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Naimi A, Yashmi I, Jebeleh R, Imani Mofrad M, Azimian Abhar S, Jannesar Y, Heidary M, Pakzad R. Comorbidities and mortality rate in COVID-19 patients with hematological malignancies: A systematic review and meta-analysis. J Clin Lab Anal 2022; 36:e24387. [PMID: 35385130 PMCID: PMC9102765 DOI: 10.1002/jcla.24387] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The global pandemic of coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It seems that there is an association between blood cancer and an increased risk of severe COVID-19. This study aimed to review the literature reporting the COVID-19 outcomes in patients with hematological malignancies. MATERIAL AND METHODS In this systematic review and meta-analysis, Pubmed, Embase, and Web of Science databases were searched using the following keywords: COVID-19, SARS-CoV-2, blood cancer, myeloma, lymphoma, and leukemia. All the published articles in English from January 1, 2019, until March 10, 2021 were collected and evaluated. RESULTS In total, 53 studies with 2395 patients were included based on inclusion criteria. Most of these studies took place in Spain (14.81%), followed by the USA (11.11%), China (9.26%), and the UK (9.26%). More than half of COVID-19 patients with hematological malignancy were male (56.73%). Oxygen therapy played an important role in COVID-19 treatment. Moreover, anticoagulant therapies such as enoxaparin and heparin were two great assists for these patients. Fever (74.24%), cough (67.64%), and fatigue (53.19%) were the most reported clinical manifestations. In addition, hypertension and dyslipidemia were the most common comorbidities. The mortality rate due to COVID-19 in patients with hematological malignancies was 21.34%. CONCLUSION This study demonstrated that hematologic cancer patients were more susceptible to a severe COVID-19 than patients without blood cancer. Thus, the management of COVID-19 in these patients requires much more attention, and their screening should perform regularly.
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Affiliation(s)
- Adel Naimi
- Cellular and Molecular Research CenterSabzevar University of Medical SciencesSabzevarIran
| | - Ilya Yashmi
- Student Research CommitteeSabzevar University of Medical SciencesSabzevarIran
| | - Reza Jebeleh
- Student Research CommitteeSabzevar University of Medical SciencesSabzevarIran
| | | | | | - Yasaman Jannesar
- Student Research CommitteeSabzevar University of Medical SciencesSabzevarIran
| | - Mohsen Heidary
- Cellular and Molecular Research CenterSabzevar University of Medical SciencesSabzevarIran
- Department of Laboratory SciencesSchool of Paramedical SciencesSabzevar University of Medical SciencesSabzevarIran
| | - Reza Pakzad
- Department of EpidemiologyFaculty of HealthIlam University of Medical SciencesIlamIran
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2
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Xiao M, You Z, Zeng C, Huang Z, Dong L. Update on neurological symptoms in patients infected with severe acute respiratory syndrome coronavirus-2. IBRAIN 2021; 7:351-361. [PMID: 37786557 PMCID: PMC10528815 DOI: 10.1002/ibra.12008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 10/04/2023]
Abstract
Novel coronavirus 19 (COVID-19) is the latest and most intense epidemic, which is caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). In addition to causing respiratory symptoms, SARS-CoV-2 can have severe effects on the nervous system. Clinically, COVID-19 patients have been reported ranging from mild hypogeusia and hyposmia to severe neurological disorders, such as encephalopathy, encephalitis, strokes, and seizures syndrome. However, the pathological mechanisms of this SARS-CoV-2 neuro aggressiveness remain unclear, so it is of great significance to explore the neurological effects of SARS-CoV-2 infection. To facilitate clinicians to timely recognize the manifestations of COVID-19 patients with neurological injury and timely treatment, the author hereby reviews the latest research progress in the possible pathways, clinical manifestations, and pathogenesis of COVID-19 patients with nerve injury.
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Affiliation(s)
- Mei‐Fang Xiao
- Health Management Center, Xiangya HospitalCentral South UniversityChangshaHunanChina
- National Clinical Research Center for Geriatric Disorders, Xiangya HospitalCentral South UniversityChangshaChina
| | - Zhi‐Jian You
- Department of AnesthesiologyLiuzhou People's Hospital Affiliated to Guangxi Medical UniversityLiuzhouGuangxiChina
| | - Chang Zeng
- Health Management Center, Xiangya HospitalCentral South UniversityChangshaHunanChina
- National Clinical Research Center for Geriatric Disorders, Xiangya HospitalCentral South UniversityChangshaChina
| | - Ze‐Bing Huang
- Department of Infectious Diseases, Xiangya HospitalCentral South UniversityChangshaHunanChina
- Key Laboratory of Viral HepatitisChangshaHunanChina
| | - Liang Dong
- Department of AnesthesiologyLiuzhou People's Hospital Affiliated to Guangxi Medical UniversityLiuzhouGuangxiChina
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3
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The effect of COVID-19 derived cytokine storm on cancer cells progression: double-edged sword. Mol Biol Rep 2021; 49:605-615. [PMID: 34657251 PMCID: PMC8520341 DOI: 10.1007/s11033-021-06800-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 10/01/2021] [Indexed: 10/29/2022]
Abstract
OBJECTIVE Severe acute respiratory syndrome coronavirus 2 (SARS-COV2) was first detected in Wuhan, China in December, 2019. The emerging virus causes a respiratory illness, that can trigger a cytokine storm in the body. METHOD Cytokine storm in patient's body is associated with severe forms of disease. It is one of the main complications of coronavirus disease-2019 (COVID-19), in which immune cells play a major role. Studies have shown immune cells in the tumor environment can be effective to induce resistance to chemotherapy in cancer patients. RESULT Therefore, considering the role of immune cells to induce cytokine storm in COVID-19 patients, and their role to cause resistance to chemotherapy, they are effective on disease progression and creation of severe form of disease. CONCLUSION By examining the signaling pathways and inducing resistance to chemotherapy in tumor cells and the cells affect them, it is possible to prevent the occurrence of severe forms of the disease in cancer patients with COVID-19; it is applicable using target therapy and other subsequent treatment strategies.
