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Brazilian Task Force Offers Strategies for Managing COVID-19 and Lymphoid Malignancies

By: Celeste L. Dixon
Posted: Wednesday, May 13, 2020

With the caveat that recommendations could shift at any time “in the light of dizzyingly rapid learning about the coronavirus 2019 (COVID-19) pandemic,” senior author Carlos Sérgio Chiattone, MD, PhD, MSc, of Santa Casa School of Medical Sciences, São Paulo, and colleagues published an article in Hematology, Transfusion and Cell Therapy summarizing their views on the practical management of patients with lymphoid malignancies during the pandemic. Specifically, their article focuses on methods to minimize patients’ risk of COVID-19 infection.

“Cancer patients are at risk for severe [COVID-19] disease, including a higher risk of intensive care unit admission, need for invasive ventilation, or death,” this task force stressed.

The group had several general recommendations. First, postpone cancer therapy in patients suspected of having active COVID-19 disease. In those who are not infected with COVID-19, consider granulocyte-colony stimulating factor (G-CSF) during chemotherapy if neutropenia is expected, to minimize the risk of febrile neutropenia (and thus emergency department visits and hospital admissions), and maintain patients’ vaccination schedule, particularly of the flu vaccine.

Dr. Chiattone and his team also addressed specific categories of malignancies, offering several practical points to manage each. In each category, the first key points follow:

Chronic Lymphocytic Leukemia: Consider delaying therapy in oligosymptomatic patients, as well as in patients with non–life-threatening cytopenias.

Aggressive B-Cell Lymphomas: Consider immediate curative-intent treatment of patients with diffuse large B-cell lymphoma using R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) and consider G-CSF to mitigate neutropenia.

Indolent B-Cell Lymphomas: Consider short watch-and-wait periods for patients with mild symptoms and/or mild cytopenias.

Mantle Cell Lymphoma: Consider the watch-and-wait approach for non-nodal leukemic mantle cell lymphoma and for asymptomatic patients.

Peripheral T-Cell Lymphomas: Avoid delaying therapy, due to the disease’s aggressiveness.

Hodgkin Lymphoma: Do not delay treatment unless absolutely necessary.

For a full account of these recommendations from the Brazilian Task Force, see the link below.

Disclosure: The study authors reported no conflicts of interest.



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