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El Assil A, Benkirane S, El Kettani Y, Cherif Chefchaouni A, Mamad H, Rahali Y, Masrar A. Turnaround Time of the Hematology Results of Cancer Patients During the COVID-19 Pandemic: An Opportunity to Initiate a Quality Improvement Process. Cureus 2024; 16:e61149. [PMID: 38933641 PMCID: PMC11200148 DOI: 10.7759/cureus.61149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Turnaround time (TAT) is a crucial clinical parameter that reflects the performance of a laboratory especially in the context of oncology and the COVID-19 pandemic. Based on the Lean Six Sigma methodology, we performed a retrospective analysis of the TAT of the complete blood count (CBC) of cancer patients with the aim of reducing this delay in the future. MATERIALS AND METHODS Over one month of the COVID-19 pandemic, a retrospective evaluative audit was carried out on the TAT of the CBC in an oncology department. The root causes of failures of the overall analysis process were detected. The initiation of an improvement approach was implemented through the creation of an improvement flowchart and a new request form. The hospital information system (HIS) data were exported to Microsoft Excel® (Microsoft Corporation, Redmond, Washington, United States). Using the collected data, the mean, standard deviation, median, and interquartile range were calculated using IBM SPSS Statistics for Windows, Version 23, (Released 2015; IBM Corp., Armonk, New York, United States). All time intervals were expressed in minutes. RESULTS Among 263 intra-laboratory TATs analyzed, the median intra-lab TAT was 56 minutes (interquartile range (IQR): 36-80 minutes). A total of 82% of the analyses were performed in less than 90 minutes with a predominance of the interval 30-59 at 42.9%. The main causes of failures were essentially the lack of time stamping of the samples as well as the lack of real-time communication between the biologists and the clinicians. The proposed improvement model is currently being approved by all practitioners whose main items are as follows: At the clinical department level, distinguish the request forms but also the labels of the samples of the oncology hospital by a particular color, indication of clinical signs and sampling time on the request forms and on the HIS. At the laboratory level, create a specific chain for oncology department samples, alarm notification on the HIS, and rapid telecommunication of results for vital situations. CONCLUSION The intra-lab TAT of our study is biologically acceptable. Because our work is limited by the phases outside the control of the laboratory, it should lead to a continuous improvement project.
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Affiliation(s)
- Asmae El Assil
- Central Laboratory Hematology, Ibn Sina University Hospital Center, Rabat, MAR
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | - Souad Benkirane
- Central Laboratory Hematology, Ibn Sina University Hospital Center, Rabat, MAR
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | - Yasmine El Kettani
- National Institute of Oncology, Ibn Sina University Hospital Center, Rabat, MAR
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | - Ali Cherif Chefchaouni
- National Institute of Oncology, Ibn Sina University Hospital Center, Rabat, MAR
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | - Hassane Mamad
- Central Laboratory Hematology, Ibn Sina University Hospital Center, Rabat, MAR
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | - Younes Rahali
- National Institute of Oncology, Ibn Sina University Hospital Center, Rabat, MAR
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | - Azlarab Masrar
- Central Laboratory Hematology, Ibn Sina University Hospital Center, Rabat, MAR
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
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Zhao H, He Y, Li Z, Huang Y, Ying Y, Huang Z. Impact of SARS-CoV-2 infection on patients with hematological malignancies: a retrospective study. Hematology 2023; 28:2288480. [PMID: 38063157 DOI: 10.1080/16078454.2023.2288480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/19/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate the characteristics of patients with hematological malignancies (HM) and SARS-CoV-2 infection and analyze the risk factors of their severity and mortality. METHODS A retrospective study including inpatients diagnosed HM and SARS-CoV-2 infection between December 2022 and February 2023 were conducted. Demographic information, medical history, comorbidities, diagnosis, treatment related information and outcomes were extracted from electronic medical database. The primary outcome of this study were the severity of SARS-CoV-2 infection and case-fatality rate. The clinical characteristic and outcomes of the patients were summarized and analyzed. RESULTS A total of 74 patients with HM and SARS-CoV-2 infection were included. Out of the total cases, 85.1% (63) had a mild /moderate SARS-CoV-2 infection, and 14.9% (11) were severe/ critical infection cases. A total of 8 deaths occurred in all cases for a case-fatality rate of 10.8%. Multivariate analysis identified patients with acute myeloid leukemia (AML) (P = 0.043, OR:5.274, 95%CI:1.053-26.407), primary hematological disease in active state (P = 0.005, OR:13.905, 95%CI:2.180-88.704) were independent risk factors for the severity of SARS-CoV-2 infection and patients with AML had 11.145-fold higher risk of non-survival (P = 0.020, OR:11.145, 95%CI:1.460-85.103) in comparison to the patients with other types of HM. There were no significant differences in the severity and case-fatality rate (P > 0.05) between the patients receiving chemotherapy drugs administration waiting <14 days and ≥14 days after negative SARS-CoV-2 testing. CONCLUSION The primary hematological disease in active state may be the main risk factor for negative outcome of the patents. Waiting 14 days for chemotherapy initiation after negative SARS-CoV-2 testing is unnecessary.