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4
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Marwah H, Rosseau N, Mangipudi S, Ward C, Keswani A. Investigating air pollution as a contributor to health disparities during the coronavirus disease 2019 pandemic. Ann Allergy Asthma Immunol 2021; 127:269-271. [PMID: 33965521 PMCID: PMC8102382 DOI: 10.1016/j.anai.2021.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/03/2021] [Accepted: 04/28/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Harleen Marwah
- The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Natalie Rosseau
- The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Sowmya Mangipudi
- The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Caitlin Ward
- The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Anjeni Keswani
- Division of Allergy-Immunology, The George Washington University School of Medicine and Health Sciences, Washington, DC.
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5
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Satta G, Youngstein T, Lightstone L, Gilchrist M. The utility of a local multidisciplinary working group to oversee the establishment of rapidly evolving standards of care and to support trial recruitment during the COVID-19 pandemic. Clin Med (Lond) 2021; 21:e287-e289. [PMID: 33782041 DOI: 10.7861/clinmed.2020-1021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 2019 (COVID-19) was first identified in December 2019 in Wuhan, China. The first analyses of cases described high numbers of critically ill patients requiring intensive care admission with significant late inflammatory features. By the time the first cases of SARS-CoV-2 infection were diagnosed in the UK, a wide range of drugs were under consideration and it became clear that the input of clinicians covering all organ systems (in particular, infectious diseases, haematology, rheumatology, renal medicine and intensive care) and of expert specialist pharmacists was necessary at the local level. Thus, an expert multidisciplinary (MDT) group within our organisation was convened to offer a standardised approach and robust clinical governance for the treatment of COVID-19 patients admitted to our hospitals and rapidly develop standards of care as evidence evolved. This commentary explores the methods and mechanisms for creating an MDT COVID-19 treatment working group which are applicable to any hospital likely to admit and care for high numbers of COVID-19 patients and demonstrates how the structure and governance of the group allowed for rapid adoption of both dexamethasone and tocilizumab into standard of care as data became available.
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Affiliation(s)
| | | | - Liz Lightstone
- Imperial College Healthcare NHS Trust Centre for Inflammatory Disease, London, UK and Imperial College London, London, UK
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6
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Belsky JA, Tullius BP, Lamb MG, Sayegh R, Stanek JR, Auletta JJ. COVID-19 in immunocompromised patients: A systematic review of cancer, hematopoietic cell and solid organ transplant patients. J Infect 2021; 82:329-338. [PMID: 33549624 PMCID: PMC7859698 DOI: 10.1016/j.jinf.2021.01.022] [Citation(s) in RCA: 129] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/03/2020] [Accepted: 01/30/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The clinical impact of severe coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in immunocompromised patients has not been systematically evaluated. METHODS We reviewed current literature reporting on COVID-19 in cancer (CA), hematopoietic cell (HCT), and solid organ transplant (SOT) patients and compared their clinical data and outcomes to the general population. For adult CA, HCT and SOT patients, an extensive search strategy retrieved all articles published until July 20, 2020 by combining the terms coronavirus, coronavirus infection, COVID-19, and SARS-CoV-2 in PubMed, Cochrane, and Web of Science, and following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. For the pediatric CA cohort, a global COVID-19 registry was used. For the general population cohort, a large meta-analysis was used to compare pooled prevalence estimates, and two large meta-analyses were utilized to serve as pooled comparators for hospitalized COVID-19 patients. FINDINGS Compared to the general population, adult CA and SOT patients with COVID-19 had higher comorbidities, greater levels of inflammatory markers at diagnosis, and higher rates of intensive care and hospital mortality. Pediatric CA patients and HCT patients with COVID-19 tended to have clinical presentations and outcomes similar to the general population. INTERPRETATION To our knowledge, this is the first systematic review evaluating COVID-19 phenotype and outcomes in immunocompromised patients and comparing them to the general population, which shows that hospital outcomes appear to be worse in adult CA and SOT patients, potentially due to their higher co-morbidity burden. FUNDING None.
