COVID-19 in hematology: data from a hematologic and transplant unit

Garnica, Marcia; Valetim, Marcia Rejane; Furtado, Paulo; Moreira, Maria Claudia; Bigni, Ricardo; Vinhas, Simone; Dias, Paulo Cesar; Fellows, Ilza; Martins, Wolney

doi:10.1016/j.htct.2020.08.004

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Hematology, Transfusion and Cell Therapy

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Original article • Hematol., Transfus. Cell Ther. 42 (4) • Oct-Dec 2020 • https://doi.org/10.1016/j.htct.2020.08.004 copy

COVID-19 in hematology: data from a hematologic and transplant unit

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

During the COVID-19 pandemic, special attention has been addressed in cancer care to mitigate the impact on the patient’s prognosis. We addressed our preparation to face COVID-19 pandemic in a Hematological and Stem Cell Transplant Unit in Brazil during the first two months of COVID-19 pandemic and described COVID-19 cases in patients and health care workers (HCW). Modifications in daily routines included a separation of area and professionals, SARS-CoV-2 screening protocols, and others. A total of 47 patients and 54 HCW were tested for COVID-19, by PCR-SARS-CoV-2. We report 11 cases of COVID-19 in hematological patients (including 2 post stem cell transplant) and 28 cases in HCW. Hematological cases were most severe or moderate and presented with several poor risk factors. Among HCW, COVID-19 were mostly mild, and all recovered without hospitalization. A cluster was observed among HCW. Despite a decrease in the number of procedures, the Transplant Program performed 8 autologous and 4 allogeneic SCT during the period, and 49 onco-hematological patients were admitted to continuing their treatments. Although we observed a high frequency of COVID-19 among patients and HCW, showing that SARS-CoV-2 is disseminated in Brazil, hematological patients were safely treated during pandemic times.

Keywords:
COVID-19; SARS-CoV-2; Cancer; Stem cell transplant; Health care worker; Pandemic; Cancer care

Characteristics	n = 11 (%)
Age, median [range] (years)	41 (3 - 83)
Male, n (%)	6 (55)
Baseline disease, n (%)
o Acute myeloid leukemia	3 (27)
o Acute Lymphoid leukemia	3 (27)
o Myelodysplasia	1 (9)
o Multiple Myeloma	1 (9)
o Hodgkin Disease	1 (9)
o Non-Hodgkin Lymphoma	2 (18)
Previous SCT, n (%)
o Autologous SCT	0
o Haploidentical Allogeneic SCT	2 (18)
Treatment phase, n (%)
o Before first-line therapy	2 (18)
o Induction/first-line therapy	4 (36)
o Intensification/Consolidation	3 (27)
o Post allogeneic stem cell transplant	2 (18)
COVID-19 symptoms, n (%)
o Fever	9 (82)
o Cough	7 (64)
o Dyspnea	5 (45)
o Asthenia	5 (45)
o Muscle ache, asthenia	2 (18)
o Gastrointestinal symptoms	2 (18)
o Headache or dizziness	1 (9)
o Upper respiratory symptoms	1 (9)
COVID-19 staging, n (%)
o Mild	2 (18)
o Moderate	5 (45)
o Severe	4 (36)
Comorbidities, n (%)
o Age over 60y	3 (27)
o Cardiological disease	2 (18)
o Diabetes	3 (27)
o Chronic Renal Failure	1 (9)
o Obesity	1 (9)
o Other immunosuppression	0
o More than 2 comorbidities	4 (36)
Laboratorial findings during COVID-19
o Neutrophil, cells/mm³, median (range)	803 (<100 - 13,691)
o Neutropenia (neutrophils <500cells/mm³), n (%)	5 (45%)
o Lymphocytes, cells/mm³, median (range)	503 (<100 - 2312)
o Lymphopenia (total lymphocytes <1000cels/mm³), n (%)	8 (73)
o Severe Lymphopenia (<200 cells/mm3), n (%)	5 (45)
o C reactive protein, mg/dL median (range)	18.62 (0.14 - 69)
o D-dimer level, mcg/dL median (n = 8)	2.56 (0.59 - 7.9)
o D-dimer > 3mcg/dL, n (%)	2
o Venous lactate, mg/dL median (n = 7)	29 (14 - 38)
o Venous lactate > 20 mg/dL, n (%)	5
o Fibrinogen, mg/dL median (n = 4)	630 (527 - 943)
o Troponin, ng/dL median (n = 7)	46 (< 5 - 1099)
o Ferritin, median (n = 6)	1,215 (189 - 4957)
Lung CT scan, n = 9 (%)
o Limited ground-glass opacity (< 50%)	2 (22)
o Limited ground-glass opacity (> 50%)	4 (44)
o Diffuse ground-glass opacity	3 (33)
Complications, n (%)
o Hospitalization	10 (83)
o Intensive care	6 (55)
o SARS	4 (36)
o Hemodynamic instability	5 (45)
o Hemodialysis	2 (18)
o Thromboembolisms	1 (9)
Outcome, n (%)
o Recovered	5 (45)
o Ongoing	1 (10)
o Dead	5 (45)

Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH) R. Dr. Diogo de Faria, 775 cj 133, 04037-002, São Paulo / SP - Brasil - São Paulo - SP - Brazil
E-mail: htct@abhh.org.br

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[1] *Corresponding Author at: Department of Internal Medicine; Universidade Federal do Rio de Janeiro, RJ, Brasil marciagarnica@hucff.ufrj.br