Abstract

Simple SummaryThe study investigated diagnostic, clinical and post-SARS-CoV-2 scenarios in cancer patients with SARS-CoV-2 aiming to improve management of SARS-CoV-2 infections and cancer afterwards. Around half of patients were initially asymptomatic and were diagnosed with SARS-CoV-2 during routine or contact tracing screening. Of them, 33% developed COVID-19 lately. Eventually, predominant part of patients had asymptomatic SARS-CoV-2 or mild COVID-19 course. Lymphocytopenia preceding SARS-CoV-2 was associated with a significantly increased risk for severe or critical COVID-19 course. Commonly patients experienced a treatment delay post-SARS-CoV-2; one fifth developed progressive disease (PD) within that time and/or had to undergo therapy modifications following deterioration of the performance status or PD post-COVID-19. This study provides knowledge of real-life clinical courses of SARS-CoV-2 in oncology and contributes to improving therapeutic strategies for cancer patients in the COVID-19 pandemic.Oncologists face challenges in the management of SARS-CoV-2 infections and post-SARS-CoV-2 cancer treatment. We analyzed diagnostic, clinical and post-SARS-CoV-2 scenarios in patients from three German cancer centers with RT-PCR confirmed SARS-CoV-2 infection. Sixty-three patients with SARS-CoV-2 and hematologic or solid neoplasms were included. Thirty patients were initially asymptomatic, 10 of whom developed COVID-19 symptoms subsequently. Altogether 20 (32%) patients were asymptomatic, 18 (29%) had mild, 12 (19%) severe and 13 (20%) critical courses. Lymphocytopenia increased risk of severe/critical COVID-19 three-fold (p = 0.015). Asymptomatic course was not associated with age, remission status, therapies or co-morbidities. Secondary bacterial infection accompanied more than one third of critical COVID-19 cases. Treatment was delayed post-SARS-CoV-2 in 46 patients, 9 of whom developed progressive disease (PD). Cancer therapy was modified in 8 SARS-CoV-2 survivors because of deteriorating performance or PD. At the last follow-up, 17 patients had died from COVID-19 (n = 8) or PD (n = 9) giving an estimated 73% four-month overall survival rate. SARS-CoV-2 infection has a heterogenous course in cancer patients. Lymphocytopenia carries a significant risk of severe/critical COVID-19. SARS-CoV-2 disruption of therapy is as serious as SARS-CoV-2 infection itself. Careful surveillance will allow early restart of the anti-cancer treatment.

Highlights

  • Declared a pandemic by the WHO in March 2020 corona virus disease 2019 (COVID-19) caused by the novel coronavirus 2019 (SARS-CoV-2) continues to pose many new challenges to the medical community worldwide

  • At the time of study enrollment 12 patients were in complete remission (CR), 12 in partial remission (PR), 11 had a stable disease (SD) and 20 had relapsed/progressive disease

  • Based on our data and the current literature we summarize the following key-points: 1. At diagnosis of SARS-CoV-2 infection in cancer patients, the likelihood of an asymptomatic or mild course of COVID-19 seems to be greater than that of a severe or critical one

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Summary

Introduction

Declared a pandemic by the WHO in March 2020 corona virus disease 2019 (COVID-19) caused by the novel coronavirus 2019 (SARS-CoV-2) continues to pose many new challenges to the medical community worldwide. With around 17 million new cancer cases diagnosed worldwide in 2018 [2] alone, the magnitude of possible SARS-CoV-2 consequences in the field of oncology can be very intimidating Along these lines, several studies have documented a significantly higher risk for severe COVID-19 events among cancer patients compared with non-cancer individuals [3,4,5,6,7,8,9,10]. Hematologists and oncologists must carefully balance the tremendous risk of severe SARS-CoV-2 complications against the need to continue the cancer treatment, as the latter is automatically put on hold until recovery from COVID-19 Questions such as the appropriate time to restart the cancer treatment, the duration of contagiousness, as well as about persistence of immune memory after COVID-19 and the risk of SARS-CoV-2 re-infection under systemic anticancer therapy will arise in virtually every case. Aiming to fill this gap, we analyzed the diagnostic and therapeutic strategies with regard to SARS-CoV-2 infections, as well as impact of the infection on the cancer course and treatment algorithms of 63 hematological and oncological patients from three German cancer centers

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