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Campbell A, Teh B, Mulligan S, Ross DM, Weinkove R, Gilroy N, Gangatharan S, Prince HM, Szer J, Trotman J, Lane S, Dickinson M, Quach H, Enjeti AK, Ku M, Gregory G, Hapgood G, Ho PJ, Cochrane T, Cheah C, Greenwood M, Latimer M, Berkahn L, Wight J, Armytage T, Diamond P, Tam CS, Hamad N. Australia and New Zealand consensus position statement: use of COVID-19 therapeutics in patients with haematological malignancies. Intern Med J 2024; 54:328-336. [PMID: 38146232 DOI: 10.1111/imj.16303] [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: 05/24/2022] [Accepted: 11/19/2023] [Indexed: 12/27/2023]
Abstract
Despite widespread vaccination rates, we are living with high transmission rates of SARS-CoV-2. Although overall hospitalisation rates are falling, the risk of serious infection remains high for patients who are immunocompromised because of haematological malignancies. In light of the ongoing pandemic and the development of multiple agents for treatment, representatives from the Haematology Society of Australia and New Zealand and infectious diseases specialists have collaborated on this consensus position statement regarding COVID-19 management in patients with haematological disorders. It is our recommendation that both patients with haematological malignancies and treating specialists be educated regarding the preventive and treatment options available and that patients continue to receive adequate vaccinations, keeping in mind the suboptimal vaccine responses that occur in haematology patients, in particular, those with B-cell malignancies and on B-cell-targeting or depleting therapy. Patients with haematological malignancies should receive treatment for COVID-19 in accordance with the severity of their symptoms, but even mild infections should prompt early treatment with antiviral agents. The issue of de-isolation following COVID-19 infection and optimal time to treatment for haematological malignancies is discussed but remains an area with evolving data. This position statement is to be used in conjunction with advice from infectious disease, respiratory and intensive care specialists, and current guidelines from the National COVID-19 Clinical Evidence Taskforce and the New Zealand Ministry of Health and Cancer Agency Te Aho o Te Kahu COVID-19 Guidelines.
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Affiliation(s)
- Ashlea Campbell
- Department of Haematology, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Benjamin Teh
- National Centre for Infections in Cancer and Department of Infectious Diseases, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia
| | - Stephen Mulligan
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - David M Ross
- SA Pathology and Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Department of Haematology, Flinders University and Medical Centre, Adelaide, South Australia, Australia
| | - Robert Weinkove
- Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Nicole Gilroy
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Shane Gangatharan
- Department of Haematology, Fiona Stanley Hospital, Perth, Western Australia, Australia
- University of Western Australia, Perth, Western Australia, Australia
| | - Henry Miles Prince
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Haematology, Epworth Healthcare, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Jeff Szer
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Judith Trotman
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
- Department of Haematology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Steven Lane
- Cancer Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Michael Dickinson
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Hang Quach
- University of Melbourne, Melbourne, Victoria, Australia
- Department of Haematology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Anoop K Enjeti
- Department of Haematology, Calvary Mater Hospital, Newcastle, New South Wales, Australia
- New South Wales Health Pathology, John Hunter Hospital, Newcastle, New South Wales, Australia
- University of Newcastle, Newcastle, New South Wales, Australia
| | - Matthew Ku
- University of Melbourne, Melbourne, Victoria, Australia
- Department of Haematology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Gareth Gregory
- Department of Haematology, Monash Health, Melbourne, Victoria, Australia
| | - Gregory Hapgood
- Department of Haematology, Princess Alexandra Hospital, Melbourne, Victoria, Australia
| | - Phoebe Joy Ho
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
- Department of Haematology, Royal Prince Alfred Hospital, Melbourne, Victoria, Australia
| | - Tara Cochrane
- Department of Haematology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Chan Cheah
- University of Western Australia, Perth, Western Australia, Australia
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Department of Haematology, Pathwest Laboratory Medicine, Perth, Western Australia, Australia
| | - Matthew Greenwood
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Maya Latimer
- Department of Haematology, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Leanne Berkahn
- Department of Haematology, The Auckland City Hospital, Auckland, New Zealand
- University of Auckland, Auckland, New Zealand
| | - Joel Wight
- Townsville University Hospital, Townsville, Queensland, Australia
| | | | - Peter Diamond
- Leukaemia Foundation, Sydney, New South Wales, Australia
| | - Constantine S Tam
- Department of Haematology, Alfred Hospital, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Nada Hamad
- Department of Haematology, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- School of Medicine, University of Notre Dame Australia, Sydney, New South Wales, Australia
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Hamad N, Bilmon I, Chee L, Henden A, Johnston A, Purtill D, Bajel A, Tey SK, Yeung D, Cole T, Lewis C, Butler J. ANZTCT consensus position statement on ruxolitinib in steroid-refractory acute and chronic graft-versus-host disease. Intern Med J 2023; 53:2319-2329. [PMID: 38014511 DOI: 10.1111/imj.16255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/01/2023] [Indexed: 11/29/2023]
Abstract
This position paper provides an overview of the assessment and management of both acute and chronic graft-versus-host disease (GvHD). There is a focus on the use of ruxolitinib, a selective inhibitor of Janus kinase (JAK)1 and JAK2, for the treatment of corticosteroid-refractory and corticosteroid-dependent GvHD.