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Affiliation(s)
- Jennifer A Belsky
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205 United States; Department of Pediatrics, The Ohio State University School of Medicine, Columbus, OH, United States
| | - Brian P Tullius
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205 United States; Department of Pediatrics, The Ohio State University School of Medicine, Columbus, OH, United States.
| | - Margaret G Lamb
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205 United States; Department of Pediatrics, The Ohio State University School of Medicine, Columbus, OH, United States
| | - Rouba Sayegh
- Division of Infectious Diseases, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205 United States; The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
| | - Joseph R Stanek
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205 United States
| | - Jeffery J Auletta
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205 United States; Department of Pediatrics, The Ohio State University School of Medicine, Columbus, OH, United States; Division of Infectious Diseases, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205 United States; The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
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7
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Fung M, Babik JM. COVID-19 in Immunocompromised Hosts: What We Know So Far. Clin Infect Dis 2021; 72:340-350. [PMID: 33501974 PMCID: PMC7337668 DOI: 10.1093/cid/ciaa863] [Citation(s) in RCA: 319] [Impact Index Per Article: 106.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/23/2020] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused significant morbidity and mortality for patients and stressed healthcare systems worldwide. The clinical features and outcomes of COVID-19 among immunosuppressed patients, who are at presumed risk of more severe disease but who may also have decreased detrimental inflammatory responses, are not well characterized. We review the existing literature on COVID-19 among immunocompromised populations ranging from patients with cancer and solid-organ transplant recipients to patients with HIV and those receiving immunomodulatory therapy for autoimmune disease. Patients with malignancy and solid-organ transplant recipients may be at increased risk of severe COVID-19 disease and death, whereas for those with other types of immunocompromise, current evidence is less clear. Overall, further prospective controlled studies are needed to determine the attributable risk of immunocompromising conditions and therapies on COVID-19 disease prognosis.
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Affiliation(s)
- Monica Fung
- Division of Infectious Disease, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Jennifer M Babik
- Division of Infectious Disease, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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8
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Botta C, Indrieri A, Garofalo E, Biamonte F, Bruni A, Pasqua P, Cesario F, Costanzo FS, Longhini F, Mendicino F. COVID-19: High-JAKing of the Inflammatory "Flight" by Ruxolitinib to Avoid the Cytokine Storm. Front Oncol 2021; 10:599502. [PMID: 33489899 PMCID: PMC7819896 DOI: 10.3389/fonc.2020.599502] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 12/03/2020] [Indexed: 12/11/2022] Open
Abstract
Since SARS-CoV-2 outbreak in December 2019, world health-system has been severely impacted with increased hospitalization, Intensive-Care-Unit (ICU) access and high mortality rates, mostly due to severe acute respiratory failure and multi-organ failure. Excessive and uncontrolled release of proinflammatory cytokines (cytokine release/storm syndrome, CRS) have been linked to the development of these events. The recent advancements of immunotherapy for the treatment of hematologic and solid tumors shed light on many of the molecular mechanisms underlying this phenomenon, thus rendering desirable a multidisciplinary approach to improve COVID-19 patients' outcome. Indeed, currently available therapeutic-strategies to overcome CRS, should be urgently evaluated for their capability of reducing COVID-19 mortality. Notably, COVID-19 shares different pathogenic aspects with acute graft-versus-host-disease (aGVHD), hemophagocytic-lymphohistiocytosis (HLH), myelofibrosis, and CAR-T-associated CRS. Specifically, similarly to aGVHD, an induced tissue damage (caused by the virus) leads to increased cytokine release (TNFα and IL-6) which in turn leads to exaggerated dendritic cells, macrophages (like in HLH) and lymphocytes (as in CAR-T) activation, immune-cells migration, and tissue-damage (including late-stage fibrosis, similar to myelofibrosis). Janus Kinase (JAK) signaling represents a molecular hub linking all these events, rendering JAK-inhibitors suitable to limit deleterious effects of an overwhelming inflammatory-response. Accordingly, ruxolitinib is the only selective JAK1 and JAK2-inhibitor approved for the treatment of myelofibrosis and aGVHD. Here, we discuss, from a molecular and hematological point of view, the rationale for targeting JAK signaling in the management of COVID-19 patients and report the clinical results of a patient admitted to ICU among the firsts to be treated with ruxolitinib in Italy.
