Chemotherapy During Active
SARS-CoV2 Infection: A Case Report
and Review of the Literature
Krzysztof Woz´niak 1*, Wojciech Sachs 2
, Piotr Boguradzki 2
, Grzegorz Władysław Basak 2
and Rafał Stec1
1 Department of Oncology, Medical University of Warsaw, Warsaw, Poland, 2 Department of Hematology, Transplantation
and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
COVID-19 has become the biggest public health problem and one of the most important
causes of death in many countries in the world. SARS-CoV-2 infection is most likely to be
fatal in elderly patients with concomitant diseases. In this article we present two cases of
asymptomatic SARS-CoV-2-positive patients suffering from cancer who were treated with
chemotherapy. The first case, a patient with primary mediastinal B-cell lymphoma, shows
that confirmed SARS-CoV-2 infection does not have to be a contraindication to
chemotherapy. We describe the course of disease and discuss doubts related to the
choice of chemotherapy regimen. The second patient was a male with metastatic sigmoid
cancer treated with FOLFOX4 as first-line palliative chemotherapy. This case draws
attention to asymptomatic SARS-CoV-2 carriers who underwent chemotherapy. Our
patient was safely treated with chemotherapy without long break caused by viral infection.
It should be remembered that there are asymptomatic carriers among cancer patients and
that they may spread infection to others. On the other hand, delaying chemotherapy can
cause rapid disease progression and reduce overall survival of our patients.
Keywords: COVID-19, PMBCL, colorectal cancer, mortality rate, chemotherapy, SARS-CoV-2
INTRODUCTION
Coronavirus disease 2019 (COVID-19) is a disease known since December 2019, caused by SARSCoV-2 virus. This acute respiratory disease was first noted in Wuhan, China and rapidly spread all
over the world. On 11 March 2020, the World Health Organization (WHO) announced pandemic of
SARS-CoV-2 infection. Since then COVID-19 has become the most prominent public health problem
and one of the most important causes of death in many countries in the world. SARS-CoV-2 infection
is most likely to be fatal in elderly patients with concomitant diseases (1). It has been proven that
patients with cancer are more vulnerable to SARS-CoV-2 infection (2). They seem to be especially at
risk of severe complications (3) and death due to COVID-19 (4–9). The worst prognosis concerns
patients infected with COVID-19 and hematological malignancy (10–18). That is why treatment of
cancer patient has become more difficult in pandemic era. Patients have to be protected from SARSCoV-2 infection and at the same time they need treatment for cancer. It is known that most of SARSCoV-2-positive patients have mild symptoms or no symptoms of the infection (19, 20). The crucial
issue is how to deal with SARS-CoV-2-positive but asymptomatic oncological patients who require
Frontiers in Oncology | www.frontiersin.org 1 April 2021 | Volume 11 | Article 662211
Edited by:
Alessandro Isidori,
AORMN Hospital, Italy
Reviewed by:
Michele Merli,
University of Insubria, Italy
Claudio Cerchione,
Istituto Scientifico Romagnolo
per lo Studio e il Trattamento
dei Tumori (IRCCS), Italy
*Correspondence:
Krzysztof Woz´niak
<PRESIDIO_ANONYMIZED_EMAIL_ADDRESS>
Specialty section:
This article was submitted to
Hematologic Malignancies,
a section of the journal
Frontiers in Oncology
Received: 31 January 2021
Accepted: 22 March 2021
Published: 12 April 2021
Citation:
Woz´niak K, Sachs W, Boguradzki P,
Basak GW and Stec R (2021)
Chemotherapy During Active SARSCoV2 Infection: A Case Report and
Review of the Literature.
Front. Oncol. 11:662211.
doi: 10.3389/fonc.2021.662211
MINI REVIEW
published: 12 April 2021
doi: 10.3389/fonc.2021.662211
chemotherapy. There are limited data about the risks of
chemotherapy and the effect of cytotoxic therapy on the course
of viral infection. In this article we describe cases of two patients
who underwent chemotherapy during SARS-CoV-2 infection and
a review of available literature.
