vessel wall. In the lung, pericytes are responsible for maintaining the integrity of the alveolar-capillary membrane and coordinating vascular repair in response to injury. Loss of pericyte communication with alveolar capillaries and a switch to a pro-inflammatory/pro-fibrotic phenotype are common features of lung disorders associated with vascular remodeling, inflammation, and fibrosis. In this article, we will address how to differentiate pericytes from other cells, discuss the molecular mechanisms that regulate the interactions of pericytes and endothelial cells in the pulmonary circulation, and the experimental tools currently used to study pericyte biology both in vivo and in vitro. We will also discuss evidence that links pericytes to the pathogenesis of clinically relevant lung disorders such as pulmonary hypertension, idiopathic lung fibrosis, sepsis, and SARS-COVID. Future studies dissecting the complex interactions of pericytes with other pulmonary cell populations will likely reveal critical insights into the origin of pulmonary diseases and offer opportunities to develop novel therapeutics to treat patients afflicted with these devastating disorders. © 2021 American Physiological Society. Compr Physiol 11:2227-2247, 2021.
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Affiliation(s)
- Ke Yuan
- Division of Respiratory Diseases Research, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Stuti Agarwal
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - Ananya Chakraborty
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - David F. Condon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - Hiral Patel
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - Serena Zhang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - Flora Huang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - Salvador A. Mello
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | | | - Rocio Vasquez
- University of Central Florida, Orlando, Florida, USA
| | - Vinicio A. de Jesus Perez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, California, USA
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212
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Lazarus G, Budiman RA, Rinaldi I. Does immune checkpoint inhibitor increase the risks of poor outcomes in COVID-19-infected cancer patients? A systematic review and meta-analysis. Cancer Immunol Immunother 2021; 71:373-386. [PMID: 34173850 PMCID: PMC8233621 DOI: 10.1007/s00262-021-02990-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 06/16/2021] [Indexed: 12/17/2022]
Abstract
Background The association between immune checkpoint inhibitor (ICI) and outcomes of cancer patients with coronavirus disease 2019 (COVID-19) infection has yet to be systematically evaluated. This meta-analysis aims to investigate the effects of ICI treatment on COVID-19 prognosis, including mortality, severity, and any other prognosis-related outcomes. Methods Eligible studies published up to 27 February 2021 were included and assessed for risk of bias using the Quality in Prognosis Studies tool. A random-effects meta-analysis was conducted to estimate the pooled effect size along with its 95% confidence intervals. The quality of body evidence was evaluated using the modified Grading of Recommendations Assessment, Development, and Evaluation framework. Results Eleven studies involving a total of 2826 COVID-19-infected cancer patients were included in the systematic review. We discovered a moderate-to-high quality of evidence that ICI was not associated with a higher mortality risk, while the other outcomes yielded a very low-to-low-evidence quality. Although our findings indicated that ICI did not result in a higher risk of severity and hospitalization, further evidence is required to confirm our findings. In addition, we discovered that prior exposure to chemoimmunotherapy may be linked with a higher risk of COVID-19 severity (OR 8.19 [95% CI: 2.67–25.08]; I2 = 0%), albeit with small sample size. Conclusion Our findings indicated that ICI treatment should not be adjourned nor terminated during the current pandemic. Rather, COVID-19 vigilance should be increased in such patients. Further studies with larger cohorts and higher quality of evidence are required to substantiate our findings. Trial registration number This project has been prospectively registered at PROSPERO (registration ID: CRD42020202142) on 4 August 2020. Supplementary Information The online version contains supplementary material available at 10.1007/s00262-021-02990-9.
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Affiliation(s)
- Gilbert Lazarus
- Faculty of Medicine, Universitas Indonesia, Jl. Salemba Raya No. 6, RW 5, Kenari, Kec. Senen, Kota Jakarta Pusat, Jakarta, 10430, Indonesia.
| | - Refael Alfa Budiman
- Faculty of Medicine, Universitas Indonesia, Jl. Salemba Raya No. 6, RW 5, Kenari, Kec. Senen, Kota Jakarta Pusat, Jakarta, 10430, Indonesia
| | - Ikhwan Rinaldi
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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213
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Değerli E, Derin S, Oruç K, Şengül Samancı N, Bedir Ş, Çelik E, Şentürk Öztaş N, Alkan G, Demirelli FH, Demirci NS. The demographic characteristics, prognosis, and relationship with cancer subtypes of hospitalized COVID-19 patients with malignancy: A single-center experience. J Med Virol 2021; 93:5839-5845. [PMID: 34081337 PMCID: PMC8242719 DOI: 10.1002/jmv.27123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/13/2021] [Accepted: 06/01/2021] [Indexed: 11/05/2022]
Abstract
Undoubtedly, cancer patients have suffered the most from the COVID-19 pandemic process. However, cancer is a heterogeneous disease, and each patient has responded differently to COVID-19. We aimed to describe the clinical characteristics and outcomes of patients with cancer and COVID-19. We retrospectively reviewed 45 cancer patients hospitalized in the Cerrahpaşa Medical Faculty COVID-19 department from March 23 to October 23, 2020. We analyzed the demographic characteristics, symptoms, laboratory findings, treatment, prognosis, and cancer subtypes of patients and mortality who were hospitalized for COVID-19. Between March 23 and October 23, 2020, 45 hospitalized cancer patients who had laboratory-confirmed COVID-19 infection were included, with a median age of 60 years (range: 23-92). Patients were divided into two groups a survivor and a non-survivor. Symptoms, demographic information, comorbidities, treatments for COVID-19, and laboratory findings of the two groups were evaluated separately. Two parameters were found, which showed a significant difference between non-survivors and survivors displaying a disadvantage for COPD and low platelet count (p = 0.044-0.038). The mortality rate of all patients was 66%. The presence of comorbidities such as COPD and low platelet count in cancer patients with COVID-19 infection may draw the attention of physicians.
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Affiliation(s)
- Ezgi Değerli
- Department of Medical Oncology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Sümeyra Derin
- Department of Medical Oncology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Kerem Oruç
- Department of Medical Oncology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Nilay Şengül Samancı
- Department of Medical Oncology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Şahin Bedir
- Department of Medical Oncology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Emir Çelik
- Department of Medical Oncology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Nihan Şentürk Öztaş
- Department of Medical Oncology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Gülin Alkan
- Department of Medical Oncology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Fuat H Demirelli
- Department of Medical Oncology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Nebi S Demirci
- Department of Medical Oncology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Istanbul, Turkey
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214
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Indini A, Tourlaki A, Grossi F, Gambini D, Brambilla L. COVID-19 Vaccination in Patients with Classic Kaposi's Sarcoma. Vaccines (Basel) 2021; 9:632. [PMID: 34200648 PMCID: PMC8228949 DOI: 10.3390/vaccines9060632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/28/2021] [Accepted: 06/08/2021] [Indexed: 01/10/2023] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) has represented an overwhelming challenge for worldwide health systems. Patients with cancer are considered at higher risk for severe COVID-19 and increased mortality in case of infection. Although data on the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in patients with cancer are limited, there is enough evidence supporting anti-infective vaccination in general in patients with active cancer, or with history of previous malignancy. Subjects with classic Kaposi's sarcoma (KS) represent a small subset of cancer patients, which should be considered at heightened risk for infections due to several factors including age, and impaired immune function status. Several cases of human herpesviruses reactivation among critically ill COVID-19 patients have been described. Moreover, in case of severe infection and treatment with immunomodulating agents, patients with CKS are exposed at significant risk of viral reactivation and disease progression. Considering the baseline clinical risk factors of patients with CKS, and the complex interplay of the two viral agents, SARS-CoV-2 vaccination should be strongly recommended among patients with KS. KS represents an interesting field to study the interactions among chronic viral infections, SARS-CoV-2 and the host's immune system. Prospective observational studies are needed to provide more insights on vaccine activity and safety among patients with cancer, optimal vaccine schedules, potential interactions with antineoplastic therapies, and other comorbidities including chronic viral infections.
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Affiliation(s)
- Alice Indini
- Medical Oncology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Athanasia Tourlaki
- Dermatology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.T.); (L.B.)
| | - Francesco Grossi
- Medical Oncology Unit, Department of Medicine and Surgery, University of Insubria, ASST dei Sette Laghi, 21100 Varese, Italy;
| | - Donatella Gambini
- Medical Oncology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Lucia Brambilla
- Dermatology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.T.); (L.B.)
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215
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Fu C, Stoeckle JH, Masri L, Pandey A, Cao M, Littman D, Rybstein M, Saith SE, Yarta K, Rohatgi A, Makarov DV, Sherman SE, Morrissey C, Jordan AC, Razzo B, Theprungsirikul P, Tsai J, Becker DJ. COVID-19 outcomes in hospitalized patients with active cancer: Experiences from a major New York City health care system. Cancer 2021; 127:3466-3475. [PMID: 34096048 PMCID: PMC8239692 DOI: 10.1002/cncr.33657] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 12/12/2022]
Abstract
Background The authors sought to study the risk factors associated with severe outcomes in hospitalized coronavirus disease 2019 (COVID‐19) patients with cancer. Methods The authors queried the New York University Langone Medical Center's records for hospitalized patients who were polymerase chain reaction–positive for severe acute respiratory syndrome coronavirus 2 (SARS CoV‐2) and performed chart reviews on patients with cancer diagnoses to identify patients with active cancer and patients with a history of cancer. Descriptive statistics were calculated and multivariable logistic regression was used to determine associations between clinical, demographic, and laboratory characteristics with outcomes, including death and admission to the intensive care unit. Results A total of 4184 hospitalized SARS CoV‐2+ patients, including 233 with active cancer, were identified. Patients with active cancer were more likely to die than those with a history of cancer and those without any cancer history (34.3% vs 27.6% vs 20%, respectively; P < .01). In multivariable regression among all patients, active cancer (odds ratio [OR], 1.89; CI, 1.34‐2.67; P < .01), older age (OR, 1.06; CI, 1.05‐1.06; P < .01), male sex (OR for female vs male, 0.70; CI, 0.58‐0.84; P < .01), diabetes (OR, 1.26; CI, 1.04‐1.53; P = .02), morbidly obese body mass index (OR, 1.87; CI, 1.24‐2.81; P < .01), and elevated D‐dimer (OR, 6.41 for value >2300; CI, 4.75‐8.66; P < .01) were associated with increased mortality. Recent cancer‐directed medical therapy was not associated with death in multivariable analysis. Among patients with active cancer, those with a hematologic malignancy had the highest mortality rate in comparison with other cancer types (47.83% vs 28.66%; P < .01). Conclusions The authors found that patients with an active cancer diagnosis were more likely to die from COVID‐19. Those with hematologic malignancies were at the highest risk of death. Patients receiving cancer‐directed therapy within 3 months before hospitalization had no overall increased risk of death. Lay Summary Our investigators found that hospitalized patients with active cancer were more likely to die from coronavirus disease 2019 (COVID‐19) than those with a history of cancer and those without any cancer history. Patients with hematologic cancers were the most likely among patients with cancer to die from COVID‐19. Patients who received cancer therapy within 3 months before hospitalization did not have an increased risk of death.
Investigators have found that hospitalized patients with active cancer are more likely to die from coronavirus disease 2019 than those with a history of cancer and those without any cancer history. Patients who receive antineoplastic medications at least 3 months before hospitalization have no overall increased risk of death.
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Affiliation(s)
- Chen Fu
- NYU Grossman School of Medicine, New York, New York
| | | | - Lena Masri
- Manhattan VA Medical Center, New York, New York
| | | | - Meng Cao
- NYU Grossman School of Medicine, New York, New York
| | | | | | - Sunil E Saith
- NYU Langone Medical Center-Brooklyn, Brooklyn, New York
| | - Kinan Yarta
- NYU Langone Medical Center-Winthrop, Mineola, New York
| | | | | | | | | | | | | | | | - Joseph Tsai
- NYU Langone Medical Center-Brooklyn, Brooklyn, New York
| | - Daniel J Becker
- NYU Grossman School of Medicine, New York, New York.,Manhattan VA Medical Center, New York, New York
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216
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Saleh G, Ahmed A, Hassanain O, Emad A, Essameldin S, Ragai M, Saad Y. Nutrition in Cancer Patients Positive for COVID-19; Case Series and a Systematic Review of Literature. Nutr Cancer 2021; 74:450-462. [PMID: 34080508 DOI: 10.1080/01635581.2021.1931363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cancer is making patients vulnerable to diseases by impairing immunity directly or by anticancer therapy. In COVID-19 era, it is mandatory to face cancer with more organized & prompter response. Nutrition plays an important role in prevention & management of cancer patients. The objective of this study is to understand the role of nutrition in cancer patients during Corvid 19 era. We conducted literature searches till May 2020, electronic databases, evidence-based collections, relevant websites and trial registries about SARS-CoV2/COVID-19 and nutrition in cancer patients. Search generated 836 sources; 83/836 sources were relevant. This review summarized role of nutrition in predisposition, prevention and management of COVID-19 in cancer patient and role of vitamins, mineral supplements and microbiota in era of COVID-19. In this review, implementing appropriate nutritional care with vitamins or mineral supplementation & their effect on outcome remain largely unknown. COVID co-infection with cancer whether under chemotherapy or not have worse outcome especially in male adults. Findings may help in creating recommendations on nutritional protocol of management & prevention of complications during ongoing COVID-19 pandemic for all cancer patients.