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Affiliation(s)
- Cirino Botta
- Hematology Unit, Department of Hemato-Oncology, "Annunziata" Hospital of Cosenza, Cosenza, Italy
| | - Alessia Indrieri
- Telethon Institute of Genetics and Medicine (TIGEM), Pozzuoli, Italy
- Institute for Genetic and Biomedical Research (IRGB), National Research Council (CNR), Milan, Italy
| | - Eugenio Garofalo
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Flavia Biamonte
- Department of Clinical and Experimental Medicine, "Magna Graecia" University, Catanzaro, Italy
| | - Andrea Bruni
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Pino Pasqua
- Anesthesia and Intensive Care Unit, "Annunziata" Hospital of Cosenza, Cosenza, Italy
| | - Francesco Cesario
- Hematology Unit, Department of Hemato-Oncology, "Annunziata" Hospital of Cosenza, Cosenza, Italy
| | | | - Federico Longhini
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Francesco Mendicino
- Hematology Unit, Department of Hemato-Oncology, "Annunziata" Hospital of Cosenza, Cosenza, Italy
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9
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Raiteri A, Piscaglia F, Granito A, Tovoli F. Tocilizumab: From Rheumatic Diseases to COVID-19. Curr Pharm Des 2021; 27:1597-1607. [PMID: 33719967 DOI: 10.2174/1381612827666210311141512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 02/07/2023]
Abstract
Tocilizumab is a humanised interleukin-6 receptor-inhibiting monoclonal antibody that is currently approved for the treatment of rheumatoid arthritis and other immune-related conditions. Recently, tocilizumab has been investigated as a possible treatment for severe coronavirus-induced disease 2019 (COVID-19). Despite the lack of direct antiviral effects, tocilizumab could reduce the immune-induced organ damage caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV2) infection. Until recently, most reports on tocilizumab for COVID-19 included a limited number of patients, preventing an overall evaluation of its efficacy and safety for this specific condition. Therefore, we reviewed the literature regarding the physiopathological rationale of tocilizumab for COVID-19 and its outcomes. We searched the MEDLINE database with the string "(SARS-CoV-2 OR coronavirus OR COVID-19 OR MERS- cov OR SARS-cov) AND (IL-6 OR interleukin 6 OR tocilizumab)". While the scientific rationale supporting tocilizumab for COVID-19 is solid, the evidence regarding the outcomes remains controversial. Available data and results from ongoing trials will provide useful information in the event of new COVID-19 outbreaks or future pandemics from different coronaviruses.
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Affiliation(s)
- Alberto Raiteri
- Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, via Albertoni 15, Italy
| | - Fabio Piscaglia
- Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, via Albertoni 15, Italy
| | - Alessandro Granito
- Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, via Albertoni 15, Italy
| | - Francesco Tovoli
- Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, via Albertoni 15, Italy
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10
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Toor SM, Saleh R, Sasidharan Nair V, Taha RZ, Elkord E. T-cell responses and therapies against SARS-CoV-2 infection. Immunology 2021; 162:30-43. [PMID: 32935333 PMCID: PMC7730020 DOI: 10.1111/imm.13262] [Citation(s) in RCA: 124] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/27/2020] [Accepted: 09/04/2020] [Indexed: 12/17/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is caused by SARS-CoV-2, a novel coronavirus strain. Some studies suggest that COVID-19 could be an immune-related disease, and failure of effective immune responses in initial stages of viral infection could contribute to systemic inflammation and tissue damage, leading to worse disease outcomes. T cells can act as a double-edge sword with both pro- and anti-roles in the progression of COVID-19. Thus, better understanding of their roles in immune responses to SARS-CoV-2 infection is crucial. T cells primarily react to the spike protein on the coronavirus to initiate antiviral immunity; however, T-cell responses can be suboptimal, impaired or excessive in severe COVID-19 patients. This review focuses on the multifaceted roles of T cells in COVID-19 pathogenesis and rationalizes their significance in eliciting appropriate antiviral immune responses in COVID-19 patients and unexposed individuals. In addition, we summarize the potential therapeutic approaches related to T cells to treat COVID-19 patients. These include adoptive T-cell therapies, vaccines activating T-cell responses, recombinant cytokines, Th1 activators and Th17 blockers, and potential utilization of immune checkpoint inhibitors alone or in combination with anti-inflammatory drugs to improve antiviral T-cell responses against SARS-CoV-2.
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Affiliation(s)
- Salman M. Toor
- Qatar Biomedical Research Institute (QBRI)Hamad Bin Khalifa University (HBKU)Qatar Foundation (QF)P.O. Box: 34110DohaQatar
| | - Reem Saleh
- Qatar Biomedical Research Institute (QBRI)Hamad Bin Khalifa University (HBKU)Qatar Foundation (QF)P.O. Box: 34110DohaQatar
| | - Varun Sasidharan Nair
- Qatar Biomedical Research Institute (QBRI)Hamad Bin Khalifa University (HBKU)Qatar Foundation (QF)P.O. Box: 34110DohaQatar
| | - Rowaida Z. Taha
- Qatar Biomedical Research Institute (QBRI)Hamad Bin Khalifa University (HBKU)Qatar Foundation (QF)P.O. Box: 34110DohaQatar
| | - Eyad Elkord
- Qatar Biomedical Research Institute (QBRI)Hamad Bin Khalifa University (HBKU)Qatar Foundation (QF)P.O. Box: 34110DohaQatar
- Biomedical Research CenterSchool of Science, Engineering and EnvironmentUniversity of SalfordManchesterUK
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11
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Sun C, Li J, Xiang H, Li C, Shang A, Chang W, Gui X, Wang Y, Wang H, Cheng Q, Zhang C, Yuan G, Wan C, Liu Q, Wang L, Huang Z, Liang C, Wu Y, Hu Y. COVID-19 in patients with multiple myeloma: a cross-sectional survey from the most severely affected region in China. Leuk Lymphoma 2020; 62:731-734. [PMID: 33269626 DOI: 10.1080/10428194.2020.1834098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Chunyan Sun
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junying Li
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Chunrui Li
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Anfang Shang
- Yi Chang Central People's Hospital, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
| | - Wei Chang
- China Resources & Wisco General Hospital, Wuhan, China
| | - Xiya Gui
- Hanchuan People's Hospital, Hanchuan, China
| | - Yadan Wang
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongxiang Wang
- Wuhan Central Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qianwen Cheng
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chun Zhang
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guolin Yuan
- Xiangyang Central Hospital, The Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Chucheng Wan
- Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Qihuan Liu
- Dongfeng Hospital, Hubei University of Medicine, Shiyan, China
| | - Long Wang
- The First People's Hospital of JingMen, JingMen, China
| | - Zhiping Huang
- JingZhou Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Caixia Liang
- The First People's Hospital of JingZhou, JingZhou, China
| | - Yaogong Wu
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Hu
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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12
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The Outcome of Six Patients with COVID-19 Infection and Multiple Myeloma. Mediterr J Hematol Infect Dis 2020; 12:e2020082. [PMID: 33194156 PMCID: PMC7643781 DOI: 10.4084/mjhid.2020.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/22/2020] [Indexed: 11/08/2022] Open
Abstract
No abstract, as A letter to the Editor.