CASE 1
A 22-year-old patient without chronic diseases was admitted to
the Department of Thoracic Surgery to establish diagnosis of
mediastinal tumor. The first symptom of the disease was
pathological fracture of the right arm. On admission, the
patient’s performance status was good (ECOG score 1); he had
no symptoms of infection. He complained of mild chest
discomfort and hyperhidrosis, without fever. He denied
dyspnea, cough, weight loss, loss of smell and taste. Blood
oxygenation was normal (97%). Laboratory tests showed no
abnormalities in peripheral blood count (WBC 7.27x109
/L,
HGB 10.7 g/L, PLT 273 109
/L), but there was elevated level of
LDH (1650 U/L). SARS-CoV-2 molecular nasal swab test before
thoracorurgical procedure was negative. He had a biopsy of the
mediastinal tumor, which confirmed primary mediastinal B-cell
lymphoma (PMBCL): large B-lymphocytes, CD20+, CD23+/-,
CD 30+/-, BCL6+, c-myc+, BCL2+ (double expressor), cyclD1-,
Ki67 80%. Computed tomography scan revealed mediastinal
tumor infiltrating thoracic wall, ascending aorta, pulmonary
trunk. There were found two satellite tumors, 17 mm in
diameter, in segments 4, 5 and 6 of the right lung; lymphoma
tumors in the pancreas, pelvis, 10th right rib and proximal end of
right humerus with pathological fracture. There was no
lymphadenopathy detected. Active lymphoproliferative process
was confirmed also in positron emission tomography scan (PET
CT). The diagnosis was made of PMBCL stage IV according to
Ann Arbour classification, aaIPI (age-adjusted international
prognostic index) high intermediate (3 points). It was decided
to perform orthopedic surgery of the pathological fracture and
then to start chemotherapy. The SARS-CoV-2 molecular test was
carried out before orthopedic treatment and it was positive. Date
of positive SARS-CoV-2 test (twelve days after admission to
hospital) suggests that hospital transmission of SARS-CoV-2
infection was the most probable. The patient was still in good
performance status, without acute symptoms of COVID-19.
There was no cough or fever detected. In the next CT scan
(Figure 1), ground glass opacities in about 15% of the lungs were
described – a typical imaging feature of SARS-CoV-2 infection.
The patient was complaining of mild constant chest discomfort,
but this symptom was present before SARS-CoV-2 infection and
most probably caused by the presence of tumor mass in the
mediastinum. Because of advanced stage PMBCL, it was decided
to start lymphoma’s pretreatment. The patient was treated with
5-day regimen of cyclophosphamide 200 mg/m2
/day and
prednisone 40 mg/m2
/day. We did not observe acute tumor
lysis syndrome after this therapy. Laboratory tests showed
normal level of LDH. Patient tolerated pretreatment very well
without any side effects. No additional symptoms of SARS-CoV2 infection appeared. Another SARS-CoV-2 test was also
positive. It was decided to treat patient with chemotherapy
according to CHOP-14 regimen (cyclophosphamide 750mg/
m2
, doxorubicin 50mg/m2
, vincristin 1,4mg/m2
, prednisone
40mg/m2). It was decided against the use of rituximab due to
the risk of negative effect on SARS-CoV-2 infection.
Chemotherapy was supported by G-CSF (filgrastim)
administration and prophylaxis of tumor lysis syndrome. After
two cycles of chemotherapy partial response of the lymphoma
was observed in a CT scan. The patient complained of increased
chest discomfort and tachycardia was detected. There were no
abnormalities in ECG. Echocardiography examination showed
myocardial injury with generalized hypokinesis and decreased
ejection fraction (EF) of 45%, aortic valve regurgitation and
tachycardia. Biochemical markers of myocardial injury –
troponin I, NTproBNP and CK-MB mass – were within
normal values. Cardiac drugs were administered (ACE
inhibitor, beta-blocker) with good treatment results. The third
and fourth cycles of chemotherapy were administered, with
liposomal doxorubicin (Myocet) replacing doxorubicin in
CHOP-14 regimen. The next SARS-CoV-2 test was negative.
The patient is still continuing treatment with chemotherapy,
since 4. cycle with rituximab (R-COMP).
