Isidori Alessandro, de Leval Laurence, Gergis Usama, Musto Pellegrino, Porcu Pierluigi
Hematology and Stem Cell Transplant Center, AORMN Hospital, Pesaro, Italy.
Institute of Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Front Oncol. 2020 Aug 14;10:1439. doi: 10.3389/fonc.2020.01439. eCollection 2020.
The COVID-19 pandemic has created unprecedented hurdles to the delivery of care to patients with cancer. Patients with hematologic malignancies appear to have a greater risk of SARS-CoV-2 infection and severe disease due to myelosuppression and lymphopenia. The first challenge, therefore, is how to continue to deliver effective, curative therapy to vulnerable patients and at the same time avoid exposing them, and their health care teams (HCT), to SARS-CoV-2. An additional challenge is the timely completion of the diagnostic and staging studies required to formulate appropriate treatment plans. Deferred procedures and avoidance of multiple trips to the surgical, diagnostic, and laboratory suites require same day consolidation of all procedures. With laboratory medicine absorbed by the need to deploy large scale COVID-testing, the availability of routine molecular tests is affected. Finally, we are increasingly faced with the challenge of making complex treatment decisions in SARS-CoV-2 positive patients with aggressive but potentially curable blood cancers. When to treat, how to treat, when to wait, how long to wait, how to predict and manage toxicities, and how to avoid compromising cure rates remains unknown. We present an outline of the scientific, medical, and operational challenges posed by the COVID-19 pandemic at selected American and European institutions and offer our current view of the key elements of a response. While the peak of the pandemic may be past us, in the absence of a vaccine risks remain, and our alertness and response to future challenges need to be refined and consolidated.
新冠疫情给癌症患者的治疗带来了前所未有的障碍。血液系统恶性肿瘤患者由于骨髓抑制和淋巴细胞减少，似乎感染新冠病毒和患重症的风险更高。因此，首要挑战是如何继续为脆弱患者提供有效的治愈性治疗，同时避免他们及其医护团队接触新冠病毒。另一个挑战是及时完成制定适当治疗方案所需的诊断和分期检查。推迟手术和避免多次前往外科、诊断和实验室科室需要在同一天整合所有检查。由于实验室医学被大规模新冠检测的需求所占据，常规分子检测的可用性受到影响。最后，我们越来越面临在感染新冠病毒的侵袭性但可能治愈的血癌患者中做出复杂治疗决策的挑战。何时治疗、如何治疗、何时等待、等待多久、如何预测和管理毒性以及如何避免影响治愈率仍不明确。我们概述了新冠疫情给美国和欧洲部分机构带来的科学、医学和运营挑战，并提供了我们目前对应对关键要素的看法。虽然疫情高峰可能已经过去，但在没有疫苗的情况下风险依然存在，我们对未来挑战的警惕性和应对措施需要进一步完善和巩固。
