Managing patients with leukemia during the COVID-19 pandemic

The report recommends several treatment modifications for patients with leukemia during the high-risk period of the COVID-19 pandemic. The main recommendations are to reduce clinic visits, use less intensive chemotherapy, and care through telemedicine for effective treatment.

Managing patients with leukemia during the COVID-19 pandemic is challenging. It was estimated that up to 30% of patients with cancer die if infected with COVID-19. Intensive chemotherapy with higher doses of drugs makes leukemia treatment very complicated. Treatment modifications are necessary to balance the risks of COVID-19 infection and restricting patients to specialized hospital care.

This article provided recommendations for the treatment of patients with leukemia during the COVID-19 pandemic.

All patients must be tested for COVID-19. Patients with newly diagnosed acute lymphoblastic leukemia (ALL) lacking Ph-chromosome should be given HCVAD-based chemotherapy. Ph-chromosome is a cancerous genetic abnormality. HCVAD involves cyclophosphamide (Cytoxan), vincristine (Oncovin), doxorubicin (Adriamycin), and dexamethasone (Decadron).

Such patients who are younger than 60 years and tested negative for COVID-19 should be given lower doses of HCVAD and blinatumomab (Blincyto). This will reduce infection risks without affecting outcomes. For patients with ALL harboring Ph-chromosome, ponatinib (Iclusig) and blinatumomab can reduce infection risks.

Patients with acute myeloid leukemia (AML) undergoing intensive therapy in hospitals should not be released until their blood-cell counts recover. Less intensive AML therapies involve drugs like venetoclax (Venclexta) and cytarabine (Cytosar-U). They are not generally recommended for patients younger than 60 years. However, they can be considered for patients in COVID-19 affected areas with limited hospital beds.

Patients with chronic myeloid leukemia (CML) are not considered at high risk of infection. Treatment should not be paused or delayed for patients with chronic phase CML. Patients with newly diagnosed CML are generally treated with tyrosine kinase inhibitors (TKIs). The side effects of these drugs should be carefully considered to avoid COVID-19 related respiratory problems.

Patients with chronic lymphocytic leukemia (CLL) are generally older with weak immune systems. They are considered at high risk of infection. Therefore, new therapy should not be started during the high-risk period of the pandemic. Treatments must be adjusted to individual conditions. Drugs suppressing new blood-cell production, like fludarabine (Fludara), may be avoided to reduce hospital visits.

The authors recommended less intensive chemotherapy for reducing hospitalizations of patients with leukemia during the COVID-19 pandemic. Treatment should be adjusted based on leukemia type, patients’ conditions, and toxicities of chemotherapy.