pci-32765 and Pneumonia--Viral

Topics: Adenine; Aged; Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; Betacoronavirus; Bridged Bicyclo Compounds, Heterocyclic; Coronavirus Infections; COVID-19; Female; Follow-Up Studies; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Middle Aged; Pandemics; Piperidines; Pneumonia, Viral; Prognosis; Pyrazoles; Pyrimidines; Rituximab; SARS-CoV-2; Sulfonamides

Topics: Adenine; Agammaglobulinaemia Tyrosine Kinase; Aged; Betacoronavirus; Coronavirus Infections; COVID-19; Female; Humans; Lung Injury; Male; Middle Aged; Pandemics; Piperidines; Pneumonia, Viral; Protein Kinase Inhibitors; Pyrazoles; Pyrimidines; SARS-CoV-2; Waldenstrom Macroglobulinemia

As the SARS-CoV-2 (COVID-19) pandemic spreads and the number of Bruton's tyrosine kinase inhibitor (BTKi)-treated COVID-19-affected patients grows, we must consider the pros and cons of BTKi discontinuation for our patients. In favor of BTKi continuation, BTK plays an active role in macrophage polarization. By modulating key transcription factors, BTK may regulate macrophage polarization downstream of classic M1 and M2 polarizing stimuli and mitigate the hyperinflammatory state associated with COVID-19. In favor of BTKi discontinuation, we note a potentially increased risk of secondary infections and impaired humoral immunity. We hypothesize that the potential benefit of blunting a hyperinflammatory response to SARS-CoV-2 through attenuation of M1 polarization outweighs the potential risk of impaired humoral immunity, not to mention the risk of rapid progression of B-cell malignancy following BTKi interruption. On the basis of this, we suggest continuing BTKi in patients with COVID-19.

Topics: Adenine; Agammaglobulinaemia Tyrosine Kinase; Anti-Inflammatory Agents; Antineoplastic Agents; Benzamides; Betacoronavirus; Coronavirus Infections; COVID-19; Humans; Inflammation; Leukemia, Lymphocytic, Chronic, B-Cell; Lymphoma, B-Cell; Macrophages; Pandemics; Piperidines; Pneumonia, Viral; Protein Kinase Inhibitors; Pyrazines; Pyrazoles; Pyrimidines; SARS-CoV-2

Topics: Adenine; Age Factors; Aged; Aged, 80 and over; Antineoplastic Agents; Antiviral Agents; Betacoronavirus; Biomarkers; Coronavirus Infections; COVID-19; Disease Progression; Female; Ferritins; Fibrin Fibrinogen Degradation Products; Humans; Hydroxychloroquine; Leukemia, Lymphocytic, Chronic, B-Cell; Lymphopenia; Male; Middle Aged; Pandemics; Piperidines; Pneumonia, Viral; Prevalence; Protein Kinase Inhibitors; Pyrazoles; Pyrimidines; SARS-CoV-2; Spain; Survival Analysis

Topics: Adenine; Agammaglobulinaemia Tyrosine Kinase; Aged; Aged, 80 and over; Benzamides; Betacoronavirus; Coronavirus Infections; COVID-19; Female; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Middle Aged; Pandemics; Piperidines; Pneumonia, Viral; Protein Kinase Inhibitors; Pyrazines; Pyrazoles; Pyrimidines; SARS-CoV-2

Chronic lymphocytic leukemia (CLL) is a disease of the elderly, characterized by immunodeficiency. Hence, patients with CLL might be considered more susceptible to severe complications from COVID-19. We undertook this retrospective international multicenter study to characterize the course of COVID-19 in patients with CLL and identify potential predictors of outcome. Of 190 patients with CLL and confirmed COVID-19 diagnosed between 28/03/2020 and 22/05/2020, 151 (79%) presented with severe COVID-19 (need of oxygen and/or intensive care admission). Severe COVID-19 was associated with more advanced age (≥65 years) (odds ratio 3.72 [95% CI 1.79-7.71]). Only 60 patients (39.7%) with severe COVID-19 were receiving or had recent (≤12 months) treatment for CLL at the time of COVID-19 versus 30/39 (76.9%) patients with mild disease. Hospitalization rate for severe COVID-19 was lower (p < 0.05) for patients on ibrutinib versus those on other regimens or off treatment. Of 151 patients with severe disease, 55 (36.4%) succumbed versus only 1/38 (2.6%) with mild disease; age and comorbidities did not impact on mortality. In CLL, (1) COVID-19 severity increases with age; (2) antileukemic treatment (particularly BTK inhibitors) appears to exert a protective effect; (3) age and comorbidities did not impact on mortality, alluding to a relevant role of CLL and immunodeficiency.

Topics: Adenine; Age Factors; Aged; Aged, 80 and over; Antineoplastic Agents; Betacoronavirus; Comorbidity; Coronavirus Infections; COVID-19; Female; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Middle Aged; Pandemics; Piperidines; Pneumonia, Viral; Prognosis; Protein Kinase Inhibitors; Pyrazoles; Pyrimidines; Retrospective Studies; SARS-CoV-2; Severity of Illness Index; Surveys and Questionnaires

The emergence of the covid-19 disease pandemic caused by the 2019 novel coronavirus has required a re-evaluation of treatment practices for clinicians caring for patients with chronic lymphocytic leukemia (cll). The American Society for Hematology (ash) has provided a series of recommendations for the treatment of patients with cll during the pandemic, covering a range of topics, including testing for covid-19, cll treatment initiation and selection, use of immunoglobulin therapy, in-person monitoring, and treatment of patients with cll and covid-19. We summarize the ash recommendations and discuss their applicability as guidelines for the treatment of cll during the covid-19 pandemic in Canada.

Topics: Adenine; Ambulatory Care; Antineoplastic Agents; Appointments and Schedules; Betacoronavirus; Canada; Coronavirus Infections; COVID-19; Disease Management; Hospitalization; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Leukemia, Lymphocytic, Chronic, B-Cell; Pandemics; Piperidines; Pneumonia, Viral; Practice Guidelines as Topic; Pyrazoles; Pyrimidines; SARS-CoV-2

Topics: Adenine; Betacoronavirus; Checklist; Coronavirus Infections; COVID-19; Hematologic Neoplasms; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Pandemics; Piperidines; Pneumonia, Viral; Prescriptions; Protein Kinase Inhibitors; Pyrazoles; Pyrimidines; SARS-CoV-2; Surveys and Questionnaires; Telemedicine; Time-to-Treatment