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Affiliation(s)
- Gulsen Saleh
- Clinical Nutrition Department, 57357 Cancer Children Hospital of Egypt (CCHE), Cairo, Egypt.,Public Health Department, National Nutrition Institute (NNI), Cairo, Egypt
| | - Aliaa Ahmed
- Clinical Nutrition Department, 57357 Cancer Children Hospital of Egypt (CCHE), Tanta, Egypt
| | - Omneya Hassanain
- Epidemiology and Biostatistics Unit, Research Department, 57357 Cancer Children Hospital of Egypt (CCHE), Cairo, Egypt
| | - Aya Emad
- Clinical Nutrition Department, 57357 Cancer Children Hospital of Egypt (CCHE), Cairo, Egypt
| | - Samer Essameldin
- Clinical Nutrition Department, 57357 Cancer Children Hospital of Egypt (CCHE), Cairo, Egypt
| | - Marianne Ragai
- Clinical Nutrition Department, 57357 Cancer Children Hospital of Egypt (CCHE), Cairo, Egypt
| | - Yasmin Saad
- Clinical Nutrition Department, 57357 Cancer Children Hospital of Egypt (CCHE), Cairo, Egypt.,Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Grivas P, Khaki AR, Wise-Draper TM, French B, Hennessy C, Hsu CY, Shyr Y, Li X, Choueiri TK, Painter CA, Peters S, Rini BI, Thompson MA, Mishra S, Rivera DR, Acoba JD, Abidi MZ, Bakouny Z, Bashir B, Bekaii-Saab T, Berg S, Bernicker EH, Bilen MA, Bindal P, Bishnoi R, Bouganim N, Bowles DW, Cabal A, Caimi PF, Chism DD, Crowell J, Curran C, Desai A, Dixon B, Doroshow DB, Durbin EB, Elkrief A, Farmakiotis D, Fazio A, Fecher LA, Flora DB, Friese CR, Fu J, Gadgeel SM, Galsky MD, Gill DM, Glover MJ, Goyal S, Grover P, Gulati S, Gupta S, Halabi S, Halfdanarson TR, Halmos B, Hausrath DJ, Hawley JE, Hsu E, Huynh-Le M, Hwang C, Jani C, Jayaraj A, Johnson DB, Kasi A, Khan H, Koshkin VS, Kuderer NM, Kwon DH, Lammers PE, Li A, Loaiza-Bonilla A, Low CA, Lustberg MB, Lyman GH, McKay RR, McNair C, Menon H, Mesa RA, Mico V, Mundt D, Nagaraj G, Nakasone ES, Nakayama J, Nizam A, Nock NL, Park C, Patel JM, Patel KG, Peddi P, Pennell NA, Piper-Vallillo AJ, Puc M, Ravindranathan D, Reeves ME, Reuben DY, Rosenstein L, Rosovsky RP, Rubinstein SM, Salazar M, Schmidt AL, Schwartz GK, Shah MR, Shah SA, Shah C, Shaya JA, Singh SRK, Smits M, Stockerl-Goldstein KE, Stover DG, Streckfuss M, Subbiah S, Tachiki L, Tadesse E, Thakkar A, Tucker MD, Verma AK, Vinh DC, Weiss M, Wu JT, Wulff-Burchfield E, Xie Z, Yu PP, Zhang T, Zhou AY, Zhu H, Zubiri L, Shah DP, Warner JL, Lopes G. Association of clinical factors and recent anticancer therapy with COVID-19 severity among patients with cancer: a report from the COVID-19 and Cancer Consortium. Ann Oncol 2021; 32:787-800. [PMID: 33746047 PMCID: PMC7972830 DOI: 10.1016/j.annonc.2021.02.024] [Citation(s) in RCA: 216] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/18/2021] [Accepted: 02/28/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Patients with cancer may be at high risk of adverse outcomes from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We analyzed a cohort of patients with cancer and coronavirus 2019 (COVID-19) reported to the COVID-19 and Cancer Consortium (CCC19) to identify prognostic clinical factors, including laboratory measurements and anticancer therapies. PATIENTS AND METHODS Patients with active or historical cancer and a laboratory-confirmed SARS-CoV-2 diagnosis recorded between 17 March and 18 November 2020 were included. The primary outcome was COVID-19 severity measured on an ordinal scale (uncomplicated, hospitalized, admitted to intensive care unit, mechanically ventilated, died within 30 days). Multivariable regression models included demographics, cancer status, anticancer therapy and timing, COVID-19-directed therapies, and laboratory measurements (among hospitalized patients). RESULTS A total of 4966 patients were included (median age 66 years, 51% female, 50% non-Hispanic white); 2872 (58%) were hospitalized and 695 (14%) died; 61% had cancer that was present, diagnosed, or treated within the year prior to COVID-19 diagnosis. Older age, male sex, obesity, cardiovascular and pulmonary comorbidities, renal disease, diabetes mellitus, non-Hispanic black race, Hispanic ethnicity, worse Eastern Cooperative Oncology Group performance status, recent cytotoxic chemotherapy, and hematologic malignancy were associated with higher COVID-19 severity. Among hospitalized patients, low or high absolute lymphocyte count; high absolute neutrophil count; low platelet count; abnormal creatinine; troponin; lactate dehydrogenase; and C-reactive protein were associated with higher COVID-19 severity. Patients diagnosed early in the COVID-19 pandemic (January-April 2020) had worse outcomes than those diagnosed later. Specific anticancer therapies (e.g. R-CHOP, platinum combined with etoposide, and DNA methyltransferase inhibitors) were associated with high 30-day all-cause mortality. CONCLUSIONS Clinical factors (e.g. older age, hematological malignancy, recent chemotherapy) and laboratory measurements were associated with poor outcomes among patients with cancer and COVID-19. Although further studies are needed, caution may be required in utilizing particular anticancer therapies. CLINICAL TRIAL IDENTIFIER NCT04354701.
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Affiliation(s)
- P Grivas
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA.
| | - A R Khaki
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA; Stanford University, Stanford, USA
| | | | - B French
- Vanderbilt University Medical Center, Nashville, USA
| | - C Hennessy
- Vanderbilt University Medical Center, Nashville, USA
| | - C-Y Hsu
- Vanderbilt University Medical Center, Nashville, USA
| | - Y Shyr
- Vanderbilt University Medical Center, Nashville, USA
| | - X Li
- Vanderbilt University School of Medicine, Nashville, USA
| | | | - C A Painter
- Broad Institute, Cancer Program, Cambridge, USA
| | - S Peters
- Lausanne University, Lausanne, Switzerland
| | - B I Rini
- Vanderbilt University Medical Center, Nashville, USA
| | | | - S Mishra
- Vanderbilt University Medical Center, Nashville, USA
| | - D R Rivera
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, USA
| | - J D Acoba
- University of Hawaii Cancer Center, Honolulu, USA
| | - M Z Abidi
- University of Colorado School of Medicine, Aurora, USA
| | - Z Bakouny
- Dana-Farber Cancer Institute, Boston, USA
| | - B Bashir
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, USA
| | | | - S Berg
- Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, USA
| | | | - M A Bilen
- Winship Cancer Institute of Emory University, Atlanta, USA
| | - P Bindal
- Beth Israel Deaconess Medical Center, Boston, USA
| | - R Bishnoi
- University of Florida, Gainesville, USA
| | - N Bouganim
- McGill University Health Centre, Montréal, Canada
| | - D W Bowles
- University of Colorado School of Medicine, Aurora, USA
| | - A Cabal
- University of California San Diego, Moores Cancer Center, La Jolla, USA
| | - P F Caimi
- University Hospitals Seidman Cancer Center, Cleveland, USA; Case Western Reserve University, Cleveland, USA
| | - D D Chism
- Thompson Cancer Survival Center, Knoxville, USA
| | - J Crowell
- St. Elizabeth Healthcare, Edgewood, USA
| | - C Curran
- Dana-Farber Cancer Institute, Boston, USA
| | - A Desai
- Mayo Clinic Cancer Center, Rochester, USA
| | - B Dixon
- St. Elizabeth Healthcare, Edgewood, USA
| | - D B Doroshow
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - E B Durbin
- Markey Cancer Center, University of Kentucky, Lexington, USA
| | - A Elkrief
- McGill University Health Centre, Montréal, Canada
| | - D Farmakiotis
- The Warren Alpert Medical School of Brown University, Providence, USA
| | - A Fazio
- Tufts Medical Center Cancer Center, Boston and Stoneham, USA
| | - L A Fecher
- University of Michigan Rogel Cancer Center, Ann Arbor, USA
| | - D B Flora
- St. Elizabeth Healthcare, Edgewood, USA
| | - C R Friese
- University of Michigan Rogel Cancer Center, Ann Arbor, USA
| | - J Fu
- Tufts Medical Center Cancer Center, Boston and Stoneham, USA
| | - S M Gadgeel
- Henry Ford Cancer Institute/Henry Ford Health System, Detroit, USA
| | - M D Galsky
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - D M Gill
- Intermountain Healthcare, Salt Lake City, USA
| | | | - S Goyal
- George Washington University, Washington DC, USA
| | - P Grover
- University of Cincinnati Cancer Center, Cincinnati, USA
| | - S Gulati
- University of Cincinnati Cancer Center, Cincinnati, USA
| | - S Gupta
- Cleveland Clinic Taussig Cancer Institute, Cleveland, USA
| | | | | | - B Halmos
- Albert Einstein Cancer Center/Montefiore Medical Center, Bronx, USA
| | - D J Hausrath
- Vanderbilt University School of Medicine, Nashville, USA
| | - J E Hawley
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, USA
| | - E Hsu
- Hartford HealthCare, Hartford, USA; University of Connecticut, Farmington, USA
| | - M Huynh-Le
- George Washington University, Washington DC, USA
| | - C Hwang
- Henry Ford Cancer Institute/Henry Ford Health System, Detroit, USA
| | - C Jani
- Mount Auburn Hospital, Cambridge, USA
| | | | - D B Johnson
- Vanderbilt University Medical Center, Nashville, USA
| | - A Kasi
- University of Kansas Medical Center, Kansas City, USA
| | - H Khan
- The Warren Alpert Medical School of Brown University, Providence, USA
| | - V S Koshkin
- University of California, San Francisco, San Francisco, USA
| | - N M Kuderer
- Advanced Cancer Research Group, LLC, Kirkland, USA
| | - D H Kwon
- University of California, San Francisco, San Francisco, USA
| | | | - A Li
- Baylor College of Medicine, Houston, USA
| | | | - C A Low
- Intermountain Healthcare, Salt Lake City, USA
| | | | - G H Lyman
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA
| | - R R McKay
- University of California San Diego, Moores Cancer Center, La Jolla, USA
| | - C McNair
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, USA
| | - H Menon
- Penn State Health/Penn State Cancer Institute/St. Joseph Cancer Center, Hershey, USA
| | - R A Mesa
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, USA
| | - V Mico
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, USA
| | - D Mundt
- Advocate Aurora Health, Milwaukee, USA
| | - G Nagaraj
- Loma Linda University Cancer Center, Loma Linda, USA
| | - E S Nakasone
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA
| | - J Nakayama
- Case Western Reserve University, Cleveland, USA; University Hospitals Cleveland Medical Center, Cleveland, USA
| | - A Nizam
- Cleveland Clinic Taussig Cancer Institute, Cleveland, USA
| | - N L Nock
- University Hospitals Seidman Cancer Center, Cleveland, USA; Case Western Reserve University, Cleveland, USA
| | - C Park
- University of Cincinnati Cancer Center, Cincinnati, USA
| | - J M Patel
- Beth Israel Deaconess Medical Center, Boston, USA
| | - K G Patel
- University of California Davis Comprehensive Cancer Center, Sacramento, USA
| | - P Peddi
- Willis-Knighton Cancer Center, Shreveport, USA
| | - N A Pennell
- Cleveland Clinic Taussig Cancer Institute, Cleveland, USA
| | | | - M Puc
- Virtua Health, Marlton, USA
| | | | - M E Reeves
- Loma Linda University Cancer Center, Loma Linda, USA
| | - D Y Reuben
- Medical University of South Carolina, Charleston, USA
| | | | - R P Rosovsky
- Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | | | - M Salazar
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, USA
| | | | - G K Schwartz
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, USA
| | - M R Shah
- Rutgers Cancer Institute of New Jersey, New Brunswick, USA
| | - S A Shah
- Stanford University, Stanford, USA
| | - C Shah
- University of Florida, Gainesville, USA
| | - J A Shaya
- University of California San Diego, Moores Cancer Center, La Jolla, USA
| | - S R K Singh
- Henry Ford Cancer Institute/Henry Ford Health System, Detroit, USA
| | - M Smits
- ThedaCare Regional Cancer Center, Appleton, USA
| | | | - D G Stover
- The Ohio State University, Columbus, USA
| | | | - S Subbiah
- Stanley S. Scott Cancer Center, LSU Health Sciences Center, New Orleans, USA
| | - L Tachiki
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA
| | - E Tadesse
- Advocate Aurora Health, Milwaukee, USA
| | - A Thakkar
- Albert Einstein Cancer Center/Montefiore Medical Center, Bronx, USA
| | - M D Tucker
- Vanderbilt University Medical Center, Nashville, USA
| | - A K Verma
- Albert Einstein Cancer Center/Montefiore Medical Center, Bronx, USA
| | - D C Vinh
- McGill University Health Centre, Montréal, Canada
| | - M Weiss
- ThedaCare Regional Cancer Center, Appleton, USA
| | - J T Wu
- Stanford University, Stanford, USA
| | | | - Z Xie
- Mayo Clinic Cancer Center, Rochester, USA
| | - P P Yu
- Hartford HealthCare, Hartford, USA
| | - T Zhang
- Duke University, Durham, USA
| | - A Y Zhou
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, USA
| | - H Zhu
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - L Zubiri
- Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - D P Shah
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, USA
| | - J L Warner
- Vanderbilt University Medical Center, Nashville, USA
| | - GdL Lopes
- University of Miami/Sylvester Comprehensive Cancer Center, Miami, USA
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218
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Ahmed J, Faisal M, Jalalah M, Alsaiari M, Alsareii S, Harraz FA. An efficient amperometric catechol sensor based on novel polypyrrole-carbon black doped α-Fe2O3 nanocomposite. Colloids Surf A Physicochem Eng Asp 2021. [DOI: 10.1016/j.colsurfa.2021.126469] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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219
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Yan H, Liang X, Du J, He Z, Wang Y, Lyu M, Yue L, Zhang F, Xue Z, Xu L, Ruan G, Li J, Zhu H, Xu J, Chen S, Zhang C, Lv D, Lin Z, Shen B, Zhu Y, Qian B, Chen H, Guo T. Proteomic and metabolomic investigation of serum lactate dehydrogenase elevation in COVID-19 patients. Proteomics 2021; 21:e2100002. [PMID: 33987944 PMCID: PMC8237019 DOI: 10.1002/pmic.202100002] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/01/2021] [Accepted: 05/05/2021] [Indexed: 01/08/2023]
Abstract
Serum lactate dehydrogenase (LDH) has been established as a prognostic indicator given its differential expression in COVID‐19 patients. However, the molecular mechanisms underneath remain poorly understood. In this study, 144 COVID‐19 patients were enrolled to monitor the clinical and laboratory parameters over 3 weeks. Serum LDH was shown elevated in the COVID‐19 patients on admission and declined throughout disease course, and its ability to classify patient severity outperformed other biochemical indicators. A threshold of 247 U/L serum LDH on admission was determined for severity prognosis. Next, we classified a subset of 14 patients into high‐ and low‐risk groups based on serum LDH expression and compared their quantitative serum proteomic and metabolomic differences. The results showed that COVID‐19 patients with high serum LDH exhibited differentially expressed blood coagulation and immune responses including acute inflammatory responses, platelet degranulation, complement cascade, as well as multiple different metabolic responses including lipid metabolism, protein ubiquitination and pyruvate fermentation. Specifically, activation of hypoxia responses was highlighted in patients with high LDH expressions. Taken together, our data showed that serum LDH levels are associated with COVID‐19 severity, and that elevated serum LDH might be consequences of hypoxia and tissue injuries induced by inflammation.