CASE 2
The second patient is a 56-year-old man with sigmoid cancer and
unresectable liver metastases treated with the first line of
palliative chemotherapy with FOLFOX4 regimen. The patient
was in good performing status (ECOG 1), complaining of
polyneuropathy grade 1 after oxaliplatin treatment. He had
coronary heart disease; he underwent myocardial infarction in
FIGURE 1 | Chest computed tomography scan.
Woz´ niak et al. Chemotherapy During Active SARS-CoV-2 Infection
Frontiers in Oncology | www.frontiersin.org 2 April 2021 | Volume 11 | Article 662211
2015, with coronary artery angioplasty (PTCA). He underwent
sigmoidectomy in November 2019 and was diagnosed with
sigmoid adenocarcinoma (pT3N1b). Examination of tumor
tissue detected KRAS mutation in codon 12. In January 2020
he started chemotherapy with FOLFOX4 regimen. Due to
polyneuropathy the dose of oxaliplatin has been reduced to
65mg/m2
.
Between 10.11.2020 and 12.11.2020 the patient administrated
21st. cycle of FOLFOX4. From 14.11.2020 to 27.11.2020 the
patient was in quarantine because his daughter was tested
positive of SARS-CoV-2 infection.
He had no symptoms of infection. On 24.11.2020 he underwent
genetic SARS-CoV-2 test, which gave negative result. On 06.12.202
SARS-CoV-2 antibodies level was measured. This investigation
revealed positive antibody levels: IgM 4.54 s/c (>0.99 considered
positive) and IgG 4.16 (>1.40 considered positive). This shows that
our patient had asymptomatic SARS-CoV-2 infection during
chemotherapy. The most probable source of infection was
patient’s daughter. It is also highly possible that patient
underwent SARS-CoV-2 infection in the time of quarantine, but
it is not possible to prove the way of transmission and the exact
time of infection. In this situation hospital transmission of SARSCoV-2 infection is less probable, but cannot be excluded. The next
cycle of chemotherapy had to be postponed to a week later because
of 3rd grade neutropenia. The patient is still continuing
chemotherapy without any new side effects and complications.
DISCUSSION
Primary mediastinal B-cell lymphoma (PMBCL) is a rare type of
aggressive lymphoma. It constitutes about 3% of non-Hodgkin
lymphomas and 6–10% of diffuse large B-cell lymphomas (21)
Prognosis is relatively good – 5-year overall survival (OS) is 93–
98% in early stage of disease and 70–75% in the group of patients
with negative prognostic factors (21). According to ESMO
Guidelines (22) the R-CHOP chemotherapy regimen remains a
standard therapy. More intensive regimens such as DA-EPOCHR could be considered depending on a center’s experience. In
many centers also other regimens such as dose-dense R-CHOP,
R-V/MACOP-B or GMALL are used.
The role of immunosuppression during SARS-CoV-2
infection is unclear. It has been proven that small doses of
dexamethasone reduce mortality in severe COVID-19 by
stopping autoimmune destruction of the lungs (so called
“cytokine storm”) (23). There were some observations
suggesting that steroids shorten period of oxygen dependence
and improve disease course (24). It has been proven in an open
randomized trial that dexamethasone (at a dose of 6mg daily)
reduces 28-day mortality in patients hospitalized due to SARSCoV-2 (25). These results form the basis of many clinical
guidelines, also Polish ones, which recommend dexamethasone
in the treatment of patients with COVID-19 (26). However,
we must remember that there are a lot of data suggesting
that immunosuppression in early stage of COVID-19 is
not recommended.
Another drug, which is considered as a useful treatment to
prevent aggressive autoimmune reaction, is cyclophosphamide.
Cyclophosphamide is a part of many chemotherapy regimens
such as CHOP, which was administered to our patient.
Cyclophosphamide is also used as immunosuppressive drug
after haploidentical stem-cell transplantation or other organ
transplantations and is widely used in rheumatological
disorders. There are attempts to use cyclophosphamide in
cytokine storm prevention (27). A case of a young man who
underwent COVID-19 simultaneously with immunosuppressive
regimen containing cyclophosphamide has been reported. The
authors suspect that cyclophosphamide could prevent this
patient from developing severe course of pulmonary infection
(28). Nowadays cyclophosphamide is not used as a standard
SARS-CoV-2 therapy.
