Omicron related COVID-19 prevention and treatment measures for patients with hematological malignancy and strategies for modifying hematologic treatment regimes

Severe metabolic accumulation of VV116 in kidney transplant patients with impaired renal function: a case series report

The treatment of COVID-19 in the post-transplant individuals is challenging, primarily due to the drug-drug interaction between nirmatrelvir/ritonavir and tacrolimus. Deuremidevir hydrobromide tablets (VV116) is an orally small molecule agents target SARS-CoV-2 RdRp and inhibits viral replication. It may have a low likelihood of drug-drug interactions and has a potential to provide new treatment option. We described three cases of renal transplant patients with concomitant impaired renal function who developed COVID-19 pneumonia and were treated with VV116. Despite varying degrees of drug accumulation, these patients achieved rapid viral clearance and showed prompt improvement in pneumonia symptoms. Notably, tacrolimus blood concentrations remained within the therapeutic range throughout treatment, and no clinically significant adverse events were observed despite the drug accumulation.

Outcomes and Risk Factors in Patients with Hematologic Malignancies Following Late-Stage SARS-CoV-2 Infection

Purpose

To investigate the outcomes and risk factors for patients with hematologic malignancies (HM) following late-stage SARS-CoV-2 infection.

Background

Patients with HM such as lymphoproliferative malignancies (including acute lymphoblastic leukemia and multiple myeloma) and myeloproliferative malignancies (including acute myeloid leukemia, myeloproliferative neoplasm, and myelodysplastic syndrome) are at increased risk of severe illness and high mortality from COVID-19. This study examines the impact of SARS-CoV-2 infection severity on HM prognosis during the late phase of COVID-19, using data from 203 patients at Shanxi Bethune Hospital.

Methods

This is a retrospective cohort study. Data was collected from hospitalized HM patients at a single center from December 1, 2023, to December 31, 2023. The primary outcome was overall survival (OS). Multivariable Cox regression was used to identify risk factors.

Results

This analysis includes data from 203 hospitalized patients with HM aged 36 to 67 years (median, 58 years). SARS-CoV-2 infection was observed in 42.86% (87/203) of the patients, among whom severe/critical cases accounted for 14.29% (29/203). Multivariable Cox regression shows active disease (hazard ratio [HR] 2.16, 95% confidence interval [CI] 1.00-4.64, p = 0.049), hematopoietic stem cell transplantation (HSCT) (HR 4.06, 95% CI 1.02-16.12, p = 0.047), and targeted therapy (HR 2.60, 95% CI 1.23-5.50, p = 0.012) were associated with a higher incidence of progression. In contrast, individuals whose platelets count ≥50×109/L at baseline (HR = 0.36, 95% CI 0.17-0.78, p = 0.009) and ferritin levels less than 500 µg/L (HR = 0.54, 95% CI 0.34-0.86, p = 0.010) were associated with a lower incidence of progression. Active status (HR 7.06, 95% CI 2.10-23.76, p = 0.002), HSCT (HR 7.17, 95% CI 1.10-46.63, p = 0.039), and severe/critical SARS-CoV-2 infection in HM patients (HR 11.98, 95% CI 2.57-55.82, p = 0.002) were associated with higher incidences of all cause of mortality. While a higher platelet level (≥50×109/L) was linked to a lower mortality (HR 0.16, 95% CI 0.05-0.49, p = 0.002).

Conclusion

In the late stage of the COVID-19 pandemic, active disease status, recent HSCT, and severe/critical SARS-CoV-2 infection significantly increased the risks of disease progression and mortality in HM patients. Higher baseline platelet counts were associated with improved outcomes.

COVID-19 in acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS): a propensity matched analysis (2020-2021)

Background

By 2023, COVID-19 had caused 6.8 million deaths in the United States. COVID-19 presents more severely in leukemia compared to solid tumors (OR 1.6, p<0.05). However, data on Acute Myeloid Leukemia (AML) and Myelodysplastic Syndrome (MDS) are limited. We investigated the mortality in AML and MDS patients with COVID-19.

Methods

Data from the 2020-2021 National Inpatient Sample was used to conduct a cross-sectional analysis. We identified AML and MDS patients with COVID-19 hospitalizations through ICD-10 codes. Analysis was done by propensity matching and multivariate regression with a p-value of ≤0.05.

Results

Of 28,028 AML admissions, 336 (1.2%) were admitted for COVID-19. AML-COVID-19 cohort had a lower hospitalization risk (aOR 0.3, p=0.000) and higher mortality (21.7% vs 8.7%; aOR 1.6, p=0.023) than AML patients admitted for other causes. AML patients post-HSCT (Hematopoietic Stem Cell Transplantation) had a higher risk of COVID-19 (20.2% vs 9.8%; aOR 2.6, p=0.000) and increased mortality (19.1% vs 6.7%; aOR 4.1, p=0.000) compared to other causes. Similarly, of 28,148 MDS patients, 769 (2.7%) were admitted for COVID-19. The MDS-COVID-19 cohort had a lower hospitalization risk (aOR 0.59, p=0.000) and higher mortality (19.6% vs 6.6%; aOR 2.2, p=0.000) compared to other causes. In MDS, HSCT did not alter the risk of COVID-19 hospitalizations (3% vs 3.9%; aOR 0.9, p=0.662), but these patients had higher mortality (17.4% vs 5.1%; aOR 4.0, p=0.032).

Conclusion

COVID-19 hospitalization was low in AML and MDS but carried a high mortality risk. Post-HSCT, the mortality is high, warranting research into understanding the underlying factors.

COVID-19 in patients with anemia and haematological malignancies: risk factors, clinical guidelines, and emerging therapeutic approaches

Extensive research in countries with high sociodemographic indices (SDIs) to date has shown that coronavirus disease 2019 (COVID-19) may be directly associated with more severe outcomes among patients living with haematological disorders and malignancies (HDMs). Because individuals with moderate to severe immunodeficiency are likely to undergo persistent infections, shed virus particles for prolonged periods, and lack an inflammatory or abortive phase, this represents an overall risk of morbidity and mortality from COVID-19. In cases suffering from HDMs, further investigation is needed to achieve a better understanding of triviruses and a group of related variants in patients with anemia and HDMs, as well as their treatment through vaccines, drugs, and other methods. Against this background, the present study aimed to delineate the relationship between HDMs and the novel COVID-19, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Besides, effective treatment options for HDM cases were further explored to address this epidemic and its variants. Therefore, learning about how COVID-19 manifests in these patients, along with exploiting the most appropriate treatments, may lead to the development of treatment and care strategies by clinicians and researchers to help patients recover faster. Video Abstract.

Hyperimmune Plasma and Immunoglobulins against COVID-19: A Narrative Review

Since late 2019, the new SARS-CoV-2 virus belonging to the Coronaviridae family has been responsible for COVID-19 pandemic, a severe acute respiratory syndrome. Several antiviral therapies, mostly derived from previous epidemics, were initially repurposed to fight this not rarely life-threatening respiratory illness. Among them, however, the only specific antibody-based therapy available against SARS-CoV-2 infection during the first year of the pandemic was represented by COVID-19 convalescent plasma (CCP). CCP, collected from recovered individuals, contains high levels of polyclonal antibodies of different subclasses able to neutralize SARS-CoV-2 infection. Tens of randomized controlled trials have been conducted during the last three years of the pandemic to evaluate the safety and the clinical efficacy of CCP in both hospitalized and ambulatory COVID-19 patients, whose main results will be summarized in this narrative review. In addition, we will present the current knowledge on the development of anti-SARS-CoV-2 hyperimmune polyclonal immunoglobulins.