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13
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Hultcrantz M, Richter J, Rosenbaum CA, Patel D, Smith EL, Korde N, Lu SX, Mailankody S, Shah UA, Lesokhin AM, Hassoun H, Tan C, Maura F, Derkach A, Diamond B, Rossi A, Pearse RN, Madduri D, Chari A, Kaminetzky D, Braunstein MJ, Gordillo C, Reshef R, Taur Y, Davies FE, Jagannath S, Niesvizky R, Lentzsch S, Morgan GJ, Landgren O. COVID-19 Infections and Clinical Outcomes in Patients with Multiple Myeloma in New York City: A Cohort Study from Five Academic Centers. Blood Cancer Discov 2020; 1:234-243. [PMID: 34651141 PMCID: PMC7668224 DOI: 10.1158/2643-3230.bcd-20-0102] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/15/2020] [Accepted: 07/27/2020] [Indexed: 01/08/2023] Open
Abstract
Patients with multiple myeloma have a compromised immune system, due to both the disease and antimyeloma therapies, and may therefore be particularly susceptible to COVID-19. Here, we report outcomes and risk factors for serious disease in patients with multiple myeloma treated at five large academic centers in New York City in the spring of 2020, during which it was a global epicenter of the SARS-CoV-2 pandemic. Of 100 patients with multiple myeloma (male 58%; median age 68) diagnosed with COVID-19, 75 were admitted; of these, 13 patients (17%) were placed on invasive mechanical ventilation, and 22 patients (29%) expired. Of the 25 nonadmitted patients, 4 were asymptomatic. There was a higher risk of adverse outcome (intensive care unit admission, mechanical ventilation, or death) in Hispanics/Latinos (n = 21), OR = 4.7 (95% confidence interval, 1.3-16.7), and African American Blacks (n = 33), OR = 3.5 (1.1-11.5), as compared with White patients (n = 36). Patients who met the adverse combined endpoint had overall higher levels of inflammatory markers and cytokine activation. None of the other studied risk factors were significantly associated (P > 0.05) with adverse outcome: hypertension (n = 56), OR = 2.2 (0.9-5.4); diabetes (n = 18), OR = 0.9 (0.3-2.9); age >65 years (n = 63), OR = 1.8 (0.7-4.6); high-dose melphalan with autologous stem cell transplant <12 months (n = 7), OR = 0.9 (0.2-5.4); and immunoglobulin G <650 mg/dL (n = 42), OR = 0.9 (0.3-2.2). In this largest cohort to date of patients with multiple myeloma and COVID-19, we found the case fatality rate to be 29% among hospitalized patients and that race/ethnicity was the most significant risk factor for adverse outcome. Significance Patients with multiple myeloma are immunocompromised, raising the question whether they are at higher risk of severe COVID-19 disease. In this large case series on COVID-19 in patients with multiple myeloma, we report 29% mortality rates among hospitalized patients and identify race/ethnicity as the most significant risk factor for severe outcome.See related commentary by Munshi and Anderson, p. 218. This article is highlighted in the In This Issue feature, p. 215.