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Affiliation(s)
- Haixi Yan
- Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China
| | - Xiao Liang
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China.,Center for Infectious Disease Research, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, China.,Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, China
| | - Juping Du
- Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China
| | - Zebao He
- Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China
| | - Yu Wang
- Shanghai Tongren Hospital and Clinical Research Institute, Hongqiao International Institute of Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mengge Lyu
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China.,Center for Infectious Disease Research, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, China.,Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, China
| | - Liang Yue
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China.,Center for Infectious Disease Research, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, China.,Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, China
| | - Fangfei Zhang
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China.,Center for Infectious Disease Research, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, China.,Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, China
| | - Zhangzhi Xue
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China.,Center for Infectious Disease Research, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, China.,Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, China
| | - Luang Xu
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China.,Center for Infectious Disease Research, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, China.,Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, China
| | - Guan Ruan
- Westlake Omics (Hangzhou) Biotechnology Co., Ltd. No.1, Hangzhou, China
| | - Jun Li
- Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China
| | - Hongguo Zhu
- Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China
| | - Jiaqin Xu
- Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China
| | - Shiyong Chen
- Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China
| | - Chao Zhang
- Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China
| | - Dongqing Lv
- Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China
| | - Zongmei Lin
- Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China
| | - Bo Shen
- Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China
| | - Yi Zhu
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China.,Center for Infectious Disease Research, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, China.,Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, China
| | - Biyun Qian
- Shanghai Tongren Hospital and Clinical Research Institute, Hongqiao International Institute of Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haixiao Chen
- Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China
| | - Tiannan Guo
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China.,Center for Infectious Disease Research, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, China.,Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, China
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Abstract
Since coronavirus disease 2019 (COVID-19) swept all over the world, several studies have shown the susceptibility of a patient with cancer to COVID-19. In this case, the removed glioblastoma multiforme (GBM)-adjacent (GBM-A), GBM-peritumor and GBM-central (GBM-C) tissues from a convalescent patient of COVID-19, who also suffered from glioblastoma meanwhile, together with GBM-A and GBM tissues from a patient without COVID-19 history as negative controls, were used for RNA ISH, electron microscopy observing and immunohistochemical staining of ACE2 and the virus antigen (N protein). The results of RNA ISH, electron microscopy observing showed that SARS-CoV-2 directly infects some cells within human GBM tissues and SARS-CoV-2 in GBM-C tissue still exists even when it is cleared elsewhere. Immunohistochemical staining of ACE2 and N protein showed that the expressions of ACE2 are significantly higher in specimens, including GBM-C tissue from COVID-19 patient than other types of tissue. The unique phenomenon suggests that the surgical protection level should be upgraded even if the patient is in a convalescent period and the pharyngeal swab tests show negative results. Furthermore, more attention should be paid to confirm whether the shelter-like phenomenon happens in other malignancies due to the similar microenvironment and high expression of ACE2 in some malignancies.
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221
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Wang M, Fan Y, Chai Y, Cheng W, Wang K, Cao J, Hu X. Association of Clinical and Immunological Characteristics With Disease Severity and Outcomes in 211 Patients With COVID-19 in Wuhan, China. Front Cell Infect Microbiol 2021; 11:667487. [PMID: 34123873 PMCID: PMC8195246 DOI: 10.3389/fcimb.2021.667487] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 05/10/2021] [Indexed: 01/08/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) has posed a great threat to global public health. There remains an urgent need to address the clinical significance of laboratory finding changes in predicting disease progression in COVID-19 patients. We aimed to analyze the clinical and immunological features of severe and critically severe patients with COVID-19 in comparison with non-severe patients and identify risk factors for disease severity and clinical outcome in COVID-19 patients. Methods The consecutive records of 211 patients with COVID-19 who were admitted to Zhongnan Hospital of Wuhan University from December 2019 to February 2020 were retrospectively reviewed. Results Of the 211 patients with COVID-19 recruited, 111 patients were classified as non-severe, 59 as severe, and 41 as critically severe cases. The median age was obviously higher in severe and critically severe cases than in non-severe cases. Severe and critically severe patients showed more underlying comorbidities than non-severe patients. Fever was the predominant presenting symptom in COVID-19 patients, and the duration of fever was longer in critically severe patients. Moreover, patients with increased levels of serum aminotransferases and creatinine (CREA) were at a higher risk for severe and critical COVID-19 presentations. The serum levels of IL-6 in severe and critically severe patients were remarkably higher than in non-severe patients. Lymphopenia was more pronounced in severe and critically severe patients compared with non-severe patients. Lymphocyte subset analysis indicated that severe and critically severe patients had significantly decreased count of lymphocyte subpopulations, such as CD4+ T cells, CD8+ T cells and B cells. A multivariate logistic analysis indicated that older age, male sex, the length of hospital stay, body temperature before admission, comorbidities, higher white blood cell (WBC) counts, lower lymphocyte counts, and increased levels of IL-6 were significantly associated with predicting the progression to severe stage of COVID-19. Conclusion Older age, male sex, underlying illness, sustained fever status, abnormal liver and renal functions, excessive expression of IL-6, lymphopenia, and selective loss of peripheral lymphocyte subsets were related to disease deterioration and clinical outcome in COVID-19 patients. This study would provide clinicians with valuable information for risk evaluation and effective interventions for COVID-19.
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Affiliation(s)
- Man Wang
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao, China
| | - Yongzhen Fan
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, China
| | - Yuqiong Chai
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, China
| | - Wenlin Cheng
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, China
| | - Kun Wang
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao, China
| | - Jianlei Cao
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, China
| | - Xiaorong Hu
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, China
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Meng Z, Wang M, Zhao Z, Zhou Y, Wu Y, Guo S, Li M, Zhou Y, Yang S, Li W, Ying B. Development and Validation of a Predictive Model for Severe COVID-19: A Case-Control Study in China. Front Med (Lausanne) 2021; 8:663145. [PMID: 34113636 PMCID: PMC8185163 DOI: 10.3389/fmed.2021.663145] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/12/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Predicting the risk of progression to severe coronavirus disease 2019 (COVID-19) could facilitate personalized diagnosis and treatment options, thus optimizing the use of medical resources. Methods: In this prospective study, 206 patients with COVID-19 were enrolled from regional medical institutions between December 20, 2019, and April 10, 2020. We collated a range of data to derive and validate a predictive model for COVID-19 progression, including demographics, clinical characteristics, laboratory findings, and cytokine levels. Variation analysis, along with the least absolute shrinkage and selection operator (LASSO) and Boruta algorithms, was used for modeling. The performance of the derived models was evaluated by specificity, sensitivity, area under the receiver operating characteristic (ROC) curve (AUC), Akaike information criterion (AIC), calibration plots, decision curve analysis (DCA), and Hosmer–Lemeshow test. Results: We used the LASSO algorithm and logistic regression to develop a model that can accurately predict the risk of progression to severe COVID-19. The model incorporated alanine aminotransferase (ALT), interleukin (IL)-6, expectoration, fatigue, lymphocyte ratio (LYMR), aspartate transaminase (AST), and creatinine (CREA). The model yielded a satisfactory predictive performance with an AUC of 0.9104 and 0.8792 in the derivation and validation cohorts, respectively. The final model was then used to create a nomogram that was packaged into an open-source and predictive calculator for clinical use. The model is freely available online at https://severeconid-19predction.shinyapps.io/SHINY/. Conclusion: In this study, we developed an open-source and free predictive calculator for COVID-19 progression based on ALT, IL-6, expectoration, fatigue, LYMR, AST, and CREA. The validated model can effectively predict progression to severe COVID-19, thus providing an efficient option for early and personalized management and the allocation of appropriate medical resources.
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Affiliation(s)
- Zirui Meng
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Minjin Wang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenzhen Zhao
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yongzhao Zhou
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Wu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Shuo Guo
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Mengjiao Li
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yanbing Zhou
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Shuyu Yang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Binwu Ying
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
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223
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Saygideger Y, Sezan A, Candevir A, Saygıdeğer Demir B, Güzel E, Baydar O, Derinoz E, Komur S, Kuscu F, Ozyılmaz E, Kuleci S, Hanta I, Akkız H, Tasova Y. COVID-19 patients' sera induce epithelial mesenchymal transition in cancer cells. Cancer Treat Res Commun 2021; 28:100406. [PMID: 34090218 PMCID: PMC8146274 DOI: 10.1016/j.ctarc.2021.100406] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/12/2021] [Accepted: 05/24/2021] [Indexed: 12/18/2022]
Abstract
Covid-19 Pneumonia of SARS-CoV-2 pandemic infection, persists to have high disease burden especially in cancer patients. Increased inflammation and thromboembolic processes are blamed to influence cancer patients more than the others but due to lack of knowledge regarding the pathophysiology of the both the virus itself and the response of the host, more basic and translational disease modeling research is needed to understand Cancer-Covid-19 interaction. In this study, serum samples from the patients, who were hospitalized due to Covid-19 pneumonia, applied to different cancer cells and cytotoxicity, motility, proliferation and gene expression analysis were performed. Serum samples derived from healthy volunteers and the fetal bovine serum that is used regularly in cell culture experiments used as controls. Hospitalized Covid-19 patients who had also cancer, were retrospectively screened, and their clinical course were recorded. Overall 12 Patient (PS) and 4 healthy serums (CS) were included in the experiments. PS applied cells showed increased motility in A549 cells as well as lost cell to cell connection in MCF7 and HCT116 cells, and induced expression of VIM, ZEB1 and SNAIL2 mRNA levels. Eight cancer diagnosed patients who were hospitalized due to Covid-19 between April and September 2020 were also reviewed retrospectively, which 5 of them were dead during SARS-CoV-2 infection. Thorax CT images of the 2 patients showed increased metastatic nodules in the lungs as of January 2021. The results of the study indicate that metastasis may be one of the prolonged consequences of COVID-19 pandemic in cancer sufferers.
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Affiliation(s)
- Yasemin Saygideger
- Department of Pulmonary, Cukurova University School of Medicine, Adana 01330, Turkey; Department of Translational Medicine, Institute of Health Sciences, Cukurova University, Adana, Turkey; Department of Biotechnology, Institute of Natural and Applied Sciences, Cukurova University, Adana, Turkey.
| | - Aycan Sezan
- Department of Biotechnology, Institute of Natural and Applied Sciences, Cukurova University, Adana, Turkey
| | - Aslihan Candevir
- Department of Translational Medicine, Institute of Health Sciences, Cukurova University, Adana, Turkey; Department of Infectious Diseases, Cukurova University School of Medicine, Adana, Turkey
| | - Burcu Saygıdeğer Demir
- Department of Biotechnology, Institute of Natural and Applied Sciences, Cukurova University, Adana, Turkey
| | - Efraim Güzel
- Department of Pulmonary, Cukurova University School of Medicine, Adana 01330, Turkey
| | - Oya Baydar
- Department of Pulmonary, Cukurova University School of Medicine, Adana 01330, Turkey
| | - Ezgi Derinoz
- Department of Biotechnology, Institute of Natural and Applied Sciences, Cukurova University, Adana, Turkey
| | - Suheyla Komur
- Department of Infectious Diseases, Cukurova University School of Medicine, Adana, Turkey
| | - Ferit Kuscu
- Department of Infectious Diseases, Cukurova University School of Medicine, Adana, Turkey
| | - Ezgi Ozyılmaz
- Department of Pulmonary, Cukurova University School of Medicine, Adana 01330, Turkey
| | - Sedat Kuleci
- Department of Pulmonary, Cukurova University School of Medicine, Adana 01330, Turkey
| | - Ismail Hanta
- Department of Pulmonary, Cukurova University School of Medicine, Adana 01330, Turkey
| | - Hikmet Akkız
- Department of Gastroenterology, Cukurova University School of Medicine, Adana, Turkey
| | - Yesim Tasova
- Department of Infectious Diseases, Cukurova University School of Medicine, Adana, Turkey
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Pandy JG, Maaño O, Balolong-Garcia JC, Datukan JTY. Risk factors and clinical outcomes of systemic cancer treatment delays in Filipino patients with solid tumor malignancy during the COVID-19 pandemic: A single tertiary center study. Cancer Rep (Hoboken) 2021; 5:e1426. [PMID: 34021716 PMCID: PMC8209920 DOI: 10.1002/cnr2.1426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/23/2021] [Accepted: 05/04/2021] [Indexed: 01/25/2023] Open
Abstract
Background Cancer care during the Covid‐19 pandemic has been challenging especially in a developing country such as the Philippines. Oncologists were advised to prioritize chemotherapy based on the absolute benefit that the patient may receive, which outbalances the risks of Covid‐19 infection. The results of this study will allow re‐examination of how to approach cancer care during the pandemic and ultimately, help optimize treatment recommendations during this crisis. Aim This study described the factors contributing to treatment delays during the pandemic and their impact on disease progression. Materials and results This retrospective cohort study was done in St. Luke's Medical Center, a private tertiary healthcare institution based in Metro Manila, Philippines, composed of two facilities in Quezon City and Global City. Patients with solid malignancy with ongoing systemic cancer treatment prior to the peak of the pandemic were identified. Clinical characteristics and treatment data were compared between those with delayed and continued treatments. Multivariate analysis was done to determine factors for treatment delays and association of delays with disease progression and Covid‐19 infection. Of the 111 patients, 33% experienced treatment delays and 67% continued treatment during the pandemic. There was a higher percentage of patients on palliative intent who underwent treatment delay, and 64% of delays were due to logistic difficulties. Treatment delays were significantly associated with disease progression (p < .0001). There was no evidence of association between delay or continuation of treatment and risk of Covid‐19 infection. Conclusions There was no difference in Covid‐19 infection between those who delayed and continued treatment during the pandemic; however, treatment delays were associated with a higher incidence of disease progression. Our findings suggest that the risks of cancer progression due to treatment delays exceed the risks of Covid‐19 infection in cancer patients implying that beneficial treatment should not be delayed as much as possible. Logistic hindrances were also identified as the most common cause of treatment delay among Filipino patients, suggesting that efforts should be focused into assistance programs that will mitigate these barriers to ensure continuity of cancer care services during the pandemic.
