How I treat: Coronavirus disease 2019 in leukemic patients and hematopoietic cell transplant recipients.
Dionysios NeofytosNina KhannaPublished in: Transplant infectious disease : an official journal of the Transplantation Society (2024)
Among immunocompromised hosts, leukemia patients, and hematopoietic cell transplant recipients are particularly vulnerable, facing challenges in balancing coronavirus disease 2019 (COVID-19) management with their underlying conditions. In this How I Treat article, we discuss how we approach severe acute respiratory syndrome coronavirus 2 infections in daily clinical practice, considering the existing body of literature and for topics where the available data are not sufficient to provide adequate guidance, we provide our opinion based on our clinical expertise and experience. Diagnostic approaches include nasopharyngeal swabs for polymerase chain reaction testing and chest computed tomography scans for symptomatic patients at risk of disease progression. Preventive measures involve strict infection control protocols and prioritizing vaccination for both patients and their families. Decisions regarding chemotherapy or hematopoietic cell transplantation in leukemia patients with COVID-19 require careful consideration of factors such as COVID-19 severity and treatment urgency. Treatment protocols include early initiation of antiviral therapy, with nirmatrelvir/ritonavir or remdesivir. For cases of prolonged viral shedding, distinguishing between viable and non-viable viruses remains challenging but is crucial for determining contagiousness and guiding management decisions. Overall, individualized approaches considering immune status, clinical presentation, and viral kinetics are essential for effectively managing COVID-19 in leukemia patients.
Keyphrases
- coronavirus disease
- sars cov
- computed tomography
- end stage renal disease
- respiratory syndrome coronavirus
- ejection fraction
- newly diagnosed
- prognostic factors
- bone marrow
- systematic review
- acute myeloid leukemia
- magnetic resonance imaging
- clinical practice
- squamous cell carcinoma
- intensive care unit
- mesenchymal stem cells
- stem cells
- physical activity
- smoking cessation
- machine learning
- mechanical ventilation