There are limited data suggesting that other
immunosuppressive drugs, e.g. rituximab, can worsen the
course of SARS-CoV-2 infection. Rituximab is a monoclonal
anti-CD20 antibody that causes depletion of peripheral B
lymphocytes. This leads to severe humoral and cellular
immunodeficiency. Some cases of persistent SARS-CoV-2
viremia in patients after rituximab treatment have been
reported (29). Yasuda et al. described a case of patient with
focal lymphoma after recent rituximab treatment that did not
develop SARS-CoV-2 antibodies and died due to persistent
pneumonia (30). Rituximab can also prolong incubation period
of SARS-CoV-2 infection (>21 days), which could facilitate
spreading of infection in a population (31). On the other hand
there are data showing that the mortality rate of patients with
COVID-19 treated with rituximab maintenance therapy after
remission in follicular lymphoma is lower than when combined
with chemotherapy (10): 31% vs 47%. However, it is still much
higher than in general population. Because of the risk of serious
course of SARS-CoV-2 infection our patient did not receive
chemotherapy with rituximab.
Our patient developed cardiac insufficiency during PMBCL
chemotherapy. The reason of decreased ejection fraction (EF) is
unclear. Its pathogenesis seems to be multicausal. Chemotherapy
with anthracycline can be a reason of heart failure even if the
dose is lower that maximum dose. SARS-CoV-2 infection itself is
frequently related to cardiac manifestations. Cardiac
involvement manifesting as troponin level elevation is observed
in 20–30% of patients admitted to hospital due to COVID-19
(32, 33). SARS-CoV-2 infection causes pathological changes not
only in the respiratory tract but also in other organs. It causes
systemic inflammation, which plays role in endothelial damage
also in the cardiovascular system. In this way, it leads to
myocarditis, cardiac fibrosis and pericarditis (33), which are
responsible for a poor prognosis in COVID-19 patients. In the
case of our patient, it is impossible to prove which mechanism
played a key role in heart failure, but it is unlikely that SARSCoV-2 infection damaged myocardium without any lesions in
the lungs.
Neither of our patients had leukocytosis or lymphopenia
detected in blood count (which are typical for COVID-19)
before and after SARS-CoV-2 infection. This is similar to other
Woz´ niak et al. Chemotherapy During Active SARS-CoV-2 Infection
Frontiers in Oncology | www.frontiersin.org 3 April 2021 | Volume 11 | Article 662211
studies (34) in which all asymptomatic patients had normal level
of lymphocytes. Probably it indicates that the asymptomatic
carrier’s immunity is not significantly disturbed by COVID-19.
In our second case, neutropenia appeared after infection and was
not related to chemotherapy. Usually, neutropenia appears in
severe stage of COVID-19 infection and is connected with higher
mortality (35), but it has not been reported in asymptomatic
SARS-CoV-2 carriers.
Another issue is asymptomatic lesions in lungs in CT scan,
which were detected in our first patients. This situation is
reported in about 30% of asymptomatic SARS-CoV-2 positive
patients (36).
Asymptomatic carriers are a crucial problem in COVID-19
propagation. It is suspected that they have the same infective
potential as people with symptoms (2). This fact is dangerous for
cancer patients undergoing chemotherapy because this group is
especially susceptible to severe course of COVID-19 (37).
On the other hand, as it has been shown in our cases, patients
with asymptomatic SARS-CoV-2 infection can be safely treated
with chemotherapy.
Similar observations were done by Hempel et al. (38). He
showed that most SARS-CoV-2-infected patients were
asymptomatic and the infection had no effect on chemotherapy
(38). In contrast to this observation, one meta-analysis showed
that chemotherapy during COVID-19 (or within 30 days before
COVID-19) increased the risk of death due to COVID-19 (39).
This paper did not prove that immunotherapy, targeted
therapies, cancer surgery or radiotherapy increase the mortality
rate or severe course of COVID-19.
There are data available from Kuderer’s study (6) showing
that mortality rate due to COVID-19 in population of cancer
patients is 13% and it is significantly higher than in general
population. Only 4% of patients in this group had no symptoms
of SARS-CoV-2 infection. It was proven that worse prognosis
had elderly patients, with worse ECOG (Eastern Cooperative
Oncology Group) performance status (>1), with progressive
cancer disease.