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Affiliation(s)
- Jessa Gilda Pandy
- Section of Medical Oncology, St. Luke's Medical Center, Quezon City, Philippines
| | - Omar Maaño
- Section of Medical Oncology, St. Luke's Medical Center, Quezon City, Philippines
| | | | - Jay T Y Datukan
- Section of Medical Oncology, St. Luke's Medical Center, Quezon City, Philippines
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Asghar K, Abu Bakar M, Akram MJ, Farooq A, Siddique K, Rana IA, Ali J, Rashid MU, Khan AA, Loya A. Clinical Characteristics of COVID-19-Infected Cancer Patients in Pakistan: Differences Between Survivors and Non-Survivors. Front Oncol 2021; 11:655634. [PMID: 34094950 PMCID: PMC8173078 DOI: 10.3389/fonc.2021.655634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/15/2021] [Indexed: 12/19/2022] Open
Abstract
Background Cancer patients are considered as highly vulnerable individuals in the current COVID-19 pandemic. We studied the clinical characteristics of survivor and non-survivor COVID-19-infected cancer patients in Pakistan. Patients and Methods We did a retrospective study of 70 cancer patients with PCR-confirmed COVID-19 infection from Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore and Peshawar, Pakistan between April 13 and July 09, 2020. These patients were discharged from the hospital or had died by July 09, 2020. Clinical, pathological and radiological characteristics were compared between survivors and non-survivors by fisher's exact test and chi-square test. Univariable and multivariable logistic regression models were performed to explore the risk factors of mortality. Results Seventy cancer patients with SARS-CoV-2 infection were enrolled and the majority were males 38 (54.3%). 57 (81.4%) had solid tumors and 13 (18.6%) had hematological malignancies. Dyspnea (44 cases) was the most common symptom (62.9%). Complications were reported in 51 (72.9%) patients during the course of disease. 19 (27.1%) patients were admitted to an intensive care unit (ICU). A significant increase in the C-reactive protein level and neutrophil count was observed in the deceased patients as compared to the surviving patients. D-dimer values of ≥0.2 mg/L were significantly associated with mortality (P=0.01). We identified two independent risk factors associated with death, ICU admission (P=0.007) and D-dimer (P=0.003). Conclusion Pakistani cancer patients with COVID-19 infection reported poor prognosis. Intensive surveillance of clinicopathological characteristics of cancer patients infected with COVID-19 especially D-dimer values may play a pivotal role in the outcome of the disease.
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Affiliation(s)
- Kashif Asghar
- Department of Basic Sciences Research, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Muhammad Abu Bakar
- Department of Cancer Registry and Clinical Data Management, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Muhammad Junaid Akram
- Department of Internal Medicine (Pulmonology), Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Asim Farooq
- Department of Clinical Research, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Kashif Siddique
- Department of Radiology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Iftikhar Ali Rana
- Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Jamshed Ali
- Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Peshawar, Pakistan
| | - Muhammad Usman Rashid
- Department of Basic Sciences Research, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Ashraf Ali Khan
- Department of Internal Medicine (Infectious Diseases), Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Asif Loya
- Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
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Rahimi H, Allahyari A, Ataei Azimi S, Kamandi M, Mozaheb Z, Zemorshidi F, Khadem-Rezaiyan M, Bary A, Seddigh-Shamsi M, Nodeh MM. Effect of hydroxychloroquine on COVID-19 prevention in cancer patients undergoing treatment: study protocol for a randomized controlled trial. Trials 2021; 22:349. [PMID: 34011413 PMCID: PMC8131879 DOI: 10.1186/s13063-021-05292-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/23/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES In this study, we will investigate the effect of hydroxychloroquine on the prevention of novel coronavirus disease (COVID-19) in cancer patients being treated. TRIAL DESIGN This is a two-arm, parallel-group, triple-blind, phase 2-3 randomized controlled trial. PARTICIPANTS All patients over the age of 15 years from 5 types of cancer will be included in the study. Patients with acute lymphoid and myeloid leukemias in the first line treated with curative intent, patients with high-grade non-Hodgkin's lymphoma treated with leukemia regimens, and patients with non-metastatic breast and colon cancer in the first line of treatment will enter the study. INTERVENTION AND COMPARATOR Patients are randomly assigned to two groups: one being given hydroxychloroquine and the other is given placebo. During 2 months of treatment, the two groups will be treated with hydroxychloroquine every other day with a single 200-mg tablet (Amin® Pharmaceutical Company, Isfahan, Iran) or placebo (identical in terms of shape, color, and smell). Patients will be monitored for COVID-19 symptoms during follow-up period. If any COVID-19-related signs or symptoms occur, they will be examined, thoroughly, investigated with a high resolution computerize tomography (CT) scan of the lungs and nasopharyngeal swab assessed by RT-PCR for SARS-CoV-2 virus. This study will be performed in five centers affiliated to Mashhad University of Medical Sciences, Mashhad, Iran. MAIN OUTCOMES The primary end point of this study is to investigate the incidence of COVID-19 in patients being treated for their cancer and receiving prophylactic Hydroxychloroquine. RANDOMIZATION Randomization will be performed using random permuted blocks. By using online website ( www.randomization.com ), the randomization sequence will be produced by quadruple blocks. The allocation ratio in intervention and control groups is 1:1. BLINDING (MASKING) Participants and caregivers do not know whether the patient is in the intervention or the control group. Those assessing the outcomes and data analyzer are also blinded to group assignment. SAMPLE SIZE The calculated total sample size is 60 patients, with 30 patients in each group.
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Affiliation(s)
- H Rahimi
- Division of Hematology and Oncology, Department of Internal Medicine, Faculty of Medicine, MUMS, Mashhad, Iran
| | - A Allahyari
- Division of Hematology and Oncology, Department of Internal Medicine, Faculty of Medicine, MUMS, Mashhad, Iran
| | - S Ataei Azimi
- Department of Internal Medicine, Faculty of Medicine, MUMS, Mashhad, Iran
| | - M Kamandi
- Department of Internal Medicine, Faculty of Medicine, MUMS, Mashhad, Iran
| | - Z Mozaheb
- Division of Hematology and Oncology, Department of Internal Medicine, Faculty of Medicine, MUMS, Mashhad, Iran
| | - F Zemorshidi
- Department of Neurology, Faculty of Medicine, MUMS, Mashhad, Iran
| | - M Khadem-Rezaiyan
- Department of Community Medicine, Faculty of Medicine, MUMS, Mashhad, Iran
| | - A Bary
- Razavi Hospital, Mashhad, Iran
| | - M Seddigh-Shamsi
- Department of Internal Medicine, Faculty of Medicine, MUMS, Mashhad, Iran
| | - M Moeini Nodeh
- Division of Hematology and Oncology, Department of Internal Medicine, Faculty of Medicine, MUMS, Mashhad, Iran.
- Current address: Hematology-Oncology Section, Internal Medicine Department, Ghaem Hospital, Ahmadabad Ave, Shariati Sq, Mashhad, Iran.
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227
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Pannone G, Caponio VCA, De Stefano IS, Ramunno MA, Meccariello M, Agostinone A, Pedicillo MC, Troiano G, Zhurakivska K, Cassano T, Bizzoca ME, Papagerakis S, Buonaguro FM, Advani S, Muzio LL. Lung histopathological findings in COVID-19 disease - a systematic review. Infect Agent Cancer 2021; 16:34. [PMID: 34001199 PMCID: PMC8127295 DOI: 10.1186/s13027-021-00369-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/23/2021] [Indexed: 02/08/2023] Open
Abstract
Since December 2019, the global burden of the COVID-19 pandemic has increased rapidly and has impacted nearly every country in the world, affecting those who are elderly or with underlying comorbidities or immunocompromised states. Aim of this systematic review is to summarize lung histopathological characteristics of COVID-19, not only for diagnostic purpose but also to evaluate changes that can reflect pathophysiological pathways that can inform clinicians of useful treatment strategies. We identified following histopathological changes among our patients:: hyaline membranes; endothelial cells/ interstitial cells involvement; alveolar cells, type I pneumocytes/ type II pneumocytes involvement; interstitial and/ or alveolar edema; evidence of hemorrhage, of inflammatory cells, evidence of microthrombi; evidence of fibrin deposition and of viral infection in the tissue samples.The scenario with proliferative cell desquamation is typical of Acute Respiratory Distress Syndrome (ARDS) that can be classified as diffuse alveolar damage (DAD) and not DAD-ARDS. The proposed pathological mechanism concerns the role of both innate and adaptive components of the immune system. COVID-19 lethal cases present themselves as a heterogeneous disease, characterized by the different simultaneous presence of different histological findings, which reflect histological phases with corresponding different pathological pathways (epithelial, vascular and fibrotic changes), in the same patient.
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Affiliation(s)
- Giuseppe Pannone
- Anatomic Pathology Unit, Department of Clinic and Experimental Medicine, University of Foggia, 71122, Foggia, Italy
| | | | - Ilenia Sara De Stefano
- Anatomic Pathology Unit, Department of Clinic and Experimental Medicine, University of Foggia, 71122, Foggia, Italy
| | - Maria Antonietta Ramunno
- Anatomic Pathology Unit, Department of Clinic and Experimental Medicine, University of Foggia, 71122, Foggia, Italy
| | - Mario Meccariello
- Anatomic Pathology Unit, Department of Clinic and Experimental Medicine, University of Foggia, 71122, Foggia, Italy
| | - Alessio Agostinone
- Anatomic Pathology Unit, Department of Clinic and Experimental Medicine, University of Foggia, 71122, Foggia, Italy
| | - Maria Carmela Pedicillo
- Anatomic Pathology Unit, Department of Clinic and Experimental Medicine, University of Foggia, 71122, Foggia, Italy
| | - Giuseppe Troiano
- Department of Clinic and Experimental Medicine, University of Foggia, 71122, Foggia, Italy
| | - Khrystyna Zhurakivska
- Department of Clinic and Experimental Medicine, University of Foggia, 71122, Foggia, Italy
| | - Tommaso Cassano
- Department of Clinic and Experimental Medicine, University of Foggia, 71122, Foggia, Italy
| | - Maria Eleonora Bizzoca
- Department of Clinic and Experimental Medicine, University of Foggia, 71122, Foggia, Italy
| | - Silvana Papagerakis
- Department of Surgery, College of Medicine, Health Sciences Center, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Franco Maria Buonaguro
- Molecular Biology and Viral Oncology Unit Istituto Nazionale, Tumori IRCCS "Fondazione Pascale", 80131, Naples, Italy
| | - Shailesh Advani
- Georgetown University School of Medicine, Georgetown University, Washington, DC, USA
| | - Lorenzo Lo Muzio
- Department of Clinic and Experimental Medicine, University of Foggia, 71122, Foggia, Italy
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Özdemir N, Dizdar Ö, Yazıcı O, Aksoy S, Dede DS, Budakoğlu B, Metan G, Alp A, Budakoğlu II, Öksüzoğlu ÖBÇ, Özet A, Kılıçkap S, Turhal NS, Çelik İ, Erman M, Ata N, Çelik O, Hayran M. Clinical features and outcomes of COVID-19 in patients with solid tumors: Turkish National Registry Data. Int J Cancer 2021; 148:2407-2415. [PMID: 33284987 DOI: 10.1002/ijc.33426] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/17/2020] [Accepted: 11/23/2020] [Indexed: 12/18/2022]
Abstract
We present demographic, clinical, laboratory characteristics and outcomes of the patients with solid malignancies and novel coronavirus disease (COVID-19) collected from the National COVID-19 Registry of Turkey. A total of 1523 patients with a current or past diagnosis of solid tumors and diagnosed with COVID-19 (confirmed with PCR) between 11 March and 20 May 2020 were included. The primary outcome was 30-day mortality. Median age was 61 (range: 18-94), and 752 (49%) were male. The most common types of cancers were breast (19.8%), prostate (10.9%) and colorectal cancer (10.8%). 65% of the patients had at least one comorbidity. At least one COVID-19-directed therapy was given in 73% of the patients.. Hospitalization rate of the patients was 56.6% and intensive care unit admission rate was 11.4%. Seventy-seven (5.1%) patients died within 30 days of diagnosis. The first multivariate model which included only the demographic and clinical characteristics showed older age, male gender and presence of diabetes and receipt of cytotoxic therapy to be associated with increased 30-day mortality, while breast and prostate cancer diagnoses were associated with lower 30-day mortality. In the second set, we further included laboratory parameters. The presence of leukocytosis (OR 6.7, 95% CI 3.3-13.7, P < .001), lymphocytopenia (OR 3,1, 95% CI 1,6-6,1, P = .001) and thrombocytopenia (OR 3,4 95% CI 1,5-8,1, P = .005) were found to be associated with increased 30-day mortality. Relatively lower mortality compared to Western countries and China mainly results from differences in baseline risk factors but may also implicate the importance of intensive supportive care.
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Affiliation(s)
- Nuriye Özdemir
- Department of Medical Oncology, Gazi University School of Medicine, Ankara, Turkey
| | - Ömer Dizdar
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Ozan Yazıcı
- Department of Medical Oncology, Gazi University School of Medicine, Ankara, Turkey
| | - Sercan Aksoy
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Didem Sener Dede
- Department of Medical Oncology, Anakar Yildirim Beyazit University School of Medicine, Ankara, Turkey
| | - Burçin Budakoğlu
- Department of Medical Oncology, Medikalpark Medical Center, Ankara, Turkey
| | - Gökhan Metan
- Department of Infectious diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Alpaslan Alp
- Department of Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Isıl Irem Budakoğlu
- Department of Medical Education and Informatics, Gazi University School of Medicine, Ankara, Turkey
| | - Ömür Berna Çakmak Öksüzoğlu
- Department of Medical Oncology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ahmet Özet
- Department of Medical Oncology, Gazi University School of Medicine, Ankara, Turkey
| | - Saadettin Kılıçkap
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Nazim Serdar Turhal
- Department of Medical Oncology, İstanbul Anadolu Medical Center and President of Turkish Medical Oncology Association, Istanbul, Turkey
| | - İsmail Çelik
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Mustafa Erman
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Naim Ata
- Strategy Development Department of the Ministry of Health, Ankara, Turkey
| | - Osman Çelik
- Strategy Development Department of the Ministry of Health, Ankara, Turkey
| | - Mutlu Hayran
- Department of Preventive Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
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229
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Lai YJ, Chao CH, Liao CC, Lee TA, Hsu JM, Chou WC, Wang J, Huang HC, Chang SJ, Lin YL, Li CW. Epithelial-mesenchymal transition induced by SARS-CoV-2 required transcriptional upregulation of Snail. Am J Cancer Res 2021; 11:2278-2290. [PMID: 34094684 PMCID: PMC8167694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/01/2021] [Indexed: 06/12/2023] Open
Abstract
The engagement of human angiotensin-converting enzyme 2 (hACE2) and SARS-CoV-2 spike protein facilitate virus spread. Thus far, ACE2 and TMPRSS2 expression is correlated with the epithelial-mesenchymal transition (EMT) gene signature in lung cancer. However, the mechanism for SARS-CoV-2-induced EMT has not been thoroughly explored. Here, we showed that SARS-CoV-2 induces EMT phenotypic change and stemness in breast cancer cell model and subsequently identified Snail as a modulator for this regulation. The in-depth analysis identifies the spike protein (S), but not envelope (E), nucleocapsid (N), or membrane protein (M), of SARS-CoV-2 induces EMT marker changes. Suppression of Snail expression in these cells abrogates S protein-induced invasion, migration, stemness, and lung metastasis, suggesting that Snail is required for SARS-CoV-2-mediated aggressive phenotype in cancer. This study reveals an important oncogenic role of SARS-CoV-2 in triggering breast cancer metastasis through Snail upregulation.
