Division of Pharmacy, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Acta Haematol. 2021;144(2):132-145. doi: 10.1159/000508199. Epub 2020 May 11.
The coronavirus disease 2019 (COVID-19) pandemic poses several challenges to the management of patients with leukemia. The biology of each leukemia and its corresponding treatment with conventional intensive chemotherapy, with or without targeted therapies (venetoclax, FLT3 inhibitors, IDH1/2 inhibitors, Bruton's tyrosine kinase inhibitors), introduce additional layers of complexity during COVID-19 high-risk periods. The knowledge about COVID-19 is accumulating rapidly. An important distinction is the prevalence of "exposure" versus "clinical infectivity," which determine the risk versus benefit of modifying potentially highly curative therapies in leukemia. At present, the rate of clinical infection is <1-2% worldwide. With a mortality rate of 1-5% in CO-VID-19 patients in the general population and potentially of >30% in patients with cancer, careful consideration should be given to the risk of COVID-19 in leukemia. Instead of reducing patient access to specialized cancer centers and modifying therapies to ones with unproven curative benefit, there is more rationale for less intensive, yet effective therapies that may require fewer clinic visits or hospitalizations. Here, we offer recommendations on the optimization of leukemia management during high-risk COVID-19 periods.
新型冠状病毒病 2019（COVID-19）大流行给白血病患者的管理带来了诸多挑战。每种白血病的生物学特性及其相应的治疗方法（常规强化化疗，联合或不联合靶向治疗（维奈托克、FLT3 抑制剂、IDH1/2 抑制剂、布鲁顿酪氨酸激酶抑制剂）），在 COVID-19 高风险期间增加了额外的复杂性。关于 COVID-19 的知识正在迅速积累。一个重要的区别是“暴露”与“临床传染性”的流行率，这决定了修改白血病潜在高度治愈性疗法的风险与获益。目前，全球范围内的临床感染率<1-2%。在普通人群中 COVID-19 患者的死亡率为 1-5%，而癌症患者的死亡率可能>30%，因此应仔细考虑白血病患者感染 COVID-19 的风险。与其降低患者接受专门癌症中心治疗的机会并修改为无明确疗效的疗法，不如采用强度较低但仍有效的疗法，这些疗法可能需要更少的就诊次数或住院次数。在这里，我们提供了在 COVID-19 高风险期间优化白血病管理的建议。
