Unfortunately, the statistics are all too clear: 37% of Italian patients with a blood cancer who between February and May 2020 contracted Covid-19 infection. A significantly higher mortality not only compared to the healthy population, but also to that of onco-haematological patients themselves without coronavirus. To give the numbers is the largest study conducted so far, all Italian, published in the October issue of the magazine Lancet Hematology and in the wake of the continuous growth of infections also in our country, specialists launch an appeal to protect the thousands of compatriots suffering from leukemia, lymphoma or myeloma. The message is very simple: the use of masks, respect for physical distancing, frequent washing of hands and an optimal organization of the health system that protect the sick and put hospital staff in a position to work are needed.
Cancer therapies should not be stopped
Today, over 70% of people with a diagnosis of blood cancer (about 33 thousand new cases registered each year in Italy) recover: an important milestone, achieved thanks to years of efforts in scientific research and increasingly effective therapies. “We must continue to treat our patients even during the pandemic and the first fundamental step to do so is to keep our wards covid-free – points out Paolo Corradini, president of the Italian Society of Hematology -. It is necessary to follow a programming, with strict security protocols, which enables the structures to intercept the virus early in order to intervene with the best therapies available and reduce mortality as much as possible. Treatments cannot be stopped because, as the study on Lancet Hematology, one of the main risk factors of death, in the event of contagion from Covid-19, is precisely the advanced stage of the haematological pathology. L’immunosuppression caused by the disease affecting the bone marrow, the organ that produces the immune defenses, puts patients at greater risk of death if attacked by the virus. Even in March and April, in the most critical period of the pandemic, our centers continued to treat patients regularly, recommending compliance with the fundamental rules such as the use of masks for family members and the swab for each patient before admission“.
The life-saving role of friends, colleagues and family (especially young people)
Who suffers from blood neoplasms, in short, it is particularly fragile in the face of the coronavirus epidemic both because it is more at risk of contracting the infection and because it is more likely to die from it. “Everyone must commit to protecting them – continues Corradini, director of Hematology at the National Cancer Institute in Milan -: family members, colleagues, friends must be very careful to apply prevention measures (frequent hand washing, use of masks, physical distancing). And a life-saving role is played above all by young people, who are often asymptomatic and who, when they live with a sick person, have to do what is necessary to not bring home from school, sports training, places of entertainment or work. Also serves with a flu vaccination campaign targeted at risk categories and families of haematological patients: all potential contacts of patients must be vaccinated against the flu, to create a defense cage. Also because only some patients can undergo prophylaxis, for example those transplanted for less than a year they fail to produce an immune response ».
Don’t be afraid to go to the hospital
On the other hand, especially in consideration of the fact that they have many chances of healing, «the patients themselves must continue the therapies and not be afraid to go to the hospital where we have created special paths to limit the infection. The danger of death is great even if cancer is advancing »he adds Fabio Ciceri, head of Hematology and Bone Marrow Transplant at the IRCCS San Raffaele Hospital in Milan and president of GITMO (Italian Group for Bone Marrow Transplant). Not to interrupt anti-cancer treatmentsHowever, careful health planning is also essential and the Italian specialists look to the neighbor, for example France, where, due to the very high number of infections, the number of beds for life-saving therapies, such as bone marrow transplants and CAR-T, in anticipation of a second severe wave of the virus.
The risk of having to suspend transplants and CAR-T therapy
There CAR-T cell therapy is an innovative form of immunotherapy, which uses the cells of the immune system (T lymphocytes): the latter are taken from the patient, engineered in the laboratory and trained to recognize and fight the tumor more strongly, to be then reinfused into the patient. They are indicated in the treatment of advanced and aggressive lymphomas in adults and the acute lymphoblastic leukemia in children. In addition, experiments are underway in other diseases such as multiple myeloma. Allogenic transplants, i.e. from donors, are indicated for acute leukemias, myelodysplasias and lymphomas. «CAR-T can only be performed in hospitals equipped with donor bone marrow transplant units – explains Ciceri -. The two activities coincide, because the organizational and structural requirements are superimposable. About 1,800 are carried out every year in our country bone marrow transplants as a donor. To date, compared to the same period in 2019, there has been a truly negligible decrease (about 8%): the credit goes to the enormous effort of health workers, the bone marrow donor register and the centers, which have continued to work at full capacity during the acute phase of the pandemic albeit with significant logistical difficulties and with reduced staff numbers. So far Italy has not been affected by the problem of reducing the number of beds for bone marrow transplants and CAR-T therapies, unlike what has been happening in recent weeks in Paris. But the situation can worsen in a short time. In planning the hospital reorganization, the institutions and the general and health directorates must place the preservation and continuation of this activity as a cornerstone ».
Patients with haematological diseases and SARS-CoV-2
To the retrospective study published in The Lancet Hematology 66 Italian centers participated and 536 patients were enrolled between February 25 and May 18, 2020 hematological diseases and SARS-CoV-2. “Not only blood cancers were considered, but also other malignant haematological diseases, such as myelodysplastic syndromes – underlines Francesco Passamonti, Professor of Hematology at the University of Insubria in Varese and director of Hematology at the ASST Sette Laghi di Varese -. The median time of hospitalization it was very short, equal to 16 days: 20 for the survivors and 11 for the dead. 18% were able to access intensive care and of the 536 patients considered 198, or 37%, died. A percentage 2.4 times higher than that of the general population who contracted the virus and 41.3 times higher than that of haematological patients observed in the same period last year, i.e. in the pre-Covid era. Analyzing the data it emerges that those who risk more, if infected, are the elderly patients, those with acute myeloid leukemia and non-Hodgkin’s lymphoma, and all those with progressive disease. The study – continues Passamonti, who is the main author of the work – was promoted by Sie, in collaboration with FIL (Italian Lymphoma Foundation), SEIFEM (Epidemiological Surveillance of Infections in Hemopathies) and SIES (Italian Society of Experimental Hematology) and is for now the largest in the world to have analyzed the clinical characteristics and risk factors associated with Covid-19 in people affected by malignant blood diseases“. «Sie now wants to promote another study to photograph the state of health of people with haematological diseases that have survived the virus – concludes Corradini -. Many still suffer from severe breathing problems and cannot be cured, for example, with the chemotherapy. It is crucial to understand what the long-term impact of the pandemic is on population that has overcome Covid“.
October 9, 2020 (change October 9, 2020 | 18:34)
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