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Affiliation(s)
- Huihan Zhao
- Department of Hematology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
- School of Information and Management, Guangxi Medical University, Nanning, People's Republic of China
| | - Yu He
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
- Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Guangxi, People's Republic of China
| | - Zhongqing Li
- Department of Hematology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Yanlu Huang
- Department of Hematology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Yanping Ying
- Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Zhaoquan Huang
- Department of Pathology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
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Zeylabi F, Nameh Goshay Fard N, Parsi A, Pezeshki SMS. Bone marrow alterations in COVID-19 infection: The root of hematological problems. Curr Res Transl Med 2023; 71:103407. [PMID: 37544028 DOI: 10.1016/j.retram.2023.103407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/04/2023] [Accepted: 07/24/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION The 2019 coronavirus disease (COVID-19) is a respiratory infection caused by the SARS-CoV-2 virus with a significant impact on the hematopoietic system and homeostasis. The effect of the virus on blood cells indicates the involvement of the bone marrow (BM) as the place of production and maturation of these cells by the virus and it reminds the necessity of investigating the effect of the virus on the bone marrow. METHOD To investigate the effects of COVID-19 infection in BM, we reviewed literature from the Google Scholar search engine and PubMed database up to 2022 using the terms "COVID-19; SARS-CoV-2; Bone marrow; Thrombocytopenia; Hemophagocytosis; Pancytopenia and Thrombocytopenia. RESULTS Infection with the SARS-CoV-2 virus is accompanied by alterations such as single-line cytopenia, pancytopenia, hemophagocytosis, and BM necrosis. The presence of factors such as cytokine release syndrome, the direct effect of the virus on cells through different receptors, and the side effects of current treatments such as corticosteroids are some of the important mechanisms in the occurrence of these alterations. CONCLUSION To our knowledge, this review is the first study to comprehensively investigate BM alterations caused by SAR-CoV-2 virus infection. The available findings show that the significant impact of this viral infection on blood cells and the clinical consequences resulting from them are deeper than previously thought and it may be rooted in the changes that the virus causes in the BM of patients.
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Affiliation(s)
- Fatemeh Zeylabi
- Cellular and Molecular Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Najmeh Nameh Goshay Fard
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Abazar Parsi
- Alimentary Tract Research Center, Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Magen H, Avigdor A, Nevo L, Fried S, Gibori A, Levin EG, Lustig Y, Shkury E, Rahav G. Anti-RBD IgG antibodies and neutralizing antibody levels after the second BNT162b2 dose in patients with plasma cell disorders. PLoS One 2023; 18:e0284925. [PMID: 37126496 PMCID: PMC10150979 DOI: 10.1371/journal.pone.0284925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 12/26/2022] [Indexed: 05/02/2023] Open
Abstract
Patients with plasma cell disorders (PCD) are at an increased risk for severe morbidity and mortality due to COVID-19. Recent data have suggested that patients with hematological malignancies, including those with PCD, have suboptimal antibody response to COVID-19 vaccination. We compared the antibody titers of 213 patients with PCD to those of 213 immunocompetent healthcare workers after the second vaccine dose of the BNT162b2 mRNA vaccine. Blood samples were taken 2-4 weeks after the second vaccination and analyzed for anti-receptor binding-domain immunoglobulin G (RBD-IgG) antibodies and neutralizing antibodies (NA). At a median of 20 days after the second vaccine dose, 172 patients (80.8%) developed anti-RBD-IgG antibodies with a geometric mean titer (GMT) of 2.7 (95% confidence interval [CI], 2.4-3.1). In the control group 210 (98.9%) developed anti-RBD-IgG antibodies after a median of 21 days, with a GMT of 5.17 (95%CI, 4.8-5.6), p<0.0001. NA were observed in 151 patients with MM (70.9%) and in 210 controls (98.9%). The GMT of NA in patients with MM and controls was 84.4 (95% CI, 59.0-120.6), and 420.2 (95% CI, 341.4-517.1), respectively (p<0.0001). Multivariable logistic regression revealed that the number of prior therapy lines and age were significant predictors of poor humoral response among patients with MM. Injection site reaction, headache and fatigue were the most common adverse events after vaccination. Adverse events were less common in patients with MM than in controls. In conclusion, a significant percentage of patients with MM developed protecting NA to the BNT162b2 mRNA vaccine, which appears to be safe in this patient population.
