Összefoglaló. Az áttekintő közlemény foglalkozik a legfontosabb olyan helyzetekkel, amely a koronavírus-betegség (COVID–19) pandémia idején a kemo- és biológiai terápiás irányelvek változását érinti leukémiában, lymphomákban, csontvelő-transzplantációs helyzetekben. Külön figyelmet kell fordítani és eltérő teendőket kell megfogalmazni a kezelési fázisok, például indukció, konszolidáció, fenntartó és egyéb kezelésmódok tekintetében. Nagy figyelmet érdemelnek a nemzetközi ajánlások, de egyben finom értékelést is kívánnak bizonyos gyógyszerek esetében, például monoklonális antitestek, szteroidok, innovatívabb akut leukémiás szerek, kolóniastimuláló faktorok, JAK2-gátlók, interferonok, tirozin-kináz-gátlók stb. esetében. Foglalkozunk a nemzetközi csontvelő-transzplantációval kapcsolatos ajánlásokkal. Mindent nagyban befolyásol az aktuális COVID-pandémiás helyzet. Természetesen foglalkozunk a vakcináció kérdéseivel is onkohematológiai kórképekben. A COVID és az onkohematológia viszonyrendszere a gyakorlati cselekvések terén még mindig tanuló fázisban van, meg kell találni az összhangot a pandémia és a klinikai gyakorlat összehangolása tekintetében. A gyorsan változó COVID-helyzet megkívánja, hogy ismereteinket és cselekvéseinket napi szinten frissen tartsuk, a szokásosnál többet támaszkodjunk a tapasztalatokra, s figyeljünk oda a standard publikációk mellett a hitelesnek vélt, s a helyzet miatt elengedhetetlenül szükséges, gyorsan kommunikált állásfoglalásokra is.
Summary. A brief analysis of international recommendations and applicable clinical decisions are summarized regarding the clinical care of oncohaematological patients in the era of COVID-19 pandemic. General precautionary measures are extremely important. Special attention is paid to different groups of patients (i.e. leukaemias, lymphomas, transplant situations), along with analysing different treatment phases, e.g. watch and wait, induction, consolidation, maintenance, etc. Some recommendations are really remarkable with some drugs and protocols, however they do need fine tuning and careful individual decisions, e.g. monoclonal antibodies, steroids, some innovative agents in acute myeloid leukaemia, colony stimulation, ATRA based therapies, some 2nd line tyrosine kinase inhibitors in chronic myeloid leukaemia, etc. Some aspects of international COVID-19 specific transplantational guidelines are also covered. Vaccination recommendations and experience are also in the focus. It may not be stressed enough, that we are still in the learning phase of harmonization of COVID-19 pandemic and oncohaematology care, this is still a moving target, depending a lot on actual pandemic situation and periods. Considering ever changing COVID situation one should follow peer reviewed publications as before, but of course frequently review new COVID statements, in an effort to preserve, maintain efficiency of endangered oncohaematological care.
Amicucci M, Canesi M, Rostagno E, et al. How we have protected our patients: The Italian pediatric onco-hematology units’ response to the COVID-19 pandemic. Pediatr Blood Cancer 2020; 67: e28505.
Mina A, Besien KN, Leoinidas C, et al. Hematological manifestations of COVID-19 Leuk Lymphoma 2020; 61: 2790–2798.
Passamonti F, Cattaneo C, Arcaini LV, 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: e737–e745.
Lamure S, Duléry R, Di Blasi R, et al. Determinants of outcome in Covid-19 hospitalized patients with lymphoma: A retrospective multicenter cohort study. EClinicalMedicine 2020 Oct. 27; 100549. .
Tugce NY, Naim A, Fevzi A, et al. The outcome of COVID-19 in patients with hematological malignancy. Med Virol. 2021; 93: 1099–1104.
Bruna R, Cavo M, Merli F, et al. Sustained response after remdesivir and convalescent plasma therapy in a B-cell depleted patient with protracted COVID-19. Clin Infect Dis. 2021; 73: e4020–e4024.
Jeong C, Ji WK, Soong KR, et al. COVID-19 transmission and blood transfusion: A case report. Leukemia 2020; 12: e9629.
Paul S, Rauschh CR, Jain N, et al. Treating leukemia in the time of Covid-19. Acta Hematol. 2021;144(2):132-145. .
Brissot F, Labopin M, Baron F, et al. Management of patients with acute leukemia during the COVID-19 outbreak: practical guidelines from the acute leukemia working party of the European Society for Blood and Marrow Transplantation. Bone Marrow Transplant. 2021; 56: 532–535.
Khan AM, Ajmal Z, Raval M, et al. Concurrent diagnosis of acute myeloid leukemia and COVID-19: A management challenge. Leukemia 2021; 35: 279–281.
