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Neofytos D, Khanna N. How I treat: Coronavirus disease 2019 in leukemic patients and hematopoietic cell transplant recipients. Transpl Infect Dis 2024:e14332. [PMID: 38967400 DOI: 10.1111/tid.14332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/14/2024] [Accepted: 06/21/2024] [Indexed: 07/06/2024]
Abstract
Among immunocompromised hosts, leukemia patients, and hematopoietic cell transplant recipients are particularly vulnerable, facing challenges in balancing coronavirus disease 2019 (COVID-19) management with their underlying conditions. In this How I Treat article, we discuss how we approach severe acute respiratory syndrome coronavirus 2 infections in daily clinical practice, considering the existing body of literature and for topics where the available data are not sufficient to provide adequate guidance, we provide our opinion based on our clinical expertise and experience. Diagnostic approaches include nasopharyngeal swabs for polymerase chain reaction testing and chest computed tomography scans for symptomatic patients at risk of disease progression. Preventive measures involve strict infection control protocols and prioritizing vaccination for both patients and their families. Decisions regarding chemotherapy or hematopoietic cell transplantation in leukemia patients with COVID-19 require careful consideration of factors such as COVID-19 severity and treatment urgency. Treatment protocols include early initiation of antiviral therapy, with nirmatrelvir/ritonavir or remdesivir. For cases of prolonged viral shedding, distinguishing between viable and non-viable viruses remains challenging but is crucial for determining contagiousness and guiding management decisions. Overall, individualized approaches considering immune status, clinical presentation, and viral kinetics are essential for effectively managing COVID-19 in leukemia patients.
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Affiliation(s)
- Dionysios Neofytos
- Division of Infectious Diseases, Transplant Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Nina Khanna
- Departments of Biomedicine and Clinical Research, Division of Infectious Diseases, University and University Hospital of Basel, Basel, Switzerland
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Usikova EV, Kaplanov KD, Vorob'ev VI, Lobanova TI, Ul'yanova MA, Kisilichina DG, Kobzev YN, Shikhbabaeva DI, Vinogradova OY, Ptushkin VV. Efficacy of the combination of venetoclax and hypomethylating agents in the treatment of patients with primary, relapsed and/or refractory acute myeloid leukemia. BULLETIN OF THE MEDICAL INSTITUTE "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH) 2022. [DOI: 10.20340/vmi-rvz.2022.6.clin.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Relevance and goals. Treatment of patients with acute myeloid leukemia has traditionally been highly intensive and includes induction therapy using cytarabine and anathracyclines. In addition to new opportunities in the treatment of acute myeloid leukemia, the problem of toxicity of high-intensity therapy in elderly and young somatically burdened patients is quite acute. International clinical trials of phases I-III demonstrated a combination of high efficacy and acceptable hematological toxicity of combinations of hypomethylating agents and venetoclax in the first line of therapy, as well as in the treatment of resistant forms and relapses of acute myeloid leukemia in the older age group, which contributed to the study of the effectiveness of combinations of hypomethylating agents and venetoclax in the treatment of similar groups of young comorbid patients. In this work, we evaluated the efficiency of a combination of hypomethylating agents and venetoclax and overall and disease-free survival in patients with acute myeloid leukemia in routine practice.Methods. In the period from October 2017 to December 2021 on the basis of the Department of Hematology No. 11 and the Department of Bone Marrow and Hematopoietic Stem Cell Transplantation No. 56 of the Botkin Hospital (Moscow, Russia) 33 patients with acute myeloid leukemia received venetoclax therapy in combination with decitabine or azacitidine: 14 (42%) men and 19 (58%) women, median age was 60 years (23–83 years). In 42% (14 of 33) of cases, the regimen was prescribed for resistant course or relapse of acute myeloid leukemia and in 61% (20 of 33) as induction therapy. Three patients (15%) out of 19 from the group of newly diagnosed acute myeloid leukemia received this treatment regimen in the first line, taking into account the ECOG status 3-4. By August 2022, 13 (39%) patients are alive, 20 (61%) people have died. Overall survival, the rate of complete remission and complete remission with incomplete recovery, the rate of achieving negativity of minimal residual disease, the frequency of hematological toxicity and infectious complications were assessed. Statistical data processing used: frequency analysis using contingency tables (Fisher's exact test), survival analysis using the Kaplan-Meier method.Results. Complete remission and complete remission