Lee et al. (4) has shown that after adjusting for known risk
factors (age, gender, and comorbidities), chemotherapy in the
past 4 weeks had no significant effect on mortality from
COVID-19 disease, in comparison to patients without
recent chemotherapy.
There are also data published which suggest that worse
prognosis of patients with solid tumors is connected with
known risk factors only, such as age and comorbidities. In
Ruthrich’s paper (7) mortality rate of cancer patients was
higher than in non-cancer group (22,5% vs 14%) but after
adjustments for other risk factors, mortality was comparable.
There is growing number of papers which proves that
prognosis of COVID-19 is very poor in group of patients with
hematologic cancer (Tab. 1). Vijenthira et al. in metaanalysis (10)
has shown that risk of death due to COVID-19 in group of
hospitalized hematologic malignancies patients is 34% and it is
much higher than in general population. In this group the
highest risk of death had patients with acquired bone marrow
failure syndromes (53%), acute leukemias (41%), plasma cell
dyscrasias (33%) and lymphomas (32%).
Similarly, very high mortality rate (37%) was shown by
Passamonti et al. (11). In this paper the following independent
risk factors of death are identified: elderly age, progressive
disease, neoplasm type- myeloid leukemia, aggressive nonHodgking lymphoma, indolent lymphoma.
In the analysis of 264 patients published by the ASH Research
Collaborative Data Hub (12), mortality rate was comparable to
the other studies (30%). Authors pay attention to the group of
patients with pre-COVID prognosis of <12 months (due to the
hematologic malignancy), who have especially unfavorable
course of COVID-19. These patients had higher risk of
moderate or severe COVID-19 and more often were not
admitted to intensive care unit in favor of palliative treatment.
It contributes to the very poor outcome in this group.
In some retrospective studies, the mortality rate in the
hematologic cancer patients cohort was as high as 50%, and it
was even more than twice higher than with the case of solid
tumors (13). Such poor outcomes can be seen in cohort of
hospitalized patients only, mostly with poor prognosis before
SARS-Co-V2 infection. Slightly lower death rate reports Yang
(14). In his paper it was shown that chemotherapy in the last
four weeks before COVID-19 was an independent death
risk factor.
Yigenoglu (15) has shown fatality rate of 13.8% compared
to 6.8% in the group of patients without cancer. These results
are much lower than in similar studies concerning patients
with hematologic malignancies. However, the mortality rate
proportion between the cancer patients and the non-cancer
patients was comparable to the other studies. Oncological
patients statistically more often underwent severe COVID19 and were hospitalized in ICU. The explanation of
these results can be a fact that the study group, in contrast
to any other analyses, constituted mostly of the nonhospitalized patients.
Our two case reports show that chemotherapy can be
administered during SARS-CoV-2 infection. Decision about
systemic treatment in SARS-CoV-2-positive patients should be
made by multidisciplinary team after consideration of all
treatment options and risks of chemotherapy. The
development of symptomatic SARS-CoV-2 infection (COVID19 disease) during chemotherapy has to be taken into account in
pandemic era.
AUTHOR CONTRIBUTIONS
KW contributed to design of the study and wrote the first draft of
the manuscript. RS contributed to conception of the study and
contributed to the revision. PB contributed to design discussion
and revision of the manuscript. WS was collecting the clinical
data and contributed to critical revision of the manuscript. GB
contributed to the manuscript revision. All authors contributed
to the article and approved the submitted version.
