COVID-19 and Other Viral Infections in Patients With Hematologic Malignancies.
Courtney E HarrisAbi VijenthiraShin Yeu OngLindsey Robert BadenLisa K HicksJohn H BairdPublished in: American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Annual Meeting (2023)
COVID-19 and our armamentarium of strategies to combat it have evolved dramatically since the virus first emerged in late 2019. Vaccination remains the primary strategy to prevent severe illness, although the protective effect can vary in patients with hematologic malignancy. Strategies such as additional vaccine doses and now bivalent boosters can contribute to increased immune response, especially in the face of evolving viral variants. Because of these new variants, no approved monoclonal antibodies are available for pre-exposure or postexposure prophylaxis. Patients with symptomatic, mild-to-moderate COVID-19 and risk features for developing severe COVID-19, who present within 5-7 days of symptom onset, should be offered outpatient therapy with nirmatrelvir/ritonavir (NR) or in some cases with intravenous (IV) remdesivir. NR interacts with many blood cancer treatments, and reviewing drug interactions is essential. Patients with severe COVID-19 should be managed with IV remdesivir, tocilizumab (or an alternate interleukin-6 receptor blocker), or baricitinib, as indicated based on the severity of illness. Dexamethasone can be considered on an individual basis, weighing oxygen requirements and patients' underlying disease and their perceived ability to clear infection. Finally, as CD19-targeted and B-cell maturation (BCMA)-targeted chimeric antigen receptor (CAR) T-cell therapies become more heavily used for relapsed/refractory hematologic malignancies, viral infections including COVID-19 are increasingly recognized as common complications, but data on risk factors and prophylaxis in this patient population are scarce. We summarize the available evidence regarding viral infections after CAR T-cell therapy.
Keyphrases
- sars cov
- coronavirus disease
- cell therapy
- risk factors
- respiratory syndrome coronavirus
- immune response
- end stage renal disease
- chronic kidney disease
- early onset
- low dose
- gene expression
- acute lymphoblastic leukemia
- rheumatoid arthritis
- peritoneal dialysis
- copy number
- machine learning
- dendritic cells
- systemic lupus erythematosus
- acute myeloid leukemia
- case report
- binding protein
- electronic health record
- bone marrow
- prognostic factors
- cancer therapy
- dna methylation
- diffuse large b cell lymphoma
- drug delivery
- big data