Covid-19 and malignant hemopathies: Experience of the clinical hematology service of the university hospital center ibn sina in rabat
Authors: K. Hajar, F. Safae, M. Alaoui, C. Yasmine, C. Wyssal, B. Sami, B. Majdouline, H. Soukayna, A. Wafae, M. Mouna, H. Hicham, A. Mohammed, T. M. Zoubida
Journal: HemaSphere (2021)

Background: Since September 2020, Morocco has experienced the 2nd wave of covid-19 infection explaining the high daily rate of new infections and deaths from this infection Aims: the aims is to describe the state of play of this infection in patients followed for malignant hematologic disease Methods: This is a retrospective and observational study during the 2nd wave of the COVID-19 pandemic in Morocco (from September 2019 to February 2021) carried out at the clinical hematology service of the Ibn Sina University Hospital center in Rabat concerning patients followed for active malignant hemopathy who presented with COVID-19 infection Results: we have collected 25 cases. The average age estimated as: 40 years (18-65 years), sex ratio: 1.27 (14 M / 11F). We objectified 40% of patients with large B cell lymphoma, 8% with acute leukemia, 40% with multiple myeloma, 2% with myelodysplasia, and 5% with CLL. At the time of COVID - 19 infection, 80% of patients were on chemotherapy, and another 20%) had not yet started chemotherapy. 9 patients presented with comorbidities: arterial hypertension in 12% of cases, diabetes in 8% of cases, and obesity (BMI> 30) in 16% of cases. The main symptoms of COVID-19 in our patients were: Asthenia (80%) dyspnea (81%), and cough (50%), none of our patients presented neurological, digestive, cutaneous vasculitis, myocarditis,or ORL signs. lymphopenia was noted in 90% of cases, an inflammatory syndrome in 30% of cases. hepatic tests were normal in all patients. 8% of patients had chronic renal failure. D-Dimers were elevated in 40% of patients. thoracic CT revealed pulmonary lesions of the corads 4 and 5 type in 75% of cases, extended between 25-50% of lung surface in 90% of cases, no thrombosis or pulmonary embolism were observed. 18% of patients were paucisymptomatic for COVID-19 infection, 70% of patients had moderate symptoms, and 12% of patients had severe respiratory-type symptoms. 80% of patients had normal initial AAS with 97% O2, 10% had presented respiratory distress with AAS <90% O2. they received oxygen therapy by the high concentration O2 mask, optiflow and CPAP as needed. 16% of patients were hospitalized in intensive care for NIV. All the patients received the anti-covid treatment according to the Moroccan national protocol: azithromycin and vitamin therapy (vit C, D, zinc) in 100% of the patients, and hydroxychloroquine in 70% of the patients. No patient received lopinavir / ritonavir, anakinra or tociluzimab, or remdesivir. because of severe sepsis on bronchopulmonary infection, we used broad-spectrum antibiotics in 8.3% cases. (80%) of patients received corticosteroid therapy (dexamethasone) and 90% had an enoxaparin at a preventive anticoagulant dose. because of the Covid-19 infection, chemotherapy was postponed or not started (2-3 weeks). ARDS was present in 16%. The average length of stay in hospital was 15 days (10-40 days). All of our patients have recovered from their Covid- 19 infection. We deplore 12% of deaths linked to the progression of hemopathy. No patient experienced spontaneous recovery from their hemopathies after infection with Covid-19. 1 patient (4%) followed for CLL under ibrutinib maintained a normal lymphocytosis at 4400/ mm3 persistent after 6 months of evolution. We noted an early relapse of the Covid -19 infection on day 22 of the 1st infection in 4% of patients with hypogammaglobulinemia. Summary/Conclusion: The COVID-19 pandemic had a significant negative impact on the care of patients with malignant hemopathy, limiting patients' access to chemotherapy.