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Affiliation(s)
- Hila Magen
- Division of Hematology and Bone-Marrow Transplantation, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Abraham Avigdor
- Division of Hematology and Bone-Marrow Transplantation, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Lee Nevo
- Division of Hematology and Bone-Marrow Transplantation, Sheba Medical Center, Ramat Gan, Israel
| | - Shalev Fried
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Amit Gibori
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Einav G Levin
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- The Infection Prevention and Control Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Yaniv Lustig
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Israel Ministry of Health and Sheba Medical Center, Ramat Gan, Israel
| | - Eden Shkury
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Galia Rahav
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Infectious Disease Unit and Laboratory, Sheba Medical Center, Ramat Gan, Israel
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Tsilingiris D, Nasiri-Ansari N, Spyrou N, Magkos F, Dalamaga M. Management of Hematologic Malignancies in the Era of COVID-19 Pandemic: Pathogenetic Mechanisms, Impact of Obesity, Perspectives, and Challenges. Cancers (Basel) 2022; 14:2494. [PMID: 35626099 PMCID: PMC9139192 DOI: 10.3390/cancers14102494] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/14/2022] [Accepted: 05/16/2022] [Indexed: 02/04/2023] Open
Abstract
The COVID-19 pandemic brought about an unprecedented societal and healthcare system crisis, considerably affecting healthcare workers and patients, particularly those with chronic diseases. Patients with hematologic malignancies faced a variety of challenges, pertinent to the nature of an underlying hematologic disorder itself as well as its therapy as a risk factor for severe SARS-CoV-2 infection, suboptimal vaccine efficacy and the need for uninterrupted medical observation and continued therapy. Obesity constitutes another factor which was acknowledged since the early days of the pandemic that predisposed people to severe COVID-19, and shares a likely causal link with the pathogenesis of a broad spectrum of hematologic cancers. We review here the epidemiologic and pathogenetic features that obesity and hematologic malignancies share, as well as potential mutual pathophysiological links predisposing people to a more severe SARS-CoV-2 course. Additionally, we attempt to present the existing evidence on the multi-faceted crucial challenges that had to be overcome in this diverse patient group and discuss further unresolved questions and future challenges for the management of hematologic malignancies in the era of COVID-19.
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Affiliation(s)
- Dimitrios Tsilingiris
- First Department of Propaedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, 17 St Thomas Street, 11527 Athens, Greece
| | - Narjes Nasiri-Ansari
- Department of Biological Chemistry, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias, 11527 Athens, Greece
| | - Nikolaos Spyrou
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Faidon Magkos
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, DK-2200 Frederiksberg, Denmark
| | - Maria Dalamaga
- Department of Biological Chemistry, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias, 11527 Athens, Greece
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Latif MB, Shukla S, Del Rio Estrada PM, Ribeiro SP, Sekaly RP, Sharma AA. Immune mechanisms in cancer patients that lead to poor outcomes of SARS-CoV-2 infection. Transl Res 2022; 241:83-95. [PMID: 34871809 PMCID: PMC8641406 DOI: 10.1016/j.trsl.2021.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 02/09/2023]
Abstract
Patients with cancers have been severely affected by the COVID-19 pandemic. This is highlighted by the adverse outcomes in cancer patients with COVID-19 as well as by the impact of the COVID-19 pandemic on cancer care. Patients with cancer constitute a heterogeneous population that exhibits distinct mechanisms of immune dysfunction, associated with distinct systemic features of hot (T-cell-inflamed/infiltrated) and cold (Non-T-cell-inflamed and/or infiltrated) tumors. The former show hyper immune activated cells and a highly inflammatory environment while, contrastingly, the latter show the profile of a senescent and/or quiescent immune system. Thus, the evolution of SARS-CoV-2 infection in different types of cancers can show distinct trajectories which could lead to a variety of clinical and pathophysiological outcomes. The altered immunological environment including cytokines that characterizes hot and cold tumors will lead to different mechanisms of immune dysfunction, which will result in downstream effects on the course of SARS-CoV-2 infection. This review will focus on defining the known contributions of soluble pro- and anti-inflammatory mediators on immune function including altered T-cells and B-cells responses and as well on how these factors modulate the expression of SARS-CoV-2 receptor ACE2, TMPRSS2 expression, and lymph node fibrosis in cancer patients. We will propose immune mechanisms that underlie the distinct courses of SARS-CoV-2 infection in cancer patients and impact on the success of immune based therapies that have significantly improved cancer outcomes. Better understanding of the immune mechanisms prevalent in cancer patients that are associated to the outcomes of SARS-CoV-2 infection will help to identify the high-risk cancer patients and develop immune-based approaches to prevent significant adverse outcomes by targeting these pathways.
