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COVID-19 and AML: Case Report of Toddler With Severe Therapy-Induced Immunosuppression

By: Sarah Campen, PharmD
Posted: Tuesday, May 19, 2020

A case of COVID-19 in a 13-month-old girl with high-risk acute myeloid leukemia (AML) was recently described in the British Journal of Haematology. Despite presenting with febrile neutropenia and severe treatment-induced immunosuppression, the girl recovered in the hospital, with no respiratory complications.

“We found no evidence that the comorbidities presented by our patient influenced in any significant way the disease course,” stated Claudio Favre, MD, of Meyer Children’s University Hospital, Florence, Italy, and colleagues. “Even highly immunocompromised children on anticancer therapy may have a favorable outcome.”

Bloodwork drawn after completion of the patient’s third chemotherapy cycle of the induction phase revealed a low white blood cell count, low hemoglobin, and low platelets. Routine evaluation for SARS-CoV-2 by nasal and pharyngeal swab—upon patient presentation to the clinic for red blood cell and platelet transfusion—was positive. She was admitted to the hospital, where fecal testing for SARS-CoV-2 was also positive. By day 3, she had a fever of 102.7°F, with a chest x-ray showing bilateral reticular markings consistent with SARS-CoV-2 infection.

Hydroxychloroquine was started, followed by lopinavir/ritonavir on day 4 and teicoplanin on day 6 due to a continued rise in C-reactive protein and the persistence of fever. By day 9, her clinical condition improved, with resolution of fever and normalization of C-reactive protein values (day 10). Therapy was gradually de-escalated by discontinuing hydroxychloroquine (day 11), lopinavir/ritonavir (day 12), and teicoplanin (day 14). Oxygen therapy was never required, and chest x-ray at discharge on day 18 showed no significant change from baseline.

“Optimized management of COVID-19 is essential,” concluded the authors. “Nevertheless, the resumption of oncologic treatment should remain among our first priorities.”

Disclosure: The authors reported no conflicts of interest.



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