How Does COVID-19 Affect Those With Hematological Cancer?

By | 16 February 2021

It is now a known fact that COVID-19 disease is more severe in elderly people and those with the additional disease. Patients with hematological cancer, especially those whose immune system is suppressed; The type of chemotherapy administered has a higher risk of contracting COVID-19 disease due to the complications and accompanying diseases of the disease.

Hematological cancer patients, which constitute approximately 10% of all cancers and whose defense system is suppressed, have a higher risk of getting COVID-19 disease due to the type of chemotherapy applied, complications of the disease, and associated diseases.

The need for intensive care and ventilation, sepsis, cytokine regulation disorder, multi-organ failure, and death are observed more frequently in cancer patients caught with COVID-19. In cancer patients who have recently received chemotherapy and tested positive for COVID-19 PCR, the mortality rate reaches 30% within 30 days. Although hematological cancer cases pass COVID-19, antibody positivity is not observed even 15 days or later after the symptoms due to abnormalities in lymphocyte subgroups.

Cancer treatments make COVID-19 treatment difficult
Chemotherapy, radiotherapy, targeted therapy, or immune treatments also worsen the disease and make treatment difficult in hematologic cancer cases. Patients with leukemia and lymphoma with the suppressed immune system are more frequently caught in COVID-19 due to hypogammaglobulinemia, lymphopenia, neutropenia, steroid administration, advanced age, co-existing diseases, frequent transfusions, and frequent presence in the hospital environment.

Although some of the hematological cancers do not require urgent treatment due to the course of the disease, some require both urgent and high-dose chemotherapy, high-dose radiotherapy, and even stem cell transplantation. Therefore, problems arise in the management of hematological cancer cases in the presence of COVID-19.

Also, all patients with hematological cancer (especially those with acute leukemia and stem cell transplant candidates/transplants) wear masks, pay attention to their personal hygiene and comply with social distance due to their illnesses, apply protective measures regardless of the COVID-19 crisis, thus reducing the risk of getting COVID-19. they drop themselves. Along with the treatment of COVID-19 and its complications, curative treatments should be applied in a balanced way in patients with hematologic cancer.

Things to watch out for until a vaccine is found
Until effective anti-viral therapy for COVID-19 is accepted and the vaccine is available, the most appropriate approach for hematologic cancer patients is:
– Observing COVID-19 symptoms such as fever, respiratory distress, cough,
– identification of asymptomatic carriers,
– Applying effective but not increasing morbidity chemotherapy by evaluating on a patient basis,
– Opening the chemotherapy treatment intervals if possible,
– Providing growth factor support together with chemotherapies to reduce the risk of neutropenia,
Application of stem cell transplantation only in the presence of an emergency and life-threatening situation,
Follow-up of cases where stem cell transplantation cannot be performed with chemotherapy,
– Early collection and storage of stem cells from stem cell donors,
– postponement of elective transactions if possible,
– using less immunosuppressive drugs,
– lowering blood and platelet transfusion thresholds,
– COVID-19 PCR must be sent to patients who will be hospitalized.

Cancer treatment method: Bone marrow
One of the treatment options for a serious blood disease, immune system disease, cancer, or genetic disease is bone marrow transplantation. Bone marrow transplant is performed in cases such as:
– To protect healthy bone marrow from high dose chemoradiotherapy required in a cancer case (autologous),
– To replace the diseased cells/bone marrow with cells taken from the healthy person (allogeneic),
– To fix the bone marrow that is not working,
– To correct immune suppression,
To correct abnormalities related to inborn metabolism or enzymatic system,
– For the rearrangement of the patient’s own stem cells / T Cells (in the treatment of autoimmune diseases).

Things to consider before bone marrow transplant
Things to consider before bone marrow transplant are similar to COVID-19 protection measures. The fact that the disease is under control or infection before the bone marrow transplant will affect the success of the transplant. Infection control measures should be considered before transplantation. Sick people should be avoided, hands should not be shaken, their hands should be washed frequently and their visits should be reduced.