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Affiliation(s)
- Muhammad Bilal Latif
- Pathology Advanced Translational Research Unit, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | - Sudhanshu Shukla
- Pathology Advanced Translational Research Unit, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | - Perla Mariana Del Rio Estrada
- Pathology Advanced Translational Research Unit, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | - Susan Pereira Ribeiro
- Pathology Advanced Translational Research Unit, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | - Rafick Pierre Sekaly
- Pathology Advanced Translational Research Unit, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia.
| | - Ashish Arunkumar Sharma
- Pathology Advanced Translational Research Unit, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
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Rasalkar AA, Bhatia S, Katte T, Narayanan P, Vinjamuri S, Shettihalli AK, Kabade S, Manas RN, Kadappa V, Reddy DNS. COVID-19 and its impact on cancer, HIV, and mentally ill patients. LESSONS FROM COVID-19 2022. [PMCID: PMC9347297 DOI: 10.1016/b978-0-323-99878-9.00006-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) and its disease, COVID-19 is a global pandemic creating an unprecedented medical as well economic havoc across the world. Despite the wide spread global infection rates, the death rate is low for COVID-19. However, COVID-19 patients with other comorbid conditions face severe health complications irrespective of their gender or age. As the management of COVID-19 patients is taking up health resources, it is getting difficult to treat patients suffering from other dreadful diseases like cancer, HIV, and mental health issues. In this chapter, we discuss the effects of COVID-19 and management of cancer patients of main cancer subtypes (e.g., breast, lung, blood cancers), and patients affected with HIV and mental health issues. Finally, we also add a perspective on Ayurvedic treatment and its efficacy on COVID-19 patients.
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Puła A, Robak T. Hairy cell leukemia: a brief update on current knowledge and treatment prospects. Curr Opin Oncol 2021; 33:412-419. [PMID: 34264896 DOI: 10.1097/cco.0000000000000771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW This article provides a brief update on the recommended diagnosis and treatment strategies for patients with the classic form of hairy cell leukemia (HCL) and HCL variant (HCLv). RECENT FINDINGS HCL is a chronic B-cell malignancy with multiple treatment options. In recent years, many novel drugs have been assessed for HCL treatment with promising results. The investigated nonchemotherapy options include moxetumomab pasudotox, which targets CD22; vemurafenib or dabrafenib, which target the BRAFV600E protein; trametinib, which targets mitogen-activated protein kinase enzyme; and ibrutinib, which targets Bruton tyrosine kinase. SUMMARY Purine analogs significantly improve survival in patients with HCL. However, patients often relapse, require multiple treatments, and may become refractory. The introduction of novel agents has expanded the spectrum of therapy possibilities in those patients. In the coming years, they will assist standard therapy for patients with HCL who may currently have suboptimal results.
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Affiliation(s)
- Anna Puła
- Department of Hematology, Medical University of Lodz, Lodz, Poland
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Riches JC. Impact of COVID-19 in patients with lymphoid malignancies. World J Virol 2021; 10:97-110. [PMID: 34079692 PMCID: PMC8152455 DOI: 10.5501/wjv.v10.i3.97] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/08/2021] [Accepted: 04/26/2021] [Indexed: 02/06/2023] Open
Abstract
The first cases of coronavirus disease 2019 (COVID-19) were detected in Wuhan, China, in December 2019. Since this time a concerted global effort of research and observational data gathering has meant that a great deal has been learnt about the impact of COVID-19 in patients with lymphoid malignancies. Approximately one-third of patients with lymphoid malignancies who acquire COVID-19 and have it severely enough to require hospital assessment will die from this infection. Major risk factors for a poor outcome are age and co-morbidities, but when these are taken into account lymphoma patients have a slightly greater than 2-fold increased risk compared to the general population. Notably, despite early concerns regarding the particular vulnerability of lymphoma patients due to the immunosuppressive effects of therapy, active treatment, including B-cell depleting agents such as rituximab, do not appear to be associated with an increased risk of a poorer outcome. Indeed, some treatments such as ibrutinib may be beneficial due to their modulation of the potential fatal hyperinflammatory phase of infection. There are risks associated with hemopoietic stem cell transplantation, but the collective experience is that these can be minimized by preventive strategies and that the majority of transplant recipients with COVID-19 infection will survive. Many questions remain including those regarding the outcome of COVID-19 infection in the rarer lymphoid malignancies and the efficacy of COVID-19 vaccines in lymphoma patients. This review aims to discuss these issues and present a summary of the current knowledge of the impact of COVID-19 in lymphoid malignancies.
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Affiliation(s)
- John Charles Riches
- Centre for Haemato-Oncology, Barts Cancer Institute - a Cancer Research UK Centre of Excellence, Queen Mary University of London, John Vane Science Centre, Charterhouse Square, London EC1M 6BQ, United Kingdom
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