COVID-19 in patients with acute leukemia: The experience of a hematological center
Authors: A. Malato, A. Mule, V. Calafiore, F. Di Bassiano, R. Mauro, C. Cangialosi, U. Biondo, C. Patti
Journal: HemaSphere (2021)

Background: Patients with hematologic malignancies appear to have a greater risk of SARS-CoV-2 infection and severe disease due to myelosuppression;furthermore, delays in treatment of patients with hematologic malignancies, especially those with acute leukemia planned for chemotherapy or transplantation, are associated with a risk of disease progression. To date, some societies recommend that chemotherapy should generally not be started until COVID-19 symptoms have completely resolved and viral testing becomes negative. However, implications of the aforementioned recommendations remain uncertain in routine clinical practice, and data on COVID-19 in patients with hematologic malignancies are still limited. Aims: We carried out a single-center analysis of acute leukemia inpatients who developed COVID-19 during the last year. Methods: Since February 2020 to February 2021, a total of 310 Hospitalizations,63 adult patients were admitted in our Center for treatment of hematologic malignancies. The indication for admission was acute myeloid leukemia (AML) in 50 (30%) patients, acute lymphoblastic leukemia (ALL) in4 (8%), lymphoma in 54 (33%), myeloma in4 (8%), other 31 (19%). Diagnosis of SARS-CoV-2 infection was based on virus detection by real-time polymerase chain reaction (SARS-CoV-2 E-gene RT-PCR) in respiratory tract specimens. Standard preventive measures for SARS-CoV-2 infection control were applied to all patients care, accordance with National disease control and prevention guidelines. Results: Ten (6%) patients tested positive for SARS-CoV-2 via PCR in a unique Covid-19 outbreak during hospitalization stay, and they were immediately transferred to Covid Infectious Unit. All these patients, were affected by Acute Leukemia (8 pts AML, 2 pts ALL ph negative), the majority of them was in peak of cytopenia at the Covid-19 infection time. Nine patients had been treated with intensive chemotherapy before SARS-CoV-2 confirmation. At SARS-CoV-2 diagnosis, only one patient had untreated, newly diagnosed AML;3 patients had refractory/relapsed AML. One patient was in complete remission with incomplete hematologic recovery (CRi). Deep vein thrombosis complicated by pulmonary embolism and interstitial pneumonia was observed in a patients despite anticoagulation and in thrombocytopenia. After SARS-CoV-2 infection, no leukemia-specific treatment was adjusted. Three patients (30%) died due to severe acute respiratory distress syndrome (ARDS) despite extracorporeal membrane oxygenation (ECMO) in deep aplasia, all of them was in refractory disease. Seven patients delayed in chemotherapy treatment for a media of 34 days;chemotherapy started until COVID-19 symptoms have completely resolved and two viral testing becomes negative. However, these patients are still alive and maintained their complete remission, remaining for long-time negative for SARS-CoV-2. One patient underwent to bone marrow transplantation Summary/Conclusion: Our findings support the vulnerability of patients with hematologic malignancies in the COVID-19 pandemic, and we reported a high COVID-19 infection mortality of 30%, in accordance with other hematological case series. However, deaths owing to Covid-19 were observed in patients in disease leukemia progression;furthermore, our recovered COVID-19 leukemia patients remained negative for SARSCoV- 2 after delivery of chemotherapy, and underwent to their following chemotherapy and allo-BMT program without any other complications.