Management of Patients With Hematologic Malignancies During the COVID-19 Pandemic: Practical Considerations and Lessons to Be Learned

Abstract

The COVID-19 pandemic has created unprecedented hurdles to the delivery of care to patients with cancer. Patients with hematologic malignancies appear to have a greater risk of SARS-CoV-2 infection and severe disease due to myelosuppression and lymphopenia. The first challenge, therefore, is how to continue to deliver effective, curative therapy to vulnerable patients and at the same time avoid exposing them, and their health care teams (HCT), to SARS-CoV-2. An additional challenge is the timely completion of the diagnostic and staging studies required to formulate appropriate treatment plans. Deferred procedures and avoidance of multiple trips to the surgical, diagnostic, and laboratory suites require same day consolidation of all procedures. With laboratory medicine absorbed by the need to deploy large scale COVID-testing, the availability of routine molecular tests is affected. Finally, we are increasingly faced with the challenge of making complex treatment decisions in SARS-CoV-2 positive patients with aggressive but potentially curable blood cancers. When to treat, how to treat, when to wait, how long to wait, how to predict and manage toxicities, and how to avoid compromising cure rates remains unknown. We present an outline of the scientific, medical, and operational challenges posed by the COVID-19 pandemic at selected American and European institutions and offer our current view of the key elements of a response. While the peak of the pandemic may be past us, in the absence of a vaccine risks remain, and our alertness and response to future challenges need to be refined and consolidated.

Anti-BCMA CAR T administration in a relapsed and refractory multiple myeloma patient after COVID-19 infection: a case report

“…The information available regarding management strategies for MM patients during the COVID-19 pandemic is insufficient to provide evidence-based recommendations; however, several consensus statements have been published that provide guidance. The recommendations included within this report—securing access to supportive care, taking appropriate precautions to avoid SARS-CoV-2 infection, and carefully weighing the potential risks and benefits of CAR T cell therapy—align well with existing consensus statements [ 14 , 15 ].…”

COVID-19 and hematopoietic stem cell transplantation and immune effector cell therapy: a US cancer center experience

“… 17 , 18 , 19 , 20 , 21 Perhaps, then, the field of hematologic malignancies is well poised to lead the charge in implementing precautions and safeguards to ensure that these and other high-risk patients continue to receive high-quality care throughout the ongoing pandemic. 22 , 23 , 24 , 25 , 26 , 27 …”

Lower Patient Anxiety and Unchanged Levels of Adherence to Hemato-Oncologic Treatment in Response to New Measures to Reduce Hospital Exposure Risk to COVID-19

“…Patients diagnosed with hematologic malignancies are particularly at high risk for COVID-19-related complications and mortality, [6][7][8][9][10] and are thus likely to express high anxiety levels when required to attend medical facilities for receiving their treatment. Here, we report the results of a survey on 150 lymphoma/MM patients, focusing on their COVID-19-related anxiety and its resultant impact on their adherence to treatment before and after the introduction of safety measures to reduce their risk for infection in the hospital.…”

“…[3][4][5] Patients diagnosed with hematological malignancies, such as non-Hodgkin lymphoma (NHL), Hodgkin lymphoma (HL), multiple myeloma (MM), and chronic lymphocytic leukemia (CLL), often present with significant immunodeficiency and are, therefore, considered to be at higher risk of severe COVID-19. [6][7][8][9][10] As such, patients diagnosed with hematological malignancies are often concerned about attending medical facilities, assuming that the risk of exposure to SARS-CoV-2 is greater than the risk associated with postponing their scheduled antineoplastic therapy. 11 It is imperative to adopt a tailored management strategy in which patients that require active therapy will be reassured to continue their treatment providing that there are conditions in place that ensure their safety, whereas patients that completed therapy may be followed virtually by telemedicine.…”