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Affiliation(s)
- Yun-Ju Lai
- Institute of Biomedical Sciences, Academia SinicaTaipei 115, Taiwan
- Solomont School of Nursing, Zuckerberg College of Health Sciences, University of Massachusetts Lowell113 Wilder Street, Lowell, MA 01854, USA
| | - Chi-Hong Chao
- Department of Biological Science and Technology, National Chiao Tung UniversityHsinchu 30010, Taiwan
- Department of Biological Science and Technology, National Yang Ming Chiao Tung UniversityHsinchu 30010, Taiwan
- Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Chiao Tung UniversityHsinchu 30010, Taiwan
| | - Chun-Che Liao
- Institute of Biomedical Sciences, Academia SinicaTaipei 115, Taiwan
| | - Te-An Lee
- Institute of Biomedical Sciences, Academia SinicaTaipei 115, Taiwan
| | - Jung-Mao Hsu
- Graduate Institute of Biomedical Sciences and Research Center for Cancer Biology, Medical UniversityTaichung 406040, Taiwan
| | - Wen-Cheng Chou
- Institute of Biomedical Sciences, Academia SinicaTaipei 115, Taiwan
| | - Jyun Wang
- Institute of Biomedical Sciences, Academia SinicaTaipei 115, Taiwan
| | - Hsiang-Chi Huang
- Institute of Biomedical Sciences, Academia SinicaTaipei 115, Taiwan
| | - Shing-Jyh Chang
- Department of Obstetrics and Gynecology, Hsinchu MacKay Memorial HospitalHsinchu 300, Taiwan
| | - Yi-Ling Lin
- Institute of Biomedical Sciences, Academia SinicaTaipei 115, Taiwan
- Biomedical Translational Research Center, Academia SinicaTaipei 115, Taiwan
| | - Chia-Wei Li
- Institute of Biomedical Sciences, Academia SinicaTaipei 115, Taiwan
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230
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Zhang H, Han H, He T, Labbe KE, Hernandez AV, Chen H, Velcheti V, Stebbing J, Wong KK. Clinical Characteristics and Outcomes of COVID-19-Infected Cancer Patients: A Systematic Review and Meta-Analysis. J Natl Cancer Inst 2021; 113:371-380. [PMID: 33136163 PMCID: PMC7665647 DOI: 10.1093/jnci/djaa168] [Citation(s) in RCA: 121] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/03/2020] [Accepted: 10/14/2020] [Indexed: 12/19/2022] Open
Abstract
Background Previous studies have indicated coronavirus disease 2019 (COVID-19) patients with cancer have a high fatality rate. Methods We conducted a systematic review of studies that reported fatalities in COVID-19 patients with cancer. A comprehensive meta-analysis that assessed the overall case fatality rate and associated risk factors was performed. Using individual patient data, univariate and multivariable logistic regression analyses were used to estimate odds ratios (OR) for each variable with outcomes. Results We included 15 studies with 3019 patients, of which 1628 were men; 41.0% were from the United Kingdom and Europe, followed by the United States and Canada (35.7%), and Asia (China, 23.3%). The overall case fatality rate of COVID-19 patients with cancer measured 22.4% (95% confidence interval [CI] = 17.3% to 28.0%). Univariate analysis revealed age (OR = 3.57, 95% CI = 1.80 to 7.06), male sex (OR = 2.10, 95% CI = 1.07 to 4.13), and comorbidity (OR = 2.00, 95% CI = 1.04 to 3.85) were associated with increased risk of severe events (defined as the individuals being admitted to the intensive care unit, or requiring invasive ventilation, or death). In multivariable analysis, only age greater than 65 years (OR = 3.16, 95% CI = 1.45 to 6.88) and being male (OR = 2.29, 95% CI = 1.07 to 4.87) were associated with increased risk of severe events. Conclusions Our analysis demonstrated that COVID-19 patients with cancer have a higher fatality rate compared with that of COVID-19 patients without cancer. Age and sex appear to be risk factors associated with a poorer prognosis.
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Affiliation(s)
- Hua Zhang
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, NY, USA
| | - Han Han
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, NY, USA
| | - Tianhui He
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Kristen E Labbe
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, NY, USA
| | - Adrian V Hernandez
- Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group, University of Connecticut School of Pharmacy, Storrs, CT, USA.,Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru
| | - Haiquan Chen
- Departments of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Vamsidhar Velcheti
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, NY, USA
| | - Justin Stebbing
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Kwok-Kin Wong
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, NY, USA
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Lee AJX, Purshouse K. COVID-19 and cancer registries: learning from the first peak of the SARS-CoV-2 pandemic. Br J Cancer 2021; 124:1777-1784. [PMID: 33767417 PMCID: PMC7992513 DOI: 10.1038/s41416-021-01324-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/08/2021] [Accepted: 02/19/2021] [Indexed: 12/14/2022] Open
Abstract
The SARS-Cov-2 pandemic in 2020 has caused oncology teams around the world to adapt their practice in the aim of protecting patients. Early evidence from China indicated that patients with cancer, and particularly those who had recently received chemotherapy or surgery, were at increased risk of adverse outcomes following SARS-Cov-2 infection. Many registries of cancer patients infected with SARS-Cov-2 emerged during the first wave. We collate the evidence from these national and international studies and focus on the risk factors for patients with solid cancers and the contribution of systemic anti-cancer treatments (SACT-chemotherapy, immunotherapy, targeted and hormone therapy) to outcomes following SARS-Cov-2 infection. Patients with cancer infected with SARS-Cov-2 have a higher probability of death compared with patients without cancer. Common risk factors for mortality following COVID-19 include age, male sex, smoking history, number of comorbidities and poor performance status. Oncological features that may predict for worse outcomes include tumour stage, disease trajectory and lung cancer. Most studies did not identify an association between SACT and adverse outcomes. Recent data suggest that the timing of receipt of SACT may be associated with risk of mortality. Ongoing recruitment to these registries will enable us to provide evidence-based care.
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Affiliation(s)
- Alvin J X Lee
- UCL Cancer Institute, University College London, London, UK.
| | - Karin Purshouse
- CRUK Edinburgh Cancer Research Centre, The University of Edinburgh, Edinburgh, UK
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232
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Kaur H, Thakur JS, Paika R, Advani SM. Impact of Underlying Comorbidities on Mortality in SARS-COV-2 Infected Cancer Patients: A Systematic Review and Meta-Analysis. Asian Pac J Cancer Prev 2021; 22:1333-1349. [PMID: 34048161 PMCID: PMC8408376 DOI: 10.31557/apjcp.2021.22.5.1333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 05/02/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The evidence has shown that SARS CoV-2 infected patients with comorbidities are more likely to have severe disease sequel and mortality. In SARS-CoV-2 infected cancer patients risks associated with other underlying comorbidities might vary from those in non-cancer SARS CoV-2 infected patients. The relative impact of different underlying health conditions among patients with cancer and SARS CoV-2 infection remains yet to be explored. This systematic review aims to explore the prevalence of comorbidities among cancer patients with SARS CoV-2 infection and their impact on mortality. METHODS Online databases PubMed, Embase, Scopus and Web of science were searched for articles published between 9th July 2019 to July 8th 2020.Studies of cancer patients (>18 years) with diagnosis of SARS CoV-2 infection, published in English were included. A random-effects modelling for the meta-analyses was applied to assess the pooled prevalence and odds ratio for mortality due to comorbidities in SARS CoV-2 infected cancer patients. RESULTS Total 31studies with 4086 SARS-CoV-2 infectedcancer patientsmet the inclusion criteria. Most prevalent co-morbidities in cancer patients with SARS CoV-2 infection were hypertension [42.3% (95%CI:37.5- 47.0)], diabetes [17.8% (95% CI: 15.3-20.4)] and cardiovascular diseases [16.7% (95%CI:12.9-20.4)].The risk of mortality (pOR) was significantly higher in individuals with hypertension[1.6(95%CI 1.24-2.00)], cardiovascular diseases [2.2 (95%CI 1.49- 3.27)], chronic obstructive pulmonary diseases [1.4(95% CI 1.05-2.00)] and diabetes [1.35(95%CI 1.06-1.73)]. CONCLUSION Our results indicates that the mortality in SARS-CoV-2 infected cancer patients is affected by preexisting non-cancer comorbidities. By identifying the comorbidities predictive for mortality, clinicians can better stratify the risk of cancer patients presenting with SARS-COV-2, on their initial contact with health services. .
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Affiliation(s)
- Harmanjeet Kaur
- Department of Community Medicine & School of Public Health, PGIMER, Chandigarh, India.
| | - JS Thakur
- Department of Community Medicine & School of Public Health, PGIMER, Chandigarh, India.
| | - Ronika Paika
- Department of Community Medicine & School of Public Health, PGIMER, Chandigarh, India.
| | - Shailesh M Advani
- Cancer Prevention and Control Program, Georgetown University School of Medicine, Georgetown University, Washington DC, USA.
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233
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Prete A, Falcone M, Bottici V, Giani C, Tiseo G, Agate L, Matrone A, Cappagli V, Valerio L, Lorusso L, Minaldi E, Molinaro E, Elisei R. Thyroid cancer and COVID-19: experience at one single thyroid disease referral center. Endocrine 2021; 72:332-339. [PMID: 33638758 PMCID: PMC7912964 DOI: 10.1007/s12020-021-02650-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/23/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) is challenging health systems all over the world. Cancer patients have a higher risk of being infected by SARS-Cov-2 and higher coronavirus disease 2019 (COVID-19) severity and mortality. Up to date, there were no data about COVID-19 in patients with thyroid cancer (TCs). The aim of the study was to describe the prevalence of COVID-19 in a well-characterized series of TC patients evaluated for the persistence of the neoplastic disease from March to September 2020; as secondary objective, we looked for the COVID-19 disease severity in a subgroup of multimetastatic TC patients. METHODS We evaluated 1464 patients affected by persistent TC: 67 patients who were taking multikinase inhibitors (MKIs) and 1397 under active surveillance for a persistent but stable disease. During the clinical evaluation, all patients were specifically investigated about a positive history of Sars-Cov-2 infection. RESULTS SARS-Cov-2 infection was identified in 4/1464 (0.3%) cases of patients affected by TC. We identified three cases among patients under active surveillance (0.2%), and one case among patients treated with MKI systemic therapy (1/67, 1.5%). This patient was taking vandetanib for metastatic medullary thyroid cancer (MTC), when he came to our attention referring severe fatigue, dyspnea for light physical activities. He presented a mild COVID-19 and he received exclusively supportive care. After a multidisciplinary consultation, we decided against the discontinuation of vandetanib. After 2 months from the infection, he did not present any signs of active infection, and the MTC metastatic disease was stable. CONCLUSIONS We showed that COVID-19 is not more frequent in TC patients than in general population, although a relatively higher prevalence in the group of TC patients treated with MKIs. A single patient with advanced TC and SARS-Cov-2 infection during MKIs treatment had a mild COVID-19 and did not require the discontinuation of MKI therapy. In cases of more severe COVID-19, an accurate evaluation from a multidisciplinary team would consider risks and benefits in taking the decision to continue or stop MKI treatment.
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Affiliation(s)
- Alessandro Prete
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, 56122, Pisa, Italy
| | - Marco Falcone
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Pisa, 56122, Pisa, Italy
| | - Valeria Bottici
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, 56122, Pisa, Italy
| | - Carlotta Giani
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, 56122, Pisa, Italy
| | - Giusy Tiseo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Pisa, 56122, Pisa, Italy
| | - Laura Agate
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, 56122, Pisa, Italy
| | - Antonio Matrone
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, 56122, Pisa, Italy
| | - Virginia Cappagli
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, 56122, Pisa, Italy
| | - Laura Valerio
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, 56122, Pisa, Italy
| | - Loredana Lorusso
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, 56122, Pisa, Italy
| | - Elisa Minaldi
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, 56122, Pisa, Italy
| | - Eleonora Molinaro
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, 56122, Pisa, Italy
| | - Rossella Elisei
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, 56122, Pisa, Italy.
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234
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Nicastro E, Verdoni L, Bettini LR, Zuin G, Balduzzi A, Montini G, Biondi A, D'Antiga L. COVID-19 in Immunosuppressed Children. Front Pediatr 2021; 9:629240. [PMID: 33996683 PMCID: PMC8116542 DOI: 10.3389/fped.2021.629240] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/03/2021] [Indexed: 12/15/2022] Open
Abstract
Following the spread of the SARS-CoV-2 infection and coronavirus disease 2019 (COVID-19) to a global pandemic, concerns have arisen for the disease impact in at-risk populations, especially in immunocompromised hosts. On the other hand, clinical studies have clarified that the COVID-19 clinical burden is mostly due to over-inflammation and immune-mediated multiorgan injury. This has led to downsizing the role of immunosuppression as a determinant of outcome, and early reports confirm the hypothesis that patients undergoing immunosuppressive treatments do not have an increased risk of severe COVID-19 with respect to the general population. Intriguingly, SARS-CoV-2 natural reservoirs, such as bats and mice, have evolved mechanisms of tolerance involving selection of genes optimizing viral clearance through interferon type I and III responses and also dampening inflammasome response and cytokine expression. Children exhibit resistance to COVID-19 severe manifestations, and age-related features in innate and adaptive response possibly explaining this difference are discussed. A competent recognition by the innate immune system and controlled pro-inflammatory signaling seem to be the pillars of an effective response and the premise for pathogen clearance in SARS-CoV-2 infection. Immunosuppression-if not associated with other elements of fragility-do not represent per se an obstacle to this competent/tolerant phenotype in children. Several reports confirm that children receiving immunosuppressive medications have similar clinical involvement and outcomes as the pediatric general population, indicating that maintenance treatments should not be interrupted in suspect or confirmed SARS-CoV-2 infection.
