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
Summary
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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