Woz´ niak et al. Chemotherapy During Active SARS-CoV-2 Infection
Frontiers in Oncology | www.frontiersin.org 4 April 2021 | Volume 11 | Article 662211
REFERENCES
1. Guan WJ, Ni ZY, Hu Y, LiangWH, Ou CQ, He JX, et al. Clinical
Characteristics of Coronavirus Disease 2019 in China. N Engl J Med (2020)
382(18):1708–20. doi: 10.1056/NEJMoa2002032
2. Dai M, Liu D, Liu M, Zhou F, Li G, Chen Z, et al. Patients with Cancer Appear
More Vulnerable to SARS-CoV-2: A Multicenter Study during the COVID-19
Outbreak. Cancer Discovery (2020) 10(6):783–91. doi: 10.1158/2159-
8290.CD-20-0422
3. Liang W, Guan W, Chen R, Wang W, LiJ, Xu K, et al. Cancer patients in
SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol (2020)
21(3):335–7. doi: 10.1016/S1470-2045(20)30096-6
4. Lee LY, Cazier JB, Angelis V, Arnold R, Bisht V, Campton NA, et al. COVID19 mortality in patients with cancer on chemotherapy or other anticancer
treatments: a prospective cohort study published correction appears in
Lancet. 2020 Aug 22;396(10250):534. Lancet (2020) 395(10241):1919–26.
doi: 10.1016/S0140-6736(20)31173-9
5. Garassino MC, Whisenant JG, Huang LC, Trama A, Torri V, Agustoni F, et al.
COVID-19 in patients with thoracic malignancies (TERAVOLT): first results
of an international, registry-based, cohort study. Lancet Oncol (2020) 21
(7):914–22. doi: 10.1016/S1470-2045(20)30314-4
6. Kuderer NM, Choueiri TK, Shah DP, Shyr Y, Rubinstein SM, Rivera DR,
et al. Clinical impact of COVID-19 on patients with cancer (CCC19): a
cohort study published correction appears in Lancet. 2020 Sep 12;396
(10253):758. Lancet (2020) 395(10241):1907–18. doi: 10.1016/S0140-6736
(20)31187-9
7. Rüthrich MM, Giessen-Jung C, Borgmann S, Classen AY, Dolff S, Gruner B,
et al. COVID-19 in cancer patients: clinical characteristics and outcome-an
analysis of the LEOSS registry. Ann Hematol (2021) 100(2):383–93.
doi: 10.1007/s00277-020-04328-4
8. Miyashita H, Mikami T, Chopra N, Yamada T, Chernyavsky S, Rizk D, et al.
Do patients with cancer have a poorer prognosis of COVID-19? An
experience in New York City. Ann Oncol (2020) 31(8):1088–9.
doi: 10.1016/j.annonc.2020.04.006
9. Mehta V, Goel S, Kabarriti R, Cole D, Goldfinger M, Acuna-Villaorduna A,
et al. Case Fatality Rate of Cancer Patients with COVID-19 in a New York
Hospital System. Cancer Discovery (2020) 10(7):935–41. doi: 10.1158/2159-
8290.CD-20-0516
10. Vijenthira A, Gong IY, Fox TA, Booth S, Cook G, Fattizzo B, et al. Outcomes
of patients with hematologic malignancies and COVID-19: a systematic
review and meta-analysis of 3377 patients. Blood (2020) 136(25):2881–92.
doi: 10.1182/blood.2020008824
11. Passamonti F, Cattaneo C, Arcaini L, Bruna R, Cavo M, Merli F, et al. Clinical
characteristics and risk factors associated with COVID-19 severity in patients
with haematological malignancies in Italy: a retrospective, multicentre, cohort
study. Lancet Haematol (2020) 7(10):e737–45. doi: 10.1016/S2352-3026(20)
30251-9
12. Wood WA, Neuberg DS, Thompson JC, Tallman MS, Sekeres A, Sehn LH,
et al. Outcomes of patients with hematologic malignancies and
COVID-19: A report from the ASH Research Collaborative Data
Hub. Blood Adv (2020) 4:5966–75. doi: 10.1182/bloodadvances.
2020003170
13. Meng Y, Lu W, Guo E, Liu J, Yang B, Wu P, et al. Cancer history is an
independent risk factor for mortality in hospitalized COVID-19 patients: a
propensity score-matched analysis. J Hematol Oncol (2020) 13(1):75.