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Affiliation(s)
- Malin Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joshua Richter
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Cara A. Rosenbaum
- Center for Myeloma, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York
| | - Dhwani Patel
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Eric L. Smith
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Neha Korde
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sydney X. Lu
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Urvi A. Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alexander M. Lesokhin
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hani Hassoun
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Carlyn Tan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Francesco Maura
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andriy Derkach
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Benjamin Diamond
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Adriana Rossi
- Center for Myeloma, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York
| | - Roger N. Pearse
- Center for Myeloma, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York
| | - Deepu Madduri
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ajai Chari
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - David Kaminetzky
- Department of Medicine, Multiple Myeloma Research Perlmutter Cancer Center, NYU Langone Health, New York, New York
| | - Marc J. Braunstein
- Department of Medicine, Multiple Myeloma Research Perlmutter Cancer Center, NYU Langone Health, New York, New York
| | - Christian Gordillo
- Division of Hematology and Oncology, Columbia University Medical Center, New York, New York
| | - Ran Reshef
- Division of Hematology and Oncology, Columbia University Medical Center, New York, New York
| | - Ying Taur
- Infectious Diseases, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Joan and Sanford Weill Medical College of Cornell University, New York, New York
| | - Faith E. Davies
- Department of Medicine, Multiple Myeloma Research Perlmutter Cancer Center, NYU Langone Health, New York, New York
| | - Sundar Jagannath
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ruben Niesvizky
- Center for Myeloma, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York
| | - Suzanne Lentzsch
- Division of Hematology and Oncology, Columbia University Medical Center, New York, New York
| | - Gareth J. Morgan
- Department of Medicine, Multiple Myeloma Research Perlmutter Cancer Center, NYU Langone Health, New York, New York
| | - Ola Landgren
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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14
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Giesen N, Sprute R, Rüthrich M, Khodamoradi Y, Mellinghoff SC, Beutel G, Lueck C, Koldehoff M, Hentrich M, Sandherr M, von Bergwelt-Baildon M, Wolf HH, Hirsch HH, Wörmann B, Cornely OA, Köhler P, Schalk E, von Lilienfeld-Toal M. Evidence-based management of COVID-19 in cancer patients: Guideline by the Infectious Diseases Working Party (AGIHO) of the German Society for Haematology and Medical Oncology (DGHO). Eur J Cancer 2020; 140:86-104. [PMID: 33068941 PMCID: PMC7505554 DOI: 10.1016/j.ejca.2020.09.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/20/2020] [Accepted: 09/02/2020] [Indexed: 01/08/2023]
Abstract
Since its first detection in China in late 2019 the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the associated infectious disease COVID-19 continue to have a major impact on global healthcare and clinical practice. Cancer patients, in particular those with haematological malignancies, seem to be at an increased risk for a severe course of infection. Deliberations to avoid or defer potentially immunosuppressive therapies in these patients need to be balanced against the overarching goal of providing optimal antineoplastic treatment. This poses a unique challenge to treating physicians. This guideline provides evidence-based recommendations regarding prevention, diagnostics and treatment of SARS-CoV-2 infection and COVID-19 as well as strategies towards safe antineoplastic care during the COVID-19 pandemic. It was prepared by the Infectious Diseases Working Party (AGIHO) of the German Society for Haematology and Medical Oncology (DGHO) by critically reviewing the currently available data on SARS-CoV-2 and COVID-19 in cancer patients applying evidence-based medicine criteria.
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Affiliation(s)
- Nicola Giesen
- Department of Haematology and Oncology, Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany.
| | - Rosanne Sprute
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Center for Integrated Oncology (CIO ABCD), German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany; University of Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Maria Rüthrich
- Department of Haematology and Medical Oncology, Clinic for Internal Medicine II, University Hospital Jena, Jena, Germany; Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany
| | - Yascha Khodamoradi
- Department of Internal Medicine, Infectious Diseases, Goethe University Frankfurt, Frankfurt Am Main, Germany
| | - Sibylle C Mellinghoff
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Center for Integrated Oncology (CIO ABCD), German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany; University of Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Gernot Beutel
- Department for Haematology, Haemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany; Working Party Intensive Care in Haematologic and Oncologic Patients (iCHOP) of the German Society of Haematology and Medical Oncology (DGHO)
| | - Catherina Lueck
- Department for Haematology, Haemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany; Working Party Intensive Care in Haematologic and Oncologic Patients (iCHOP) of the German Society of Haematology and Medical Oncology (DGHO)
| | - Michael Koldehoff
- Working Party Intensive Care in Haematologic and Oncologic Patients (iCHOP) of the German Society of Haematology and Medical Oncology (DGHO); Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Marcus Hentrich
- Department of Medicine III - Haematology/Oncology, Red Cross Hospital, Munich, Germany
| | - Michael Sandherr
- Specialist Clinic for Haematology and Oncology, Medical Care Center Penzberg, Penzberg, Germany
| | - Michael von Bergwelt-Baildon
