Objective: To communicate interim guidelines to safely manage myelodysplastic syndromes patients.
There are no evidences that represent myelodysplastic syndromes (MDS) patients or related conditions patients being more prone to coronavirus disease of 2019 (COVID-19) than patients with fully functional bone marrows. However patients with MDS who have recently undergone allogeneic hematopoietic stem cell transplant have have a markedly increased risk of viral infection and this risk is likely to extend to coronaviruses
It may be assumed that patients with MDS, particularly those who are more lymphopenic or who have undergone transplant within the last year, are compromised in their ability to contain the virus once infected, and have a higher likelihood of hospitalization and possible need for intensive care. Neutropenia may also increase the risk of a secondary bacterial infection after viral infection
- For patients with lower-risk MDS, (IPSS-R score <3>- Goals of therapy is to minimize transfusions and improve quality of life. Treatments that risk compromising the immune system can reasonably be delayed. Delay any therapy that increases contact with a health care environment. Consider therapies that reduce transfusion needs (such as erythropoiesis stimulating agents or luspatercept) may result in a net decrease of health care visits and potential viral exposure.
- Patients with higher-risk MDS (IPSS-R score of >3.5)- Initiate hypomethylating agent therapy without delay, and without dose adjustment. Those already on such therapy with adequate tolerance and clinical response should continue, given the relapse risk if hypomethylating agents are discontinued. It is not clear whether hypomethylating agents affect the clinical course of COVID-19 infection. Hypomethylating agents do alter cellular type 1 interferon response, which could hypothetically alter replication or cellular response to viruses, however no evidence of clinical significance has been found.
Reference: COVID-19 and Myelodysplastic Syndromes: Frequently Asked Questions. Available from: https://www.hematology.org/covid-19/covid-19-and-myelodysplastic-syndromes. Accessed May 1, 2020