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Managing Hematologic Malignancy Patient

Objective- To communicate interim guidelines to safely manage hematologic malignancies

The coronavirus disease of 2019 (COVID-19) pandemic has developed unique challenges for optimal management of hematologic malignancy patients. These patients routinely receive highly myelotoxic and lymphotoxic therapies, frequently administered with curative intent.

These guidelines are recommended to balance the risk of underlying malignancy with the risk of COVID-19 infection and mortality. Also, they are meant to minimize the need for inpatient care in hope of an expected community surge of COVID-19 infected patients, while recognizing that all patients with illness need care even during a pandemic.

The following are few general consensuses for appropriate treatment of hematologic malignancy patient:

•           Consider less intensive treatment approaches wherever possible

•           For multiple refractory Hodgkin lymphoma patients, allogeneic hematopoietic stem cell transplantation should be avoided at this time, and patients should be maintained with current standards including brentuximab vedotin and/or programmed cell death 1 inhibitors.

•           No evidence support changing or holding chemotherapy or immunotherapy in patients with cancer or in bone marrow transplant (BMT)/ stem cell transplant (SCT) patients.

•           Withholding critical anti-cancer or immunosuppressive therapy is not currently recommended. Furthermore, BMT/SCT patients may have prolonged immunosuppression despite stopping post-transplant chemotherapy.

•           For patients in deep remission who are receiving maintenance therapy, stopping chemotherapy may be an option.

•           Some patients should switch chemotherapy from IV to oral therapies, which would decrease the frequency of clinic visits.

•           Patients should be informed regarding the symptoms of COVID-19, and trained in proper hand washing, maintaining hygiene, and minimizing exposure to sick contacts and large crowds.

To ease the risks of COVID-19 infection in vulnerable patient population and to balance resource utilization, the care for hematologic malignancies patients should be altered. Common areas include utilization of oral and outpatient regimens, increasing telemedicine visits, and avoiding or omitting therapies known to be associated with higher risk of viral infection.

References:

1.         Percival, M., Lynch, R., Halpern, A., et al: Considerations for Managing Hematologic Malignancy Patients During the COVID-19 Pandemic: The Seattle Strategy JCO Oncol Pract DOI: 10.1200/ OP.20.00241

2.         COVID-19 Clinical Oncology Frequently Asked Questions (FAQs). Available from: https://www.asco.org/sites/new-www.asco.org/files/content-files/blog-release/pdf/COVID-19-Clinical Oncology-FAQs-3-12-2020.pdf. Accessed on May 1, 2020