Baruchel A, Bertrand Y, Boisset M, et al. Covid-19 and acute lymphoblastic leukemias of children and adolescents: First recommendations of the leukemia committee of the French Society for the fight against cancers and leukemias in children and adolescents (SFCE). Bull Cancer 2020; 107: 629–632.
British Society for Haematology: Covid-19 vaccine in patients with haematological disorders. https://b-s-h.org.uk/media/19195/haematology-covid-19-v10-vaccination-statement-231220.pdf
Cruz Benito B, Lazaro P, Lopez A. Managing the frontline treatment for DLBC and high grader B cell lymphoma during the Covid outbreak. Br J Hemat. 2020; 3: 386–389.
Bachanova V, Bishop MR, Dahi P, et al. Chimeric antigen receptor T cell therapy during the Covid-19 pandemic. Biol Blood Bone Marrow Transplant. 2020; 26: 1239–1246.
Challenor VR, Tucker D. SARS-CoV-2-induced remission of Hodgkin lymphoma. Br J Haematol. 2021; 192(3): 415.
Fuji T, Tsui M, Sugitani M, et al. Prolonged persistence of SARS-CoV-2 infection during A+AVD therapy for classical Hodgkin’s lymphoma. Curr Probl Cancer. 2021; 45(6):100739. .
Susek KH, Gran C, Ljunggren HG, et al. Outcome of Covid-19 patients in multiple myeloma patients in relation to treatment. Eur J Hematol. 2020; 105(6): 751–754. .
Malsy J, Veletzky L, Heide Je, et al. Sustained response after remdesivir and covalescent plasma therapy in B-cell-depleted a patient with protracted coronavirus disease 2019. Clin Infect Dis. 2021, 73: e4020–e4024.
Al Saleh AJ, Sher T, Gertz MA. Outcome of COVID-19 in multiple myeloma patients in relation to treatment. Acta Haematol. 2020; 143(5): 410–416.
Chatzikonstantinou T, Herishanu Y, Montserrat E, et al. COVID-19 and Chronic Lymphocytic Leukemia: Where We Stand Now. Leukemia 2020; 34: 1723–1725.
Weiming L, Danyu W, Jingming G. et al. COVID-19 in persons with chronic myeloid Leukaemia. Leukemia 2021; 34: 1799–1804.
Kamaz B, Mullally A. COVID-19 and myeloproliferative neoplasms: some considerations. Leukemia 2021; 35: 279–281.
Heidel F, Hochhaus A. Holding CoVID in check through JAK? The MPN-approved compound ruxolitinib as a potential strategy to treat SARS-CoV-2 induced systemic hyperinflammation. Am J Blood Res. 2021; 25: 76.
Khaled SA, Hafez AA. Aplastic anemia and COVID-19: how to break the vicious circuit? Am J Blood Res. 2020; 10(4): 60–67.
Coronavirus Disease Covid-19: EBMT Recommendations, version 16, May 27, 2021, https://www.ebmt.org/sites/default/files/2021-06/EBMT%20COVID-19%20guidelines%20v.%2016.03.pdf
Sharma A, Bhat NSt, St. Martin MS, et al. COVID-19 in Hematopoietic Cell Transplant Recipients: A CIBMTR Study. Biol Blood Marrow Transplant. 2020; 26: 2181–2189.
García-Suarez J, de la Cruz J, Cedillo Á. Impact of hematologic malignancy and type of cancer therapy on COVID-19 severity and mortality: lessons from a large population-based registry study. J Hematol Oncol. 2020; 8: 133.
Algwaiz G, Aljurf M, Koh M, et al. Real-world issues and potential solutions in hematopoietic cell transplantation during the COVID-19 pandemic: Perspectives from the worldwide network for Blood and Marrow Transplantation and Center for International Blood and Marrow Transplant Research Health Services and International Studies Committee. Biol Blood Marrow Transplant. 2020; 26(12): 2181–2189. .
Sharma A, Bhatt N, St Martin A, et al. COVID-19 in hematopoietic cell transplant recipients: A CIBMTR study. Biol Blood Marrow Transplant Cell. Ther. 2021; 27(3): S4–S5.
Sharma A, Bhatt N, St Martin A, et al. Clinical characteristics and outcomes of COVID-19 in haematopoietic stem-cell transplantation recipients: an observational cohort study. Lancet Haematol. 2021; 8: e185–e193.
Hagihara M, Ohara S, Uchida T. Practical management of patients with hematological diseases during the COVID-19 pandemic in Japan. Int J Hematol. 2021; 114: 709–718.
Debreceni Egyetem, Klinikai Központ, Járványügyi koordinációs központ, Covid 19 kezelési irányelvek. (2021)
Bobek I, Elek J, Gopcsa L, et al. 2020. évben azonosított új koronavírus okozta fertőzések megelőzésének és terápiájának kézikönyve.