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Affiliation(s)
- Emanuele Nicastro
- Pediatric Hepatology, Gastroenterology and Transplantation Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Lucio Verdoni
- Pediatric Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Laura Rachele Bettini
- MBBM Foundation, Pediatric Department, Hospital San Gerardo, University of Milano Bicocca, Monza, Italy
| | - Giovanna Zuin
- MBBM Foundation, Pediatric Department, Hospital San Gerardo, University of Milano Bicocca, Monza, Italy
| | - Adriana Balduzzi
- MBBM Foundation, Pediatric Department, Hospital San Gerardo, University of Milano Bicocca, Monza, Italy
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Andrea Biondi
- MBBM Foundation, Pediatric Department, Hospital San Gerardo, University of Milano Bicocca, Monza, Italy
| | - Lorenzo D'Antiga
- Pediatric Hepatology, Gastroenterology and Transplantation Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy
- Pediatric Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy
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235
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Spoerl S, Kremer AN, Aigner M, Eisenhauer N, Koch P, Meretuk L, Löffler P, Tenbusch M, Maier C, Überla K, Heinzerling L, Frey B, Lutzny-Geier G, Winkler TH, Krönke G, Vetter M, Bruns H, Neurath MF, Mackensen A, Kremer AE, Völkl S. Upregulation of CCR4 in activated CD8 + T cells indicates enhanced lung homing in patients with severe acute SARS-CoV-2 infection. Eur J Immunol 2021; 51:1436-1448. [PMID: 33784417 PMCID: PMC8250120 DOI: 10.1002/eji.202049135] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/21/2021] [Accepted: 03/23/2021] [Indexed: 12/15/2022]
Abstract
COVID‐19 is a life‐threatening disease leading to bilateral pneumonia and respiratory failure. The underlying reasons why a smaller percentage of patients present with severe pulmonary symptoms whereas the majority is only mildly affected are to date not well understood. Comparing the immunological phenotype in healthy donors and patients with mild versus severe COVID‐19 shows that in COVID‐19 patients, NK‐/B‐cell activation and proliferation are enhanced independent of severity. As an important precondition for effective antibody responses, T‐follicular helper cells and antibody secreting cells are increased both in patients with mild and severe SARS‐CoV‐2 infection. Beyond this, T cells in COVID‐19 patients exhibit a stronger activation profile with differentiation toward effector cell phenotypes. Importantly, when looking at the rates of pulmonary complications in COVID‐19 patients, the chemokine receptor CCR4 is higher expressed by both CD4 and CD8 T cells of patients with severe COVID‐19. This raises the hypothesis that CCR4 upregulation on T cells in the pathogenesis of COVID‐19 promotes stronger T‐cell attraction to the lungs leading to increased immune activation with presumably higher pulmonary toxicity. Our study contributes significantly to the understanding of the immunological changes during COVID‐19, as new therapeutic agents, preferentially targeting the immune system, are highly warranted.
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Affiliation(s)
- Silvia Spoerl
- Department of Internal Medicine 5, Hematology, and Oncology, University Hospital Erlangen and Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Anita N Kremer
- Department of Internal Medicine 5, Hematology, and Oncology, University Hospital Erlangen and Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Aigner
- Department of Internal Medicine 5, Hematology, and Oncology, University Hospital Erlangen and Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Nina Eisenhauer
- Department of Internal Medicine 5, Hematology, and Oncology, University Hospital Erlangen and Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Pauline Koch
- Department of Internal Medicine 5, Hematology, and Oncology, University Hospital Erlangen and Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Lina Meretuk
- Department of Internal Medicine 5, Hematology, and Oncology, University Hospital Erlangen and Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Patrick Löffler
- Department of Internal Medicine 5, Hematology, and Oncology, University Hospital Erlangen and Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Tenbusch
- Institute of Virology, University Hospital Erlangen and Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Clara Maier
- Institute of Virology, University Hospital Erlangen and Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Klaus Überla
- Institute of Virology, University Hospital Erlangen and Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Lucie Heinzerling
- Department of Dermatology, University Hospital Erlangen and Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Benjamin Frey
- Department of Radiation Oncology, University Hospital Erlangen and Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Gloria Lutzny-Geier
- Department of Internal Medicine 5, Hematology, and Oncology, University Hospital Erlangen and Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Thomas H Winkler
- Division of Genetics, Department of Biology, Nikolaus-Fiebiger-Center for Molecular Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Gerhard Krönke
- Department of Internal Medicine 3, Rheumatology, and Immunology, University Hospital Erlangen and Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Marcel Vetter
- Department of Internal Medicine 1, Gastroenterology, Pneumology, and Endocrinology, University Hospital Erlangen and Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Heiko Bruns
- Department of Internal Medicine 5, Hematology, and Oncology, University Hospital Erlangen and Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Markus F Neurath
- Department of Internal Medicine 1, Gastroenterology, Pneumology, and Endocrinology, University Hospital Erlangen and Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Andreas Mackensen
- Department of Internal Medicine 5, Hematology, and Oncology, University Hospital Erlangen and Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Andreas E Kremer
- Department of Internal Medicine 1, Gastroenterology, Pneumology, and Endocrinology, University Hospital Erlangen and Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Simon Völkl
- Department of Internal Medicine 5, Hematology, and Oncology, University Hospital Erlangen and Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
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236
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Aldhaeefi M, Tahir Z, Cote DJ, Izzy S, El Khoury J. Comorbidities and Age Are Associated With Persistent COVID-19 PCR Positivity. Front Cell Infect Microbiol 2021; 11:650753. [PMID: 33889551 PMCID: PMC8056299 DOI: 10.3389/fcimb.2021.650753] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/18/2021] [Indexed: 01/08/2023] Open
Abstract
Objectives The impact of demographics and comorbidities on the duration of COVID-19 nasopharyngeal swab PCR positivity remains unclear. The objective of our analysis is to determine the impact of age, intensive care unit (ICU) admission, comorbidities, and ethnicity on the duration of COVID-19 PCR positivity among hospitalized patients in a large group of hospital. Method We studied 530 patients from a large hospital system and time to SARS-CoV-2 virus RNA PCR negativity at any-time during hospitalization or following discharge from the hospital was the primary endpoint. We included patients 18 years or older who tested positive for COVID-19 during an inpatient, outpatient, or emergency room visit between February 1, 2020, and April 14, 2020. Results Overall, 315 (59.4%) of our patient population continued to have a positive SARS-CoV-2 virus RNA PCR 4 weeks after the initial positive test. We found that age>70 years, chronic kidney disease, hypertension, hyperlipidemia, obesity, or coronary artery disease are associated with persistent PCR positivity for more than 4 weeks after initial diagnosis. Conclusion Age, and the presence of co-morbidities should be taken into consideration when interpreting a positive COVID PCR test.
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Affiliation(s)
- Mohammed Aldhaeefi
- Department of Pharmacy Services, Brigham and Women's Hospital, Boston, MA, United States
| | - Zabreen Tahir
- Department of Neurology, Neurocritical Care, Brigham and Women's Hospital, Boston, MA, United States
| | - David J Cote
- Harvard Medical School, Boston, MA, United States
| | - Saef Izzy
- Department of Neurology, Neurocritical Care, Brigham and Women's Hospital, Boston, MA, United States.,Center for Immunology & Inflammatory Diseases, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Joseph El Khoury
- Department of Neurology, Neurocritical Care, Brigham and Women's Hospital, Boston, MA, United States.,Center for Immunology & Inflammatory Diseases, Massachusetts General Hospital, Boston, MA, United States.,Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States
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237
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Ives A, Pusztai T, Keller J, Ahern E, Chan B, Gasper H, Wyld D, Kennedy G, Dickie G, Lwin Z, Roberts NA. Resilience and ongoing quality care for cancer clinical trials during COVID-19: Experience from a tertiary hospital in Australia. Asia Pac J Clin Oncol 2021; 18:e141-e147. [PMID: 33819387 PMCID: PMC8251164 DOI: 10.1111/ajco.13570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/18/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The COVID-19 pandemic has forced rapid system-wide changes to be implemented within cancer care at an alarming pace. Clinical trials are a key element of comprehensive cancer care. Ensuring the continuing safe conduct of cancer clinical trials in the context of a pandemic is challenging. METHODS We aimed to describe the COVID-19 pandemic response of a Cancer Care Clinical Research Unit (CRU) of a tertiary hospital in Queensland, Australia. We used a mixed methods approach for this case study. Emailed directives from CRU managers to all CRU staff sharing were qualitatively analysed and mapped against our unit activities over longitudinal time points. Data from patient recruitment and protocol deviations were analysed using descriptive statistics. RESULTS Mapping activity from 11 March to 30 September 2020 revealed rapid change during the first 2 weeks. Four key strategies to accommodate change were identified: supporting patients and families, introduction of telehealth, accessing investigational product, and social distancing. Early in the pandemic we recognised that our core key stakeholders were integral to our response. When compared to the previous 12 months, our recruitment numbers dropped markedly in early phases of the response but recovered over time, as we accommodated internal and external impacts. CONCLUSION Our experience of agility as a necessity, adapting to support patients, and managing both clinical research activity and sponsors during the height of the pandemic response is presented here in order to inform future disaster response planning by clinical trial organisations.
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Affiliation(s)
- Amy Ives
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Tricia Pusztai
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Jacqui Keller
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Elizabeth Ahern
- Department of Oncology, Monash Health, Melbourne, Victoria, Australia.,School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Bryan Chan
- Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.,School of Medicine, Griffith University, Sunshine Coast, Queensland, Australia
| | - Harry Gasper
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Clinical School of Medicine, University of Queensland, St Lucia, Australia
| | - David Wyld
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Clinical School of Medicine, University of Queensland, St Lucia, Australia
| | - Glen Kennedy
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Clinical School of Medicine, University of Queensland, St Lucia, Australia
| | - Graeme Dickie
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Zarnie Lwin
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Natasha A Roberts
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,University of Queensland Centre for Clinical Research (UQCCR), Queensland, Australia.,School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
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238
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Cantini L, Bastianelli L, Lupi A, Pinterpe G, Pecci F, Belletti G, Stoico R, Vitarelli F, Moretti M, Onori N, Giampieri R, Rocchi MBL, Berardi R. Seroprevalence of SARS-CoV-2-Specific Antibodies in Cancer Patients Undergoing Active Systemic Treatment: A Single-Center Experience from the Marche Region, Italy. J Clin Med 2021; 10:jcm10071503. [PMID: 33916569 PMCID: PMC8038489 DOI: 10.3390/jcm10071503] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 03/28/2021] [Accepted: 04/02/2021] [Indexed: 12/30/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence in cancer patients may vary widely dependent on the geographic area and this has significant implications for oncological care. The aim of this observational, prospective study was to assess the seroprevalence of SARS-CoV-2 IgM/IgG antibodies in solid cancer patients referred to the academic institution of the Marche Region, Italy, between 1 July and 26 October 2020 and to determine the accuracy of the rapid serological test. After performing 3767 GCCOV-402a rapid serological tests on a total of 949 patients, seroconversion was initially observed in 13 patients (1.4%). Ten (77% of the total positive) were IgG-positive, 1 (8%) were IgM-positive and 2 (15%) IgM-positive/IgG-positive. However, only 7 out of 13 were confirmed as positive at the reference serological test (true positives), thus seroprevalence after cross-checking was 0.7%. No false negatives were reported. The kappa value of the consistency analysis was 0.71. Due to rapid serological test high false positive rate, its role in assessing seroconversion rate is limited, and the standard serological tests should remain the gold standard. However, as rapid test negative predictive value is high, GCCOV-402a may instead be useful to monitor patient immunity over time, thus helping to assist ongoing vaccination programs.
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Affiliation(s)
- Luca Cantini
- Rossana Berardi, Clinical Oncology, Università Politecnica delle Marche, A.O.U. Ospedali Riuniti, Via Conca 71, 60126 Ancona, Italy; (L.C.); (L.B.); (A.L.); (G.P.); (F.P.); (G.B.); (R.S.); (F.V.); (R.G.)
| | - Lucia Bastianelli
- Rossana Berardi, Clinical Oncology, Università Politecnica delle Marche, A.O.U. Ospedali Riuniti, Via Conca 71, 60126 Ancona, Italy; (L.C.); (L.B.); (A.L.); (G.P.); (F.P.); (G.B.); (R.S.); (F.V.); (R.G.)
| | - Alessio Lupi
- Rossana Berardi, Clinical Oncology, Università Politecnica delle Marche, A.O.U. Ospedali Riuniti, Via Conca 71, 60126 Ancona, Italy; (L.C.); (L.B.); (A.L.); (G.P.); (F.P.); (G.B.); (R.S.); (F.V.); (R.G.)
| | - Giada Pinterpe
- Rossana Berardi, Clinical Oncology, Università Politecnica delle Marche, A.O.U. Ospedali Riuniti, Via Conca 71, 60126 Ancona, Italy; (L.C.); (L.B.); (A.L.); (G.P.); (F.P.); (G.B.); (R.S.); (F.V.); (R.G.)
| | - Federica Pecci
- Rossana Berardi, Clinical Oncology, Università Politecnica delle Marche, A.O.U. Ospedali Riuniti, Via Conca 71, 60126 Ancona, Italy; (L.C.); (L.B.); (A.L.); (G.P.); (F.P.); (G.B.); (R.S.); (F.V.); (R.G.)
| | - Giovanni Belletti
- Rossana Berardi, Clinical Oncology, Università Politecnica delle Marche, A.O.U. Ospedali Riuniti, Via Conca 71, 60126 Ancona, Italy; (L.C.); (L.B.); (A.L.); (G.P.); (F.P.); (G.B.); (R.S.); (F.V.); (R.G.)
| | - Rosa Stoico
- Rossana Berardi, Clinical Oncology, Università Politecnica delle Marche, A.O.U. Ospedali Riuniti, Via Conca 71, 60126 Ancona, Italy; (L.C.); (L.B.); (A.L.); (G.P.); (F.P.); (G.B.); (R.S.); (F.V.); (R.G.)
| | - Francesca Vitarelli
- Rossana Berardi, Clinical Oncology, Università Politecnica delle Marche, A.O.U. Ospedali Riuniti, Via Conca 71, 60126 Ancona, Italy; (L.C.); (L.B.); (A.L.); (G.P.); (F.P.); (G.B.); (R.S.); (F.V.); (R.G.)
| | - Marco Moretti
- SOD Medicina di Laboratorio, A.O.U. Ospedali Riuniti, 60126 Ancona, Italy; (M.M.); (N.O.)
| | - Nicoletta Onori
- SOD Medicina di Laboratorio, A.O.U. Ospedali Riuniti, 60126 Ancona, Italy; (M.M.); (N.O.)
| | - Riccardo Giampieri
- Rossana Berardi, Clinical Oncology, Università Politecnica delle Marche, A.O.U. Ospedali Riuniti, Via Conca 71, 60126 Ancona, Italy; (L.C.); (L.B.); (A.L.); (G.P.); (F.P.); (G.B.); (R.S.); (F.V.); (R.G.)
| | | | - Rossana Berardi
- Rossana Berardi, Clinical Oncology, Università Politecnica delle Marche, A.O.U. Ospedali Riuniti, Via Conca 71, 60126 Ancona, Italy; (L.C.); (L.B.); (A.L.); (G.P.); (F.P.); (G.B.); (R.S.); (F.V.); (R.G.)
