Division of Hematology and Oncology and O'Neal Comprehensive Cancer Center, Heersink School of Medicine, University of Alabama at Birmingham (UAB), 1600 7th Avenue South, Lowder 500, Birmingham, AL, 35233, USA.
The Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA.
Curr Treat Options Oncol. 2022 May;23(5):688-702. doi: 10.1007/s11864-022-00975-z. Epub 2022 Mar 25.
The coronavirus disease-19 (COVID-19) pandemic has posed numerous challenges to the global healthcare system. Of particular gravity is adult and pediatric patients with hematologic malignancies who are among the most vulnerable groups of patients at risk of severe COVID-19 outcomes. In the early phases of the pandemic, several treatment modifications were proposed for patients with leukemia. Largely speaking, these were adopting less-intense therapies and more utilization of the outpatient setting. Over time, our understanding and management have become more nuanced. Furthermore, equipped with vaccinations to prevent COVID-19 infection and availability of treatments in the presence of COVID-19 infection, the recommendations on management of patients with leukemia have evolved. Patient's leukemia characteristics, possibility of targeted therapy, vaccination status, symptomatology, comorbidities, goal of anti-leukemic therapy, the intensity of therapy, the setting of treatment, as well as loco regional factors like dynamic incidence of COVID-19 in the community and hospital/ICU bed status are among many factors that influence the decisions. Furthermore, the oncology community has adopted delaying the anti-leukemia therapy for a limited time frame, if clinically possible, so as to still deliver most appropriate therapy while minimizing risks. Early adoption of growth factor support and conservative blood transfusion practices have helped as well. In this review, we discuss the impact of COVID-19 on outcomes and share considerations for treatments of leukemias. We describe the impact on both clinical care (from diagnosis to treatment) and research, and cover the literature on vaccines and treatments for COVID-19 in relation to leukemia.
新型冠状病毒病-19（COVID-19）大流行对全球医疗体系带来了诸多挑战。血液恶性肿瘤的成人和儿科患者尤其属于 COVID-19 重症高风险的最脆弱人群。在大流行的早期阶段，提出了针对白血病患者的多种治疗修改方案。大体上，这些方案包括采用非强化疗法和更多地利用门诊设置。随着时间的推移，我们对疾病的认识和管理变得更加细致。此外，由于预防 COVID-19 感染的疫苗和 COVID-19 感染时的治疗方法，白血病患者管理的建议也在不断发展。患者的白血病特征、靶向治疗的可能性、疫苗接种状况、症状、合并症、抗白血病治疗的目标、治疗强度、治疗设置，以及当地社区 COVID-19 的动态发病率和医院/重症监护病房床位状况等局部区域因素，都是影响决策的诸多因素之一。此外，肿瘤学界还采取了在有限的时间内延迟抗白血病治疗的策略，如果临床可行的话，以便在尽量降低风险的同时，仍然提供最合适的治疗。早期采用生长因子支持和保守输血实践也有所帮助。在这篇综述中，我们讨论了 COVID-19 对结局的影响，并分享了白血病治疗的注意事项。我们描述了 COVID-19 对临床护理（从诊断到治疗）和研究的影响，并涵盖了与白血病相关的 COVID-19 疫苗和治疗方法的文献。