doi: 10.1186/s13045-020-00907-0
14. Yang K, Sheng Y, Huang C, Jin Y, Xiong N, Jiang K, et al. Clinical
characteristics, outcomes, and risk factors for mortality in patients with
cancer and COVID-19 in Hubei, China: a multicentre, retrospective, cohort
study. Lancet Oncol (2020) 21(7):904–13. doi: 10.1016/S1470-2045(20)
30310-7
15. Yigenoglu TN, Ata N, Altuntas F, Basci S, Dal MS, Korkmaz S, et al. The
outcome of COVID-19 in patients with hematological malignancy. J Med
Virol (2021) 93(2):1099–104. doi: 10.1002/jmv.26404
16. Hultcrantz M, Richter J, Rosenbaum C, Patel D, Smith E, Korde N, et al.
COVID-19 infections and outcomes in patients with multiple myeloma in
New York City: a cohort study from five academic centers. Preprint MedRxiv
(2020) 2020.06.09.20126516. doi: 10.1101/2020.06.09.20126516
17. Mato AR, Roeker LE, Lamanna N, Allan JN, Leslie L, Pagel JM, et al.
Outcomes of COVID-19 in patients with CLL: a multicenter international
experience. Blood (2020) 136(10):1134–43. doi: 10.1182/blood.2020006965
18. Scarfò L, Chatzikonstantinou T, Rigolin GM, Quaresmini G, Motta M,
Vitale C, et al. COVID-19 severity and mortality in patients with chronic
lymphocytic leukemia: a joint study by ERIC, the European Research Initiative
on CLL, and CLL Campus. Leukemia (2020) 34(9):2354–63. doi: 10.1038/
s41375-020-0959-x
19. Oran DP, Topol EJ. Prevalence of Asymptomatic SARS-CoV-2 Infection : A
Narrative Review. Ann Intern Med (2020) 173(5):362–7. doi: 10.7326/M20-
3012
20. Nikolai LA, Meyer CG, Kremsner PG, Velavan TP. Asymptomatic SARS
Coronavirus 2 infection: Invisible yet invincible. Int J Infect Dis (2020)
100:112–6. doi: 10.1016/j.ijid.2020.08.076
21. Dabrowska-Iwanicka A, Walewski JA. Primary mediastinal large B-cell
lymphoma. Curr Hematol Malig Rep (2014) 9(3):273–83. doi: 10.1007/
s11899-014-0219-0
22. Vitolo U, Seymour JF, Martelli M, Illerhaus G, Illidge T, Zucca E, et al.
Extranodal diffuse large B-cell lymphoma (DLBCL) and primary mediastinal
B-cell lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment
and follow-up. Ann Oncol (2016) 27(suppl 5):v91–v102. doi: 10.1093/annonc/
mdw175
23. Theoharides TC, Conti P. Dexamethasone for COVID-19? Not so fast. J Biol
Regul Homeost Agents (2020) 34(3):1241–3. doi: 10.23812/20-
EDITORIAL_1-5
24. Wang Y, Jiang W, He Q, Wang C, Wang B, Zhou P, et al. A retrospective
cohort study of methylprednisolone therapy in severe patients with COVID19 pneumonia. Signal Transd Targ Ther (2020) 5(1):57. doi: 10.1038/s41392-
020-0158-2
25. RECOVERY Collaborative Group, Horby P, Lim WS, Emberson JR, Mafham M,
Bell JL, et al. Dexamethasone in Hospitalized Patients with Covid-19 -
PreliminaryReport published online ahead of print, 2020 Jul 17. N Engl J Med
(2020) 384(8):693–704. doi: 10.1056/NEJMoa2021436
26. Flisiak R, Parczewski M, Horban A, Jaroszewicz J, Kozielewicz D, Pawłowska M,
et al. Management of SARS-CoV-2 infection: recommendations of the Polish
Association of Epidemiologists and Infectiologists. Annex no. 2 as of October
13, 2020. Pol Arch Intern Med (2020) 130(10):915–8. doi: 10.20452/
pamw.15658
27. Revannasiddaiah S, Kumar Devadas S, Palassery R, Kumar Pant N, Maka VV.
A potential role for cyclophosphamide in the mitigation of acute respiratory
distress syndrome among patients with SARS-CoV-2. Med Hypotheses (2020)
144:109850. doi: 10.1016/j.mehy.2020.109850
28. Moeinzadeh F, Dezfouli M, Naimi A, Shahidi S, Moradi H. Newly Diagnosed
Glomerulonephritis During COVID-19 Infection Undergoing
Immunosuppression Therapy, a Case Report. Iran J Kidney Dis (2020) 14
(3):239–42.