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Affiliation(s)
- Nada Hamad
- St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Sydney, New South Wales, Australia
- School of Medicine, Sydney University of Notre Dame, Sydney, New South Wales, Australia
| | - Ian Bilmon
- Westmead Hospital, Sydney, New South Wales, Australia
| | - Lynette Chee
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Andrea Henden
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | | | - Duncan Purtill
- Fiona Stanley Hospital, Perth, Western Australia, Australia
- PathWest Laboratory Medicine, Perth, Western Australia, Australia
| | - Ashish Bajel
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Siok-Keen Tey
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - David Yeung
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Theresa Cole
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | | | - Jason Butler
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Guo W, Zheng Y, Feng S. Omicron related COVID-19 prevention and treatment measures for patients with hematological malignancy and strategies for modifying hematologic treatment regimes. Front Cell Infect Microbiol 2023; 13:1207225. [PMID: 37928188 PMCID: PMC10622671 DOI: 10.3389/fcimb.2023.1207225] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/20/2023] [Indexed: 11/07/2023] Open
Abstract
The Omicron variant of SARS-CoV-2 has rapidly become the dominant strain worldwide due to its high transmissibility, although it appears to be less pathogenic than previous strains. However, individuals with hematological malignancy (HM) and COVID-19 remain susceptible to severe infection and mortality, especially those with chronic lymphocytic leukemia (CLL) and those undergoing chimeric antigen receptor T-cell (CAR-T) treatment. Hematologists should thoroughly assess the severity of the patient's hematological disease and the potential risk of SARS-CoV-2 infection before initiating chemotherapy or immunosuppressive treatment. Vaccination and booster doses are strongly recommended and patients with a poor vaccine response may benefit from long-acting COVID-19 neutralizing monoclonal antibodies (such as Evusheld). Early use of small molecule antiviral drugs is recommended for managing mild COVID-19 in HM patients and those with severe immunodeficiency may benefit from SARS-CoV-2 neutralizing monoclonal antibody therapy and high-titer COVID-19 convalescent plasma (CCP). For moderate to severe cases, low-dose glucocorticoids in combination with early antiviral treatment can be administered, with cytokine receptor antagonists or JAK inhibitors added if the condition persists or worsens. In the treatment of hematological malignancies, delaying chemotherapy is preferable for CLL, acute leukemia (AL), and low-risk myelodysplastic syndrome (MDS), but if the disease progresses, appropriate adjustments in dosage and frequency of treatment are required, with the avoidance of anti-CD20 monoclonal antibody, CAR-T and hematopoietic stem cell transplantation (HSCT). Patients with chronic myelocytic leukemia (CML) and myeloproliferative neoplasms (MPNs) can continue current treatment. What's more, non-drug protective measures, the development of new vaccines and antiviral drugs, and monitoring of mutations in immunocompromised populations are particularly important.
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Affiliation(s)
- Wenjing Guo
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Yizhou Zheng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Sizhou Feng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
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