- Working Party Intensive Care in Haematologic and Oncologic Patients (iCHOP) of the German Society of Haematology and Medical Oncology (DGHO); Department of Internal Medicine III, LMU University Hospital, DKTK Partner Site Munich, BZKF Partner Site Munich, CCC-Munich, Munich, Germany
| | - Hans-Heinrich Wolf
- Department of Haematology, Oncology and Haemostaseology, Internal Medicine III, Südharzklinikum, Nordhausen, Germany
| | - Hans H Hirsch
- Transplantation & Clinical Virology, Department Biomedicine (Haus Petersplatz), University of Basel, Basel, Switzerland; Clinical Virology, Laboratory Medicine, University Hospital Basel, Basel, Switzerland; Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Bernhard Wörmann
- Division of Haematology, Oncology and Tumor Immunology, Department of Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Oliver A Cornely
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Center for Integrated Oncology (CIO ABCD), German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany; University of Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Philipp Köhler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Center for Integrated Oncology (CIO ABCD), German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany; University of Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Enrico Schalk
- Working Party Intensive Care in Haematologic and Oncologic Patients (iCHOP) of the German Society of Haematology and Medical Oncology (DGHO); Department of Haematology and Oncology, Medical Center, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Marie von Lilienfeld-Toal
- Department of Haematology and Medical Oncology, Clinic for Internal Medicine II, University Hospital Jena, Jena, Germany; Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany
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15
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Manson JJ, Crooks C, Naja M, Ledlie A, Goulden B, Liddle T, Khan E, Mehta P, Martin-Gutierrez L, Waddington KE, Robinson GA, Ribeiro Santos L, McLoughlin E, Snell A, Adeney C, Schim van der Loeff I, Baker KF, Duncan CJA, Hanrath AT, Lendrem BC, De Soyza A, Peng J, J'Bari H, Greenwood M, Hawkins E, Peckham H, Marks M, Rampling T, Luintel A, Williams B, Brown M, Singer M, West J, Jury EC, Collin M, Tattersall RS. COVID-19-associated hyperinflammation and escalation of patient care: a retrospective longitudinal cohort study. LANCET RHEUMATOLOGY 2020; 2:e594-e602. [PMID: 32864628 PMCID: PMC7442426 DOI: 10.1016/s2665-9913(20)30275-7] [Citation(s) in RCA: 167] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Background A subset of patients with severe COVID-19 develop a hyperinflammatory syndrome, which might contribute to morbidity and mortality. This study explores a specific phenotype of COVID-19-associated hyperinflammation (COV-HI), and its associations with escalation of respiratory support and survival. Methods In this retrospective cohort study, we enrolled consecutive inpatients (aged ≥18 years) admitted to University College London Hospitals and Newcastle upon Tyne Hospitals in the UK with PCR-confirmed COVID-19 during the first wave of community-acquired infection. Demographic data, laboratory tests, and clinical status were recorded from the day of admission until death or discharge, with a minimum follow-up time of 28 days. We defined COV-HI as a C-reactive protein concentration greater than 150 mg/L or doubling within 24 h from greater than 50 mg/L, or a ferritin concentration greater than 1500 μg/L. Respiratory support was categorised as oxygen only, non-invasive ventilation, and intubation. Initial and repeated measures of hyperinflammation were evaluated in relation to the next-day risk of death or need for escalation of respiratory support (as a combined endpoint), using a multi-level logistic regression model. Findings We included 269 patients admitted to one of the study hospitals between March 1 and March 31, 2020, among whom 178 (66%) were eligible for escalation of respiratory support and 91 (34%) patients were not eligible. Of the whole cohort, 90 (33%) patients met the COV-HI criteria at admission. Despite having a younger median age and lower median Charlson Comorbidity Index scores, a higher proportion of patients with COV-HI on admission died during follow-up (36 [40%] of 90 patients) compared with the patients without COV-HI on admission (46 [26%] of 179). Among the 178 patients who were eligible for full respiratory support, 65 (37%) met the definition for COV-HI at admission, and 67 (74%) of the 90 patients whose respiratory care was escalated met the criteria by the day of escalation. Meeting the COV-HI criteria was significantly associated with the risk of next-day escalation of respiratory support or death (hazard ratio 2·24 [95% CI 1·62–2·87]) after adjustment for age, sex, and comorbidity. Interpretation Associations between elevated inflammatory markers, escalation of respiratory support, and survival in people with COVID-19 indicate the existence of a high-risk inflammatory phenotype. COV-HI might be useful to stratify patient groups in trial design. Funding None.
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Affiliation(s)
- Jessica J Manson
- Department of Rheumatology, University College London Hospitals National Health Service (NHS) Trust, London, UK.,Centre for Rheumatology Research, Division of Medicine, University College London, London, UK
| | - Colin Crooks
- Nottingham Digestive Diseases Centre and NIHR Nottingham Digestive Diseases Biomedical Research Centre, Queens Medical Centre, Nottingham University Hospitals, University of Nottingham, Nottingham, UK.,Division of Epidemiology and Public Health, Nottingham City Hospital, University of Nottingham, Nottingham, UK
| | - Meena Naja
- Department of Rheumatology, University College London Hospitals National Health Service (NHS) Trust, London, UK.,Centre for Adolescent Rheumatology Versus Arthritis, Division of Medicine, University College London, London, UK
| | - Amanda Ledlie
- Department of Rheumatology, University College London Hospitals National Health Service (NHS) Trust, London, UK.,Centre for Rheumatology Research, Division of Medicine, University College London, London, UK
| | - Bethan Goulden
- Department of Rheumatology, University College London Hospitals National Health Service (NHS) Trust, London, UK
| | - Trevor Liddle
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Emon Khan
- Department of Rheumatology, University College London Hospitals National Health Service (NHS) Trust, London, UK
| | - Puja Mehta
