COVID-19 and Adult Acute Leukemia: Our Knowledge in Progress

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.

Managing and treating COVID-19 in patients with hematological malignancies: a narrative review and expert insights

“…Pre-vaccination and pre-Omicron era data from the European Hematology Association Survey indicate a high COVID-19-related mortality rate of 40% in adult AML and 26% in adult ALL patients [ 72 ]. Other registry studies also support the elevated COVID-19 mortality observed in AML patients [ 50 ]. However, large data sets are lacking for adult ALL patients with COVID-19 due to the low ALL incidence in adults [ 50 ].…”

“…Effective management of patients with AL and concurrent COVID-19 necessitates close interdisciplinary collaboration between hematologists and infectiologists. On one hand, newly diagnosed AL requires prompt initiation of chemotherapy [ 50 ]. On the other hand, intensive therapy may increase the risk of severe COVID-19 [ 50 ].…”

“…On one hand, newly diagnosed AL requires prompt initiation of chemotherapy [ 50 ]. On the other hand, intensive therapy may increase the risk of severe COVID-19 [ 50 ]. Therefore, careful consideration is needed when determining the systemic treatment approach.…”

Diagnostic and Treatment Obstacles in Acute Myeloid Leukemia: Social, Operational, and Financial

“…During the pandemic, bed occupancy rates of hospitals increased, inpatient leukemia treatment and allogeneic transplantation processes became more difficult, blood donations decreased, and blood bank reserves decreased, all of which led to problems with supportive care [ 28 ]. Under these conditions, alternative treatment options were introduced according to various guideline recommendations, such as induction treatment options that do not require hospitalization in suitable patients, blood product use and transfusion thresholds, treatment of COVID-19 infection, vaccination policies, and management of the transplantation process [ 30 – 34 ].…”

Efficacy of the combination of venetoclax and hypomethylating agents in the treatment of patients with primary, relapsed and/or refractory acute myeloid leukemia

“…Прямое или непрямое совместное воздействие на MCL-1, по-видимому, усиливает противолейкемический ответ на эти комбинации, что в настоящее время используется в клинических исследованиях эффективности сочетания венетоклакса с ингибиторами FLT3-ITD, MDM2, MEK и CDK9, а также с прямыми ингибиторами MCL-1 [27][28][29][30], недавно появившимися на фармацевтическом рынке. Сопутствующая блокировка экпрессии генов IDH1/IDH2 у пациентов с мутацией IDH1/2 может вызывать как дифференцировку, так и гибель бластов при ОМЛ, приводя к стойкому ответу на лечение [34][35][36][37].…”