The management of hematologic malignancies during the COVID-19 pandemic

ABSTRACT

Introduction: Patients with hematological malignancies have experienced a more severe clinical course of COVID-19 and higher mortality than those with solid tumors and those without cancer. The ongoing pandemic poses many challenges in assuring the correct and timely diagnosis of hemato-oncology patients as well as the optimal treatment.

Areas covered: The present paper reviews current data on the incidence and clinical course of COVID-19 in patients with hematological malignancies. A literature review of the MEDLINE database for articles was conducted via PubMed. Publications from December 2019 through September 2020 were scrutinized. The search terms used were SARS-Cov-2 OR COVID-19 in conjunction with hematological malignancies OR leukemia OR lymphoma OR multiple myeloma OR cancer. Recommendations and expert opinions either published or presented on ASH, ASCO, ESMO, NCCN websites were also reviewed.

Expert opinion: The COVID-19 pandemic has brought a pressing need to improve the management of patients with hematological malignancies, including establishing prompt diagnoses and providing effective treatment while also minimalizing the risk of SARS-Cov2 infection. The recommendations developed by many organizations based on expert opinions are helpful in making proper decisions. All cancer patients should be advised to get vaccinated against influenza and pneumococcus.

KEYWORDS:

• SARS-Cov-2
• covid-19
• hematological malignancies
• leukemia
• lymphoma
• multiple myeloma

Article highlights

• During the COVID-19 pandemic, hemato-oncology patients require optimal medical care regarding not only local epidemiological situation, but also the type and the stage of malignancy, patient age, and comorbidities, as well as drug availability.

• The risk of severe complications of COVID-19 appears to be higher in patients with hematological malignancies than in those with solid tumors and non-cancer cohorts.

• Patients should strictly follow general rules of COVID-19 prevention and every effort should be made to minimize the risk of SARS-Cov-2 infection associated with the management of hematological malignancies.

• The COVID-19 pandemic should not compromise the use of curative treatments in hemato-oncology patients. Treatment should be provided as soon as possible to patients with aggressive hematological malignancies, such as acute leukemias or aggressive lymphomas, while it could be delayed in patients with indolent malignancies or borderline indications for the start of

• therapy.

• The recommendations developed by many scientific societies and institutions are helpful in decision-making; however, not being evidence-based, they should be regarded rather as expert opinions than official guidelines.

• SARS-Cov2 should be tested by PCR of nasopharyngeal swab samples before each cycle of intensive treatment for acute leukemias and aggressive lymphomas. During local outbreaks, testing of all patients before the admission to hematology departments should be considered, as well as regular testing of the medical staff.

• All patients with hematological malignancies should be vaccinated against pneumococcus and influenza.

• This box summarizes key points contained in the article.

Acknowledgments

We thank Edward Lowczowski from the Medical University of Lodz for editorial assistance.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The study was supported in part by grants provided by the Medical University of Lodz, Poland: (No. 503/1-093-01 and 503-11-004-18)