About this Research Topic
In December 2019, an outbreak of atypical pneumonia, with severe acute respiratory syndrome (SARS), was identified in Wuhan, China. The rapid human-to-human transmission of the new zoonotic coronavirus, (SARS-CoV-2) that is responsible for what is now known as coronavirus disease 2019 (COVID-19) led to a global outbreak, which on March 11, 2020 was declared a pandemic by the World Health Organization (WHO).
The COVID-19 pandemic is an unparalleled challenge for the medical community and has created a multitude of medical, logistical, financial, and public health challenges in the delivery of optimal care for cancer patients, and in particular for patients with hematologic malignancies. Patients with leukemia, lymphoma, and myeloma frequently visit the hospital or the outpatient clinic for treatment, transfusion support, antibiotic therapy, management of complications, and disease surveillance. In addition, these patients often require prolonged hospitalizations, myelosuppressive chemotherapy, and the use of high risk procedures such as autologous or allogeneic Stem Cell Transplantation (SCT). Therefore, these patients are generally immunocompromised due to the underlying malignancy or anticancer therapy and are at higher risk of developing infections. Initial reports from China suggested that patients with cancer had an estimated twofold increased risk of contracting SARS-CoV-2 than the general population and, if infected, also had a higher risk of severe events (ICU admission, invasive ventilation, or death) compared to patients without cancer.
These risks are likely to be greater in patients with Hematologic Malignancies, leading to an urgent need to address the impact of the COVID-19 pandemic on the care of these patients. Challenges include equitable resource allocation, delivery of clinical care without undue risk of exposure to patients and health care workers, and the consent process during a time of restricted travel and isolation. Standard management of cancer patients has been impacted first by efforts to limit exposures and new cases during the acceleration phase (treatment while under a regime of isolation), then by limited access to healthcare resources during the “surge” period (deferment management), and finally by an after-surge of new diagnoses, recurrences, and disease complications that require initiation of treatment (post-surge planning for deferred patients).
This Research Topic will address a broad spectrum of emerging problems associated with the diagnosis and management of patients with Hematologic Malignancies during the COVID-19 pandemic, with suggestions of some practical approaches. We will cover issues such as delays in diagnosis, deferral of chemotherapy, utilization of SCT, modifications of maintenance treatments, access to and utilization of supportive measures, the role and safety of targeted therapies, as well as ways to mitigate these changes. We will offer views on new models of decentralized care, with the use of Telehealth, home infusion services, and remote consent.
Among the topics to be considered for this Research Topic:
• Disease course and outcomes of hematologic malignancies in COVID+ patients
• Practical approach to the care of HM in COVID positive patients, challenges, barriers, solutions, diagnostic work up, treatment deferment, use of maintenance, surveillance and follow up
• Autologous and allogeneic SCT therapy in COVID-19+ patients
• Use of Telehealth and digital health to provide care in the pandemic
• Issues related to specific drugs (BTKi, TKi, mAbs, IMIDs, immunotherapy)
• Lessons from CRS/CART cell therapy for the management of COVID-19 (IL-6R inhibitors, etc)
• Coagulation problems, MAS, and hemophagocytosis
• How to conduct clinical trials in HM in the era of COVID-19
The COVID-19 pandemic is an unparalleled challenge for the medical community and has created a multitude of medical, logistical, financial, and public health challenges in the delivery of optimal care for cancer patients, and in particular for patients with hematologic malignancies. Patients with leukemia, lymphoma, and myeloma frequently visit the hospital or the outpatient clinic for treatment, transfusion support, antibiotic therapy, management of complications, and disease surveillance. In addition, these patients often require prolonged hospitalizations, myelosuppressive chemotherapy, and the use of high risk procedures such as autologous or allogeneic Stem Cell Transplantation (SCT). Therefore, these patients are generally immunocompromised due to the underlying malignancy or anticancer therapy and are at higher risk of developing infections. Initial reports from China suggested that patients with cancer had an estimated twofold increased risk of contracting SARS-CoV-2 than the general population and, if infected, also had a higher risk of severe events (ICU admission, invasive ventilation, or death) compared to patients without cancer.
These risks are likely to be greater in patients with Hematologic Malignancies, leading to an urgent need to address the impact of the COVID-19 pandemic on the care of these patients. Challenges include equitable resource allocation, delivery of clinical care without undue risk of exposure to patients and health care workers, and the consent process during a time of restricted travel and isolation. Standard management of cancer patients has been impacted first by efforts to limit exposures and new cases during the acceleration phase (treatment while under a regime of isolation), then by limited access to healthcare resources during the “surge” period (deferment management), and finally by an after-surge of new diagnoses, recurrences, and disease complications that require initiation of treatment (post-surge planning for deferred patients).
This Research Topic will address a broad spectrum of emerging problems associated with the diagnosis and management of patients with Hematologic Malignancies during the COVID-19 pandemic, with suggestions of some practical approaches. We will cover issues such as delays in diagnosis, deferral of chemotherapy, utilization of SCT, modifications of maintenance treatments, access to and utilization of supportive measures, the role and safety of targeted therapies, as well as ways to mitigate these changes. We will offer views on new models of decentralized care, with the use of Telehealth, home infusion services, and remote consent.
Among the topics to be considered for this Research Topic:
• Disease course and outcomes of hematologic malignancies in COVID+ patients
• Practical approach to the care of HM in COVID positive patients, challenges, barriers, solutions, diagnostic work up, treatment deferment, use of maintenance, surveillance and follow up
• Autologous and allogeneic SCT therapy in COVID-19+ patients
• Use of Telehealth and digital health to provide care in the pandemic
• Issues related to specific drugs (BTKi, TKi, mAbs, IMIDs, immunotherapy)
• Lessons from CRS/CART cell therapy for the management of COVID-19 (IL-6R inhibitors, etc)
• Coagulation problems, MAS, and hemophagocytosis
• How to conduct clinical trials in HM in the era of COVID-19
Keywords: COVID-19, Hematological Malignancies, Patient Care, Treatment Plans, access to care
Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.