- Correspondence: or
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Positionspapier vom 27.01.2021 – COVID-19-Schutzimpfung bei PatientInnen mit aktiver Krebserkrankung. Geburtshilfe Frauenheilkd 2021. [DOI: 10.1055/a-1348-3454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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240
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Lazar Neto F, Salzstein GA, Cortez AL, Bastos TL, Baptista FVD, Moreira JA, Lauterbach GP, de Oliveira JC, de Assis FC, Aguiar MRA, de Deus AA, Dias MFDS, Sousa FCB, Duailibi DF, Kondo RH, de Moraes ACF, Martins MA. Comparative assessment of mortality risk factors between admission and follow-up models among patients hospitalized with COVID-19. Int J Infect Dis 2021; 105:723-729. [PMID: 33711524 PMCID: PMC7942163 DOI: 10.1016/j.ijid.2021.03.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/26/2021] [Accepted: 03/05/2021] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES This study aimed to compare differences in mortality risk factors between admission and follow-up incorporated models. METHODS A retrospective cohort study of 524 patients with confirmed COVID-19 infection admitted to a tertiary medical center in São Paulo, Brazil from 13 March to 30 April 2020. Data were collected on admission, and the third, eighth and fourteenth days of hospitalization. The hazard ratio (HR) was calculated and 28-day in-hospital mortality risk factors were compared between admission and follow-up models using a time-dependent Cox regression model. RESULTS Of 524 patients, 50.4% needed mechanical ventilation. The 28-day mortality rate was 32.8%. Compared with follow-up, admission models under-estimated the mortality HR for peripheral oxygen saturation <92% (1.21 versus 2.09), heart rate >100 bpm (1.19 versus 2.04), respiratory rate >24/min (1.01 versus 1.82) and mechanical ventilation (1.92 versus 12.93). Low oxygen saturation, higher oxygen support and more biomarkers-including lactate dehydrogenase, C-reactive protein, neutrophil-lymphocyte ratio, and urea remained associated with mortality after adjustment for clinical factors at follow-up compared with only urea and oxygen support at admission. CONCLUSIONS The inclusion of follow-up measurements changed mortality hazards of clinical signs and biomarkers. Low oxygen saturation, higher oxygen support, lactate dehydrogenase, C-reactive protein, neutrophil-lymphocyte ratio, and urea could help with prognosis of patients during follow-up.
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Affiliation(s)
- Felippe Lazar Neto
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brazil. https://twitter.com/
| | - Guilherme A Salzstein
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brazil
| | - André L Cortez
- Department of Infectious Diseases, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brazil
| | - Thaís L Bastos
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brazil
| | - Fabíola V D Baptista
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brazil
| | - Joanne A Moreira
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brazil
| | - Gerhard P Lauterbach
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brazil
| | - Julio Cesar de Oliveira
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brazil
| | - Fábio C de Assis
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brazil; Department of Emergency and Internal Medicine, Universidade de Brasília (UnB), Brazil
| | - Marília R A Aguiar
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brazil
| | - Aline A de Deus
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brazil
| | - Marcos Felipe D S Dias
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brazil
| | - Felipe C B Sousa
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brazil
| | - Daniel F Duailibi
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brazil
| | - Rodrigo H Kondo
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brazil
| | - Augusto César F de Moraes
- Department of Epidemiology, Graduate Program in Public Health, Escola de Saúde Pública, Universidade de São Paulo (FSPUSP), Brazil; YCARE (Youth/Child and cArdiovascular Risk and Environmental) Research Group, Faculdade de Medicina, Universidade de Sao Paulo (FMUSP), Brazil
| | - Milton A Martins
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brazil
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241
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Tippairote T, Peana M, Chirumbolo S, Bjørklund G. Individual risk management strategy for SARS-CoV-2 infection: A step toward personalized healthcare. Int Immunopharmacol 2021; 96:107629. [PMID: 33862554 PMCID: PMC8015431 DOI: 10.1016/j.intimp.2021.107629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/21/2021] [Accepted: 03/30/2021] [Indexed: 12/05/2022]
Abstract
Lethal or critical COVID-19 occurs most in infected hosts with certain risk factors such as advanced age or pre-existing disease. Host metabolic status significantly affects the clinical presentations of SARS-CoV-2 infection. Individual risk management is thus crucial for preventing severe COVID-19. Such susceptibility is individual, depending on a multitude of factors. Personalized risk assessment requires the inclusive analysis of big health data to stratify individual risk and derive a customized action plan. Personalized medicine requires shifting from the virology aspect per se to the whole individual's consideration, including dietary pattern, nutritional status, supporting lifestyle, co-existing diseases, and environmental factors. In this short communication, we discuss the individual management strategy for SARS-CoV2 infection as a step towards future personalized healthcare.
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Affiliation(s)
- Torsak Tippairote
- Nutritional and Environmental Medicine Department, Healing Passion Medical Center, Bangkok, Thailand
| | | | - Salvatore Chirumbolo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; CONEM Scientific Secretary, Verona, Italy
| | - Geir Bjørklund
- Council for Nutritional and Environmental Medicine (CONEM), Mo i Rana, Norway.
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242
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Zambelli A, Chiudinelli L, Fotia V, Negrini G, Bosetti T, Callegaro A, Di Croce A, Caremoli ER, Moro C, Milesi L, Poletti P, Tasca C, Mandalà M, Merelli B, Mosconi S, Arnoldi E, Bettini A, Bonomi L, Messina C, Ghilardi L, Chirco A, Maracino M, Tondini C. Prevalence and Clinical Impact of SARS-CoV-2 Silent Carriers Among Actively Treated Patients with Cancer During the COVID-19 Pandemic. Oncologist 2021; 26:341-347. [PMID: 33355953 PMCID: PMC8018331 DOI: 10.1002/onco.13654] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 12/09/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION In Europe, the SARS-CoV-2 pandemic had its first epicenter in Italy. Despite a significant mortality rate, the severity of most cases of COVID-19 infection ranges from asymptomatic to mildly symptomatic, and silent infection affects a still-unknown proportion of the general population. No information is available on the prevalence and clinical impact of SARS-CoV-2 silent infection among patients with cancer receiving anticancer treatment during the pandemic. MATERIALS AND METHODS From April 1, 2020, to the end of the same month, 560 consecutive patients with cancer, asymptomatic for COVID-19 and on anticancer treatment at Papa Giovanni XXIII Hospital in Bergamo, were evaluated and tested for SARS-CoV-2. We implemented a two-step diagnostics, including the rapid serological immunoassay for anti-SARS-CoV-2 immunoglobulin (Ig) G/IgM and the nasopharyngeal swab reverse transcriptase-polymerase chain reaction (RT-PCR) test in case of seropositivity to identify SARS-CoV-2 silent carriers. RESULTS In 560 patients, 172 (31%) resulted positive for anti-SARS-CoV-2 IgM/IgG antibodies, regardless of different type of cancer, stage, and treatment. The Ig-seropositive patients were then tested with RT-PCR nasopharyngeal swabs, and 38% proved to be SARS-CoV-2 silent carriers. At an early follow-up, in the 97 SARS-CoV-2-seropositive/RT-PCR-negative patients who continued their anticancer therapies, only one developed symptomatic COVID-19 illness. CONCLUSION Among patients with cancer, the two-step diagnostics is feasible and effective for SARS-CoV-2 silent carriers detection and might support optimal cancer treatment strategies at both the individual and the population level. The early safety profile of the different anticancer therapies, in patients previously exposed to SARS-CoV-2, supports the recommendation to continue the active treatment, at least in cases of RT-PCR-negative patients. IMPLICATIONS FOR PRACTICE This is the first study evaluating the prevalence and clinical impact of SARS-CoV-2 silent infection in actively treated patients with cancer, during the epidemic peak in one of the worst areas of the COVID-19 pandemic. Lacking national and international recommendations for the detection of asymptomatic SARS-CoV-2 infection, a pragmatic and effective two-step diagnostics was implemented to ascertain SARS-CoV-2 silent carriers. In this series, consisting of consecutive and unselected patients with cancer, the prevalence of both SARS-CoV-2-seropositive patients and silent carriers is substantial (31% and 10%, respectively). The early safety profile of the different anticancer therapies, in patients previously exposed to SARS-CoV-2, supports the recommendation to continue the active treatment, at least in case of RT-PCR-negative patients.
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Affiliation(s)
- Alberto Zambelli
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Lorenzo Chiudinelli
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, LombardyItaly
| | - Vittoria Fotia
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Giorgia Negrini
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Tommaso Bosetti
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | | | - Andrea Di Croce
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | | | - Cecilia Moro
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Laura Milesi
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Paola Poletti
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Cristina Tasca
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Mario Mandalà
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Barbara Merelli
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Stefania Mosconi
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | | | - Anna Bettini
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Lucia Bonomi
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Caterina Messina
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | | | | | - Michela Maracino
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Carlo Tondini
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
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Fasola G, Pelizzari G, Zara D, Targato G, Petruzzellis G, Minisini AM, Bin A, Donato R, Mansutti M, Comuzzi C, Candoni A, Sperotto A, Fanin R. Feasibility and Predictive Performance of a Triage System for Patients with Cancer During the COVID-19 Pandemic. Oncologist 2021; 26:e694-e703. [PMID: 33539583 PMCID: PMC8014855 DOI: 10.1002/onco.13706] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 01/22/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Triage procedures have been implemented to limit hospital access and minimize infection risk among patients with cancer during the coronavirus disease (COVID-19) outbreak. In the absence of prospective evidence, we aimed to evaluate the predictive performance of a triage system in the oncological setting. MATERIALS AND METHODS This retrospective cohort study analyzes hospital admissions to the oncology and hematology department of Udine, Italy, during the COVID-19 pandemic (March 30 to April 30, 2020). A total of 3,923 triage procedures were performed, and data of 1,363 individual patients were reviewed. RESULTS A self-report triage questionnaire identified 6% of triage-positive procedures, with a sensitivity of 66.7% (95% confidence interval [CI], 43.0%-85.4%), a specificity of 94.3% (95% CI, 93.5%-95.0%), and a positive predictive value of 5.9% (95% CI, 4.3%-8.0%) for the identification of patients who were not admitted to the hospital after medical review. Patients with thoracic cancer (odds ratio [OR], 1.69; 95% CI, 1.13-2.53, p = .01), younger age (OR, 1.52; 95% CI, 1.15-2.01, p < .01), and body temperature at admission ≥37°C (OR, 9.52; 95% CI, 5.44-16.6, p < .0001) had increased risk of positive triage. Direct hospital access was warranted to 93.5% of cases, a further 6% was accepted after medical evaluation, whereas 0.5% was refused at admission. CONCLUSION A self-report questionnaire has a low positive predictive value to triage patients with cancer and suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) symptoms. Differential diagnosis with tumor- or treatment-related symptoms is always required to avoid unnecessary treatment delays. Body temperature measurement improves the triage process's overall sensitivity, and widespread SARS-CoV-2 testing should be implemented to identify asymptomatic carriers. IMPLICATIONS FOR PRACTICE This is the first study to provide data on the predictive performance of a triage system in the oncological setting during the coronavirus disease outbreak. A questionnaire-based triage has a low positive predictive value to triage patients with cancer and suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) symptoms, and a differential diagnosis with tumor- or treatment-related symptoms is mandatory to avoid unnecessary treatment delays. Consequently, adequate recourses should be reallocated for a triage implementation in the oncological setting. Of note, body temperature measurement improves the overall sensitivity of the triage process, and widespread testing for SARS-CoV-2 infection should be implemented to identify asymptomatic carriers.
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Affiliation(s)
- Gianpiero Fasola
- Department of Oncology, Santa Maria della Misericordia HospitalUdineItaly
| | - Giacomo Pelizzari
- Department of Oncology, Santa Maria della Misericordia HospitalUdineItaly
| | - Diego Zara
- Department of Oncology, Santa Maria della Misericordia HospitalUdineItaly
| | - Giada Targato
- Department of Oncology, Santa Maria della Misericordia HospitalUdineItaly
| | | | | | - Alessandra Bin
- Department of Oncology, Santa Maria della Misericordia HospitalUdineItaly
| | - Raffaela Donato
- Department of Oncology, Santa Maria della Misericordia HospitalUdineItaly
| | - Mauro Mansutti
- Department of Oncology, Santa Maria della Misericordia HospitalUdineItaly
| | - Chiara Comuzzi
- Department of Hematology, Santa Maria della Misericordia HospitalUdineItaly
| | - Anna Candoni
- Department of Hematology, Santa Maria della Misericordia HospitalUdineItaly
| | | | - Renato Fanin
- Department of Hematology, Santa Maria della Misericordia HospitalUdineItaly,Department of Medicine, University of UdineUdineItaly
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244
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Nahshon C, Segev Y, Schmidt M, Bar-Noy T, Ostrovsky L, Lavie O. Outcomes of diagnosed COVID-19 cancer patients: concerning results of a systematic review. J Chemother 2021; 33:528-538. [PMID: 33769233 DOI: 10.1080/1120009x.2021.1899442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Since the outbreak of coronavirus disease 2019 (COVID-19), malignancy was shown to be prevalent in COVID-19 patients. This systematic review's searches were conducted in MEDLINE(R), Embase, Web of Science, and Scopos. Considered for inclusion were all reports on outcomes of cancer patients diagnosed with COVID-19. A total of 1099 references were identified through database searching and manual search. Finally, 17 references comprising 88 cancer patients, diagnosed with COVID-19, were included. Prevalence of cancer patients with COVID-19 was shown to range from 0.9% to 3%. The evidence suggested a severe clinical course of 50.6% in COVID-19 diagnosed cancer patients and a mortality rate of 34.5%. Subgroup analysis according to recent anti-cancer treatment showed a similar pattern, with the most concerning results in patients receiving recent immunotherapy/immunosuppressive treatment. COVID-19 morbidity and mortality among cancer patients should be reduced by consideration of testing asymptomatic COVID-19 cancer patients, reduction of hospital visits, and consideration of anti-cancer treatment.