29. Tepasse PR, Hafezi W, Lutz M, Kuhn J, Wilms C, Wiewrodt R, et al. Persisting
SARS-CoV-2 viraemia after rituximab therapy: two cases with fatal outcome
and a review of the literature. Br J Haematol (2020) 190(2):185–8.
doi: 10.1111/bjh.16896
30. Yasuda H, Tsukune Y, Watanabe N, Sugimoto K, Uchimura A, Tateyama M,
et al. Persistent COVID-19 Pneumonia and Failure to Develop Anti-SARSCoV-2 Antibodies During Rituximab Maintenance Therapy for Follicular
Lymphoma. Clin Lymphoma Myeloma Leuk (2020) 20(11):774–6.
doi: 10.1016/j.clml.2020.08.017
31. Koff AG, Laurent-Rolle M, Hsu JC, Malinis M. Prolonged incubation of severe
acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a patient on
rituximab therapy published online ahead of print, 2020 Oct 7. Infect Control
Hosp Epidemiol (2020) 1–2. doi: 10.1017/ice.2020.1239
32. Shi S, <PRESIDIO_ANONYMIZED_PERSON>, <PRESIDIO_ANONYMIZED_PERSON>, Cai Y, Liu T, Yang F, et al. Association of Cardiac Injury
With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China.
JAMA Cardiol (2020) 5(7):802–10. doi: 10.1001/jamacardio.2020.0950
33. Knockaert DC. Cardiac involvement in systemic inflammatory diseases. Eur
Heart J (2007) 28(15):1797–804. doi: 10.1093/eurheartj/ehm193
34. Huang Q, Hu S, Ran FM, Liang T-J, Wang H-X, Chen C-C, et al.
Asymptomatic COVID-19 infection in patients with cancer at a cancerspecialized hospital in Wuhan, China - Preliminary results. Eur Rev Med
Pharmacol Sci (2020) 24(18):9760–4. doi: 10.26355/eurrev_202009_23070
Woz´ niak et al. Chemotherapy During Active SARS-CoV-2 Infection
Frontiers in Oncology | www.frontiersin.org 5 April 2021 | Volume 11 | Article 662211
35. Yarza R, Bover M, Paredes D, Lopez-Lopez F, Jara-Casas D, Castelo-Loureiro A,
et al. SARS-CoV-2 infection in cancer patients undergoing active treatment:
analysis of clinical features and predictive factors for severe respiratory
failure and death. Eur J Cancer (2020) 135:242–50. doi: 10.1016/j.ejca.
2020.06.001
36. Varble N, Blain M, Kassin M, Xu S, Turkbey EB, Amalou A, et al. CT and
clinical assessment in asymptomatic and pre-symptomatic patients with early
SARS-CoV-2 in outbreak settings published online ahead of print, 2020 Nov
4. published correction appears in Eur Radiol. 2020 Dec 8;. Eur Radiol (2020)
1–12. doi: 10.1007/s00330-020-07401-8
37. ElGohary GM, Hashmi S, Styczynski J, Kharfan-Dabaja MA, Alblooshi RM,
de la Cámara R, et al. The risk and prognosis of COVID-19 infection in cancer
patients: Asystematic review and meta-analysis published online ahead of
print, 2020 Jul 30.Hematol Oncol Stem Cell Ther (2020)S1658–3876(20)
30122–9. doi: 10.1016/j.hemonc.2020.07.005
38. Hempel L, Piehler A, Pfaffl MW, Molnar J, Kirchner B, Robert S, et al. SARSCoV-2 infections in cancer outpatients-Most infected patients are
asymptomatic carriers without impact on chemotherapy. Cancer Med
(2020) 9(21):8020–8. doi: 10.1002/cam4.3435
39. Yekedüz E, Utkan G, Ürün Y. A systematic review and meta-analysis: the
effect of active cancer treatment on severity of COVID-19. Eur J Cancer (2020)
141:92–104. doi: 10.1016/j.ejca.2020.09.028
Conflict of Interest: The authors declare that the research was conducted in the
absence of any commercial or financial relationships that could be constructed as a
potential conflict of interest.
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