with incomplete recovery were achieved in 72.72% (24 of 33) of patients. In the group of primary acute myeloid leukemia, remissions were observed in 80% (16 out of 20) of cases, in the group with resistant course or recurrence of acute myeloid leukemia in 67% (8 out of 12) (p = 0.3). Determination of minimal residual disease by flow cytometry after the 1st course was performed for 54.54% (18 of 33) patients, while negativity was stated in 84.2% (14 of 18 patients) cases. In both groups, the incidence of hematological toxicity and infectious complications are comparable to those according to the literature data. The median follow-up was 9.5 months (1–47). Median overall survival was 39 months, 2-year overall survival was 63%, and overall 4-year survival was 39%. The disease-free survival rate was 33%.Conclusion. The combination of hypomethylating agents and venetoclax showed good efficacy and fairly high overall survival in patients of all age groups, both for primary acute myeloid leukemia and for relapses and resistant forms, regardless of previous therapy. Given the moderate hematological toxicity, as well as the relatively low rates of infectious complications during therapy, including the rather low mortality rates in case of COVID-19 infection in comparison with those on the background of high-intensity courses of therapy for acute myeloid leukemia, this scheme can be widely used not only in patients of the older age group, but also in young comorbid patients.
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Affiliation(s)
- E. V. Usikova
- Botkin City Clinical Hospital, Moscow City Hematology Center
| | - K. D. Kaplanov
- Botkin City Clinical Hospital, Moscow City Hematology Center
| | - V. I. Vorob'ev
- Botkin City Clinical Hospital, Moscow City Hematology Center
| | - T. I. Lobanova
- Botkin City Clinical Hospital, Moscow City Hematology Center
| | - M. A. Ul'yanova
- Botkin City Clinical Hospital, Moscow City Hematology Center
| | - D. G. Kisilichina
- Botkin City Clinical Hospital, Moscow City Hematology Center; Russian Medical Academy of Continuous Professional Education
| | - Yu. N. Kobzev
- Botkin City Clinical Hospital, Moscow City Hematology Center
| | | | - O. Yu. Vinogradova
- Botkin City Clinical Hospital, Moscow City Hematology Center; N.I. Pirogov Russian National Research Medical University
| | - V. V. Ptushkin
- Botkin City Clinical Hospital, Moscow City Hematology Center; N.I. Pirogov Russian National Research Medical University
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COVID-19 and Adult Acute Leukemia: Our Knowledge in Progress. Cancers (Basel) 2022; 14:cancers14153711. [PMID: 35954374 PMCID: PMC9367547 DOI: 10.3390/cancers14153711] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary We herein report a review of the current literature on adult patients with acute leukemia (AL) infected with SARS-CoV-2. SARS-CoV-2-associated mortality ranges from 20–52% in adult patients with AL, and patients with acute myeloid leukemia have a particularly high COVID-19-related mortality. Of note, most of the available data relate to the pre-vaccination era and to variants before Omicron. Based on expert opinions, the current recommendations suggest delaying systemic AL treatment in SARS-CoV-2-positive patients until SARS-CoV-2 negativity, if immediate AL treatment is not required. It is recommended to offer vaccination to all AL patients, and seronegative patients should additionally receive prophylactic administration of anti-SARS-CoV-2 monoclonal antibodies. Patients with AL infected with SARS-CoV-2 should be treated early with antiviral therapy to prevent disease progression and to enable the rapid elimination of the virus. Abstract The majority of publications regarding SARS-CoV-2 infections in adult patients with acute leukemia (AL) refer to hematological patients in general and are not focused on acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL). We herein report a review of the current literature on adult AL patients infected with SARS-CoV-2. Overall, SARS-CoV-2-associated mortality ranges from 20–52% in patients with adult AL. AML patients have a particularly high COVID-19-related mortality. Of note, most of the available data relate to the pre-vaccination era and to variants before Omicron. The impact of COVID-19 infections on AL treatment is rarely reported. Based on the few studies available, treatment delay does not appear to be associated with an increased risk of relapse, whereas therapy discontinuation was associated with worse outcomes in AML patients. Therefore, the current recommendations suggest delaying systemic AL treatment in SARS-CoV-2-positive patients until SARS-CoV-2 negativity, if immediate AL treatment is not required. It is recommended to offer vaccination to all AL patients; the reported antibody responses are around 80–96%. Seronegative patients should additionally receive prophylactic administration of anti-SARS-CoV-2 monoclonal antibodies. Patients with AL infected with SARS-CoV-2 should be treated early with antiviral therapy to prevent disease progression and enable the rapid elimination of the virus.