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Affiliation(s)
- C Nahshon
- Department of Gynecologic Surgery and Oncology, Carmel Medical Center, Haifa, Israel
| | - Y Segev
- Department of Gynecologic Surgery and Oncology, Carmel Medical Center, Haifa, Israel
| | - M Schmidt
- Department of Gynecologic Surgery and Oncology, Carmel Medical Center, Haifa, Israel
| | - T Bar-Noy
- Department of Gynecologic Surgery and Oncology, Carmel Medical Center, Haifa, Israel
| | - L Ostrovsky
- Department of Gynecologic Surgery and Oncology, Carmel Medical Center, Haifa, Israel
| | - O Lavie
- Department of Gynecologic Surgery and Oncology, Carmel Medical Center, Haifa, Israel
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245
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Johannesen TB, Smeland S, Aaserud S, Buanes EA, Skog A, Ursin G, Helland Å. COVID-19 in Cancer Patients, Risk Factors for Disease and Adverse Outcome, a Population-Based Study From Norway. Front Oncol 2021; 11:652535. [PMID: 33842366 PMCID: PMC8027113 DOI: 10.3389/fonc.2021.652535] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/12/2021] [Indexed: 12/11/2022] Open
Abstract
Background Cancer has been suggested as a risk factor for severe outcome of SARS-CoV-2 infection. In this population-based study we aimed to identify factors associated with higher risk of COVID-19 and adverse outcome. Methods Data on all confirmed SARS-CoV-2 positive patients in the period January 1 to May 31, 2020 were extracted from the Norwegian Surveillance System for Communicable Diseases. Data on cancer and treatment was available from the Cancer Registry of Norway, the Norwegian Patient Registry and the Norwegian Prescription Database. Deaths due to COVID-19 were extracted from the Cause of Death Registry. From the Norwegian Intensive Care and Pandemic Registry we retrieved data on admittance to hospital and intensive care. We determined rates of COVID-19 disease in cancer patients and the rest of the population. We also ran multivariate analyses adjusting for age and gender. Results A total of 8 410 patients were diagnosed with SARS-CoV-2 infection in Norway during the study period, of which 547 (6.5%) were cancer patients. Overall, we found similar age adjusted rates of COVID-19 in the population with cancer as in the population without cancer. Unadjusted analysis showed that patients having undergone major surgery within the past 3 months had an increased risk of COVID-19 while we did not find increased Odds Ratio (OR) related to other oncological treatment modalities. No patients treated with stem cell or bone marrow transplant were diagnosed with COVID-19. The fatality rate of COVID-19 among cancer patients was 0.10. This was similar to non-cancer patients, when adjusting for age and sex with OR (95% CI) for death= 0.99 (0.68–1.42). Patients with distant metastases had significantly increased OR of death due to COVID-19 disease of 9.31 (95% CI 2.60–33.34). For the combined outcome death and/or admittance to hospital due to COVID-19, we found significant two-fold increased risk estimates for patients diagnosed with cancer less than one 1 year ago (OR 2.08, 95% CI 1.14–3.80), for those treated with anti-cancer drugs during the past 3 months (OR 1.80, 95% CI 1.07–3.01) and for patients undergoing major surgery during the past 3 months (OR 2.19, 95% CI 1.40–3.44).
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Affiliation(s)
| | - Sigbjørn Smeland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Stein Aaserud
- Registry Department, Cancer Registry of Norway, Oslo, Norway
| | - Eirik Alnes Buanes
- Norwegian Intensive Care and Pandemic Registry (NIPaR), Bergen Health Trust, Bergen, Norway.,Department of Anaesthesiology and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Anna Skog
- Registry Department, Cancer Registry of Norway, Oslo, Norway
| | - Giske Ursin
- Registry Department, Cancer Registry of Norway, Oslo, Norway.,Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Department of Preventive Medicine, University of Southern California, Los Angeles, CA, United States
| | - Åslaug Helland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway.,Department of Genetics, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
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246
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Gorphe P, Grandbastien B, Dietz A, Duvvuri U, Ferris RL, Golusinski W, Holsinger FC, Hosal S, Lawson G, Mehanna H, Paleri V, Shaw R, Succo G, Leemans CR, Simon C. Safety and Feasibility of Surgery for Oropharyngeal Cancers During the SARS-CoV-2-Pandemic. Front Oncol 2021; 11:651123. [PMID: 33842364 PMCID: PMC8024687 DOI: 10.3389/fonc.2021.651123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/22/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Philippe Gorphe
- Department of Head and Neck Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Bruno Grandbastien
- Department of Hospital Preventive Medicine, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Andreas Dietz
- Department of Otolaryngology, Head and Neck Surgery, University Leipzig, Leipzig, Germany
| | - Umamaheswar Duvvuri
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Robert L Ferris
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Wojciech Golusinski
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, The Greater Poland Cancer Centre, Poznan, Poland
| | - Floyd Christopher Holsinger
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, CA, United States
| | - Sefik Hosal
- Department of Otolaryngology-Head and Neck Surgery, Atilim University Faculty of Medicine, Ankara, Turkey
| | - George Lawson
- ENT and Head and Neck Surgery Department, CHU UCL Namur- Site Godinne, Namur, Belgium
| | - Hisham Mehanna
- Institute for Head and Neck Studies and Education, University of Birmingham, Birmingham, United Kingdom
| | - Vinidh Paleri
- Head and Neck Unit, The Royal Marsden Hospitals NHS Foundation Trust, London, United Kingdom
| | - Richard Shaw
- Liverpool Head & Neck Centre, Aintree University Hospital, Liverpool, United Kingdom.,Department of Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Giovanni Succo
- Department of Oncology, University of Turin, Turin, Italy.,Head and Neck Oncology Unit, Candiolo Cancer Institute - FPO IRCCS, Candiolo, Italy
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam University Medical Centres, Cancer Center, VU University, Amsterdam, Netherlands
| | - Christian Simon
- Department of Otolaryngology - Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland
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247
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Loffredo M, Lucero H, Chen DY, O'Connell A, Bergqvist S, Munawar A, Bandara A, De Graef S, Weeks SD, Douam F, Saeed M, Munawar AH. The in-vitro effect of famotidine on sars-cov-2 proteases and virus replication. Sci Rep 2021; 11:5433. [PMID: 33686143 PMCID: PMC7940615 DOI: 10.1038/s41598-021-84782-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/01/2021] [Indexed: 01/07/2023] Open
Abstract
The lack of coronavirus-specific antiviral drugs has instigated multiple drug repurposing studies to redirect previously approved medicines for the treatment of SARS-CoV-2, the coronavirus behind the ongoing COVID-19 pandemic. A recent, large-scale, retrospective clinical study showed that famotidine, when administered at a high dose to hospitalized COVID-19 patients, reduced the rates of intubation and mortality. A separate, patient-reported study associated famotidine use with improvements in mild to moderate symptoms such as cough and shortness of breath. While a prospective, multi-center clinical study is ongoing, two parallel in silico studies have proposed one of the two SARS-CoV-2 proteases, 3CLpro or PLpro, as potential molecular targets of famotidine activity; however, this remains to be experimentally validated. In this report, we systematically analyzed the effect of famotidine on viral proteases and virus replication. Leveraging a series of biophysical and enzymatic assays, we show that famotidine neither binds with nor inhibits the functions of 3CLpro and PLpro. Similarly, no direct antiviral activity of famotidine was observed at concentrations of up to 200 µM, when tested against SARS-CoV-2 in two different cell lines, including a human cell line originating from lungs, a primary target of COVID-19. These results rule out famotidine as a direct-acting inhibitor of SARS-CoV-2 replication and warrant further investigation of its molecular mechanism of action in the context of COVID-19.
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Affiliation(s)
- Madeline Loffredo
- Bisect Therapeutics, Inc., 45 Dan Road, Canton, MA, USA
- Orthogon Therapeutics LLC, 960 Turnpike St, Canton, MA, USA
| | - Hector Lucero
- Bisect Therapeutics, Inc., 45 Dan Road, Canton, MA, USA
- Orthogon Therapeutics LLC, 960 Turnpike St, Canton, MA, USA
| | - Da-Yuan Chen
- National Emerging Infectious Diseases Laboratories (NEIDL), 620 Albany Street, Boston, MA, 02118, USA
- Department of Biochemistry, Boston University School of Medicine, Boston, MA, USA
| | - Aoife O'Connell
- National Emerging Infectious Diseases Laboratories (NEIDL), 620 Albany Street, Boston, MA, 02118, USA
- Department of Microbiology, Boston University School of Medicine, Boston, MA, USA
| | | | - Ahmad Munawar
- Bisect Therapeutics, Inc., 45 Dan Road, Canton, MA, USA
- Orthogon Therapeutics LLC, 960 Turnpike St, Canton, MA, USA
| | - Asanga Bandara
- Bisect Therapeutics, Inc., 45 Dan Road, Canton, MA, USA
- Orthogon Therapeutics LLC, 960 Turnpike St, Canton, MA, USA
| | - Steff De Graef
- Bisect Therapeutics, Inc., 45 Dan Road, Canton, MA, USA
- Pledge Therapeutics B.V., Gaston Geenslaan 1, Leuven, 3000, Belgium
| | - Stephen D Weeks
- Bisect Therapeutics, Inc., 45 Dan Road, Canton, MA, USA
- Pledge Therapeutics B.V., Gaston Geenslaan 1, Leuven, 3000, Belgium
| | - Florian Douam
- National Emerging Infectious Diseases Laboratories (NEIDL), 620 Albany Street, Boston, MA, 02118, USA
- Department of Microbiology, Boston University School of Medicine, Boston, MA, USA
| | - Mohsan Saeed
- National Emerging Infectious Diseases Laboratories (NEIDL), 620 Albany Street, Boston, MA, 02118, USA.
- Department of Biochemistry, Boston University School of Medicine, Boston, MA, USA.
| | - Ali H Munawar
- Bisect Therapeutics, Inc., 45 Dan Road, Canton, MA, USA.
- Orthogon Therapeutics LLC, 960 Turnpike St, Canton, MA, USA.
- Pledge Therapeutics B.V., Gaston Geenslaan 1, Leuven, 3000, Belgium.
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Codacci-Pisanelli G, Giuliani J, Bonetti A. The effect of COVID-19 pandemic on daily oncology clinical practice. Crit Rev Oncol Hematol 2021; 167:103272. [PMID: 33647444 PMCID: PMC7908834 DOI: 10.1016/j.critrevonc.2021.103272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/23/2021] [Indexed: 12/19/2022] Open
Affiliation(s)
| | - Jacopo Giuliani
- Department of Oncology, Mater Salutis Hospital - Az, ULSS 9 Scaligera, Italy
| | - Andrea Bonetti
- Department of Oncology, Mater Salutis Hospital - Az, ULSS 9 Scaligera, Italy
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Spano JP, Barre-Sinoussi F, Kieny MP, Marcelin AG, Blay JY. [COVID-19 vaccination for cancer patients: Medical and ethical need]. Bull Cancer 2021; 108:225-227. [PMID: 33674059 PMCID: PMC7885674 DOI: 10.1016/j.bulcan.2021.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jean-Philippe Spano
- AP-HP, Sorbonne université, service d'oncologie médicale, IPLESP, 81, boulevard de l'Hôpital, 75013 Paris, France.
| | | | - Marie Paule Kieny
- Organisation Mondiale de la Santé (OMS), avenue Appia 20, 1202, Genève, Suisse
| | - Anne-Geneviève Marcelin
- Sorbonne université, Institut Pierre Louis d'épidémiologie et de santé publique, Inserm 1136, 75000 Paris, France; AP-HP, hôpitaux universitaires Pitié-Salpêtrière - Charles Foix, service de virologie, 75000 Paris, France
| | - Jean-Yves Blay
- Université Claude Bernard Lyon, Centre Léon Bérard, département d'oncologie médicale, 28, rue Laënnec, 69373 Lyon cedex 08, France
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Passaro A, Bestvina C, Velez Velez M, Garassino MC, Garon E, Peters S. Severity of COVID-19 in patients with lung cancer: evidence and challenges. J Immunother Cancer 2021; 9:e002266. [PMID: 33737345 PMCID: PMC7978268 DOI: 10.1136/jitc-2020-002266] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2021] [Indexed: 12/11/2022] Open
Abstract
Cancer patients are highly vulnerable to SARS-CoV-2 infections due to frequent contacts with the healthcare system, immunocompromised state from cancer or its therapies, supportive medications such as steroids and most importantly their advanced age and comorbidities. Patients with lung cancer have consistently been reported to suffer from an increased risk of death compared with other cancers. This is possibly due to the combination of specific pathophysiological aspects, including underlying pulmonary compromise due to smoking history and the increased specific pressures on respiratory healthcare services caused by the related pandemic. Rationally and safely treating patients with lung cancer during the pandemic has become a continuous challenge over the last year. Deciding whether to offer, modify, postpone or even cancel treatments for this particular patient's population has become the crucial recurrent dilemma for lung cancer professionals. Chemotherapy, immunotherapy and targeted agents represent distinct risks factors in the context of COVID-19 that should be balanced with the short-term and long-term consequences of delaying cancer care. Despite the rapid and persistent trend of the pandemic, declared by WHO on March 11, 2020, and still ongoing at the time of writing (January 2021), various efforts were made by oncologists worldwide to understand the impact of COVID-19 on patients with cancer. Adapted recommendations of our evidence-based practice guidelines have been developed for all stakeholders. Different small and large-scale registries, such as the COVID-19 and Cancer Consortium (CCC19) and Thoracic Cancers International COVID-19 Collaboration quickly collected data, supporting cancer care decisions under the challenging circumstance created by the COVID-19 pandemic. Several recommendations were developed as guidance for prioritizing the various aspects of lung cancer care in order to mitigate the adverse effects of the COVID-19 healthcare crisis, potentially reducing the morbidity and mortality of our patients from COVID-19 and from cancer. These recommendations helped inform decisions about treatment of established disease, continuation of clinical research and lung cancer screening. In this review, we summarize available evidence regarding the direct and indirect impact of the COVID-19 pandemic on lung cancer care and patients.
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Affiliation(s)
- Antonio Passaro
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Christine Bestvina
- Department of Hematology/Oncology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Maria Velez Velez
- Division of Hematology/Oncology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Marina Chiara Garassino
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Edward Garon
- David Geffen School of Medicine, UCLA, University of California Los Angeles, Los Angeles, California, USA
| | - Solange Peters
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, CHUV, Lausanne, Switzerland
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