Finelli Carlo, Parisi Sarah
Institute of Hematology, S. Orsola-Malpighi University Hospital, Bologna, Italy.
Institute of Hematology, S. Orsola-Malpighi University Hospital, Bologna, Italy.
Adv Biol Regul. 2020 Aug;77:100742. doi: 10.1016/j.jbior.2020.100742. Epub 2020 Jul 16.
The rapid onset and worldwide spread of the COVID-19 epidemic (caused by SARS-CoV-2 coronavirus) has been associated with a profound impact in clinical practice also in the hematologic setting. First of all, given the immunosuppressive effect of many therapies that are normally administered to patients with hematological diseases, with a consequent increased risk of contracting a more severe viral infection, it has been necessary to reconsider in each individual patient the urgency and priority of the treatments foreseen by the normal standards of care. In particular, as regards allogeneic (and to a lesser extent autologous) hematopoietic cell transplantation and CAR T-cell therapy, specific recommendations have been issued by the transplant community on the criteria to be used to decide whether or not to postpone these procedures and on the clinical management of recipients and donors exposed to COVID-19. As to cytotoxic chemotherapy and other antineoplastic therapies, criteria have been proposed to decide, in the various clinical situations, which treatments were not deferrable and which instead could be postponed or replaced by less aggressive therapies. In the outpatient clinics, various organizational solutions for telemedicine have been adopted, resorting to telephone interviews and/or Information Technology, with the aim of reducing the influx of patients while maintaining an adequate control of their clinical condition. The collection of blood by the transfusion centers has been the subject of organizational measures, in order to avoid the transmission of COVID 19 while maintaining a sufficient blood collection for clinical needs. Finally, some hematologic laboratory alterations have been identified, such as thrombocytopenia, lymphopenia and coagulation abnormalities, useful for the prognostic evaluation of infected patients.
新型冠状病毒肺炎（COVID-19，由严重急性呼吸综合征冠状病毒2引起）的迅速发病和全球传播，在血液学领域的临床实践中也产生了深远影响。首先，鉴于许多通常用于血液病患者的治疗具有免疫抑制作用，从而导致感染更严重病毒感染的风险增加，因此有必要重新考虑每位患者按照正常护理标准所预见治疗的紧迫性和优先级。特别是，关于异基因（以及程度较轻的自体）造血细胞移植和嵌合抗原受体T细胞疗法，移植界已就用于决定是否推迟这些程序的标准以及对接触COVID-19的受者和供者的临床管理发布了具体建议。至于细胞毒性化疗和其他抗肿瘤疗法，已提出标准，以便在各种临床情况下决定哪些治疗不能推迟，哪些可以推迟或用侵略性较小的疗法替代。在门诊诊所，已经采用了各种远程医疗的组织解决方案，采用电话访谈和/或信息技术，目的是减少患者流量，同时保持对其临床状况的充分控制。输血中心的采血工作已成为组织措施的主题，以避免COVID-19的传播，同时保持足够的临床用血采集量。最后，已经确定了一些血液学实验室改变，如血小板减少、淋巴细胞减少和凝血异常，这些有助于对感染患者进行预后评估。
