COVD-22. COVID-19+ GLIOMA PATIENT CARE: LESSONS FROM A 5-PATIENT CASE SERIES

Abstract

Glioma patients, like other cancer patients, are at an increased risk of COVID-19 infections, but there are no specific guidelines on how their care should be modified during this pandemic. The challenge to develop such guidelines is largely related to the limited number of reported cases and lack of studies on this particular patient population. We present a 5-patient case series of glioma, detailing their baseline characteristics, treatment courses, lab abnormalities, and the changes made to their care after they developed COVID-19. The median age of the patient population was 66 years. All patients had IDH-wild type glioma (3 Grade IV, 1 Grade III, and 1 Grade II) and all of whom had received temozolomide chemotherapy shortly before COVID-19 diagnosis (median = 22 days). Three patients presented with mild non-respiratory symptoms requiring hospitalization to two of them, and adjuvant Temozolomide chemotherapy was held in all. One patient developed severe symptoms of shortness of breath requiring ICU-stay and expired eight days later. One patient was asymptomatic, tested positive during a routine pre-chemotherapy screening, and initiation of temozolomide was delayed by two weeks after a negative repeat test. All four symptomatic patients were rehabilitation facility residents. The most common lab abnormality was lymphopenia seen in 4/5 patients. Other abnormalities seen included elevated ferretin/total bilirubin/CRP/LDH/procalcitonin/D-dimer, thrombocytopenia/leukopenia, and low sodium/vitamin D. Chest x-ray findings were normal in 3/5 patients and showed ground glass opacities in 1 patient. COVID-19 screening during different phases of glioma therapy is recommended. Therapy interruptions or shortening duration of treatment particularly of temozolomide given its risk on lymphopenia may be needed. lymphopenia thresholds, MGMT promoter methylation status, and residence in rehabilitation facilities may help stratify glioma patient COVID-19 risks further. Patients and their family will need to be involved in therapies’ risk:benefit discussions during this pandemic.