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Tedjaseputra A, Kuzich JA, Thiagarajah N, Teh TC, McClelland J, Rahman M, Brook R, Chua CC, Ong DM, Tan SY, Filshie R, Fong CY, Fedele P, Bajel A, Shortt J, Wei AH. Hyperleukocytosis associated with delayed presentation among patients with acute leukemia during the COVID-19 pandemic. Leuk Lymphoma 2022; 63:2731-2734. [DOI: 10.1080/10428194.2022.2087065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Aditya Tedjaseputra
- The Alfred Hospital, Melbourne, Australia
- Monash Haematology, Melbourne, Australia
- St. Vincent’s Hospital Melbourne, Melbourne, Australia
- Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Melbourne, Australia
| | | | - Nisha Thiagarajah
- Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Melbourne, Australia
| | | | | | | | | | - Chong Chyn Chua
- The Alfred Hospital, Melbourne, Australia
- Northern Health, Melbourne, Australia
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
| | | | - Shuh-Ying Tan
- St. Vincent’s Hospital Melbourne, Melbourne, Australia
| | - Robin Filshie
- St. Vincent’s Hospital Melbourne, Melbourne, Australia
| | | | - Pasquale Fedele
- Monash Haematology, Melbourne, Australia
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Ashish Bajel
- Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Melbourne, Australia
| | - Jake Shortt
- Monash Haematology, Melbourne, Australia
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Andrew H. Wei
- The Alfred Hospital, Melbourne, Australia
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
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COVID-19-Associated Pulmonary Aspergillosis in Patients with Acute Leukemia: A Single-Center Study. J Fungi (Basel) 2021; 7:jof7110890. [PMID: 34829179 PMCID: PMC8625614 DOI: 10.3390/jof7110890] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/09/2021] [Accepted: 10/14/2021] [Indexed: 12/21/2022] Open
Abstract
Patients with coronavirus disease 19 (COVID-19) have increased susceptibility to secondary respiratory infections including invasive pulmonary aspergillosis (IPA). COVID-19-associated pulmonary aspergillosis (CAPA) is difficult to diagnose and can be associated with increased mortality especially in severe immunodeficiency such as hematological malignancies. Our study evaluates IPA in COVID-19 patients defined as COVID-19-CAPA among patients with acute leukemia (AL). A retrospective single-center study analyzed 46 patients with COVID-19 infection and acute leukemia, admitted to the Clinic for Haematology, Clinical Center of Serbia, Belgrade between the 2 April 2020 and 15 May 2021. During hospitalization, all participants were diagnosed with probable IPA according to the previous consensus definitions. Positive serology and galactomannan (GM) detection values in bronchoalveolar lavage (BAL) and serum were used as microbiological criteria. COVID-19 associated probable IPA was found in 22% (9/41) tested patients, where serum GM and IgM anti-Aspergillus antibodies were positive in 12% (5/41) and 10% (4/41) had positive serology for aspergillosis. One patient died while eight recovered during follow-up. Our study showed that COVID-19 might be a risk factor for IPA development in patients with AL. Early diagnosis and prompt treatment are required as reported mortality rates are high.
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