- Department of Rheumatology, University College London Hospitals National Health Service (NHS) Trust, London, UK.,Centre for Inflammation and Tissue Repair, UCL Respiratory, Division of Medicine, University College London, London, UK
| | - Lucia Martin-Gutierrez
- Department of Rheumatology, University College London Hospitals National Health Service (NHS) Trust, London, UK.,Centre for Rheumatology Research, Division of Medicine, University College London, London, UK
| | - Kirsty E Waddington
- Department of Rheumatology, University College London Hospitals National Health Service (NHS) Trust, London, UK.,Centre for Rheumatology Research, Division of Medicine, University College London, London, UK
| | - George A Robinson
- Department of Rheumatology, University College London Hospitals National Health Service (NHS) Trust, London, UK.,Centre for Rheumatology Research, Division of Medicine, University College London, London, UK.,Centre for Adolescent Rheumatology Versus Arthritis, Division of Medicine, University College London, London, UK
| | - Liliana Ribeiro Santos
- Department of Rheumatology, University College London Hospitals National Health Service (NHS) Trust, London, UK.,Centre for Rheumatology Research, Division of Medicine, University College London, London, UK
| | - Eve McLoughlin
- Department of Rheumatology, University College London Hospitals National Health Service (NHS) Trust, London, UK.,Centre for Rheumatology Research, Division of Medicine, University College London, London, UK
| | - Antonia Snell
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Christopher Adeney
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ina Schim van der Loeff
- NIHR Newcastle Biomedical Research Centre at Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Kenneth F Baker
- NIHR Newcastle Biomedical Research Centre at Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher J A Duncan
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Aidan T Hanrath
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,NIHR Newcastle Biomedical Research Centre at Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - B Clare Lendrem
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Anthony De Soyza
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Junjie Peng
- Centre for Rheumatology Research, Division of Medicine, University College London, London, UK.,Centre for Adolescent Rheumatology Versus Arthritis, Division of Medicine, University College London, London, UK
| | - Hajar J'Bari
- Department of Rheumatology, University College London Hospitals National Health Service (NHS) Trust, London, UK
| | - Mandy Greenwood
- Department of Rheumatology, University College London Hospitals National Health Service (NHS) Trust, London, UK
| | - Ellie Hawkins
- Department of Rheumatology, University College London Hospitals National Health Service (NHS) Trust, London, UK.,Centre for Rheumatology Research, Division of Medicine, University College London, London, UK
| | - Hannah Peckham
- Department of Rheumatology, University College London Hospitals National Health Service (NHS) Trust, London, UK.,Centre for Rheumatology Research, Division of Medicine, University College London, London, UK.,Centre for Adolescent Rheumatology Versus Arthritis, Division of Medicine, University College London, London, UK
| | - Michael Marks
- Tropical Diseases, Division of Infection and Immunity, University College London Hospitals National Health Service (NHS) Trust, London, UK.,Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Tommy Rampling
- Department of Virology, Division of Infection and Immunity, University College London Hospitals National Health Service (NHS) Trust, London, UK
| | - Akish Luintel
- Tropical Diseases, Division of Infection and Immunity, University College London Hospitals National Health Service (NHS) Trust, London, UK
| | - Bryan Williams
- National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals National Health Service (NHS) Trust, London, UK
| | - Michael Brown
- Tropical Diseases, Division of Infection and Immunity, University College London Hospitals National Health Service (NHS) Trust, London, UK
| | - Mervyn Singer
- Bloomsbury Institute for Intensive Care Medicine, University College London, London, UK
| | - Joe West
- Nottingham Digestive Diseases Centre and NIHR Nottingham Digestive Diseases Biomedical Research Centre, Queens Medical Centre, Nottingham University Hospitals, University of Nottingham, Nottingham, UK.,Division of Epidemiology and Public Health, Nottingham City Hospital, University of Nottingham, Nottingham, UK
| | - Elizabeth C Jury
- Centre for Rheumatology Research, Division of Medicine, University College London, London, UK
| | - Matthew Collin
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Rachel S Tattersall
- Department of Rheumatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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16
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Isidori A, de Leval L, Gergis U, Musto P, Porcu P. Management of Patients With Hematologic Malignancies During the COVID-19 Pandemic: Practical Considerations and Lessons to Be Learned. Front Oncol 2020; 10:1439. [PMID: 32923397 PMCID: PMC7456870 DOI: 10.3389/fonc.2020.01439] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/07/2020] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic has created unprecedented hurdles to the delivery of care to patients with cancer. Patients with hematologic malignancies appear to have a greater risk of SARS-CoV-2 infection and severe disease due to myelosuppression and lymphopenia. The first challenge, therefore, is how to continue to deliver effective, curative therapy to vulnerable patients and at the same time avoid exposing them, and their health care teams (HCT), to SARS-CoV-2. An additional challenge is the timely completion of the diagnostic and staging studies required to formulate appropriate treatment plans. Deferred procedures and avoidance of multiple trips to the surgical, diagnostic, and laboratory suites require same day consolidation of all procedures. With laboratory medicine absorbed by the need to deploy large scale COVID-testing, the availability of routine molecular tests is affected. Finally, we are increasingly faced with the challenge of making complex treatment decisions in SARS-CoV-2 positive patients with aggressive but potentially curable blood cancers. When to treat, how to treat, when to wait, how long to wait, how to predict and manage toxicities, and how to avoid compromising cure rates remains unknown. We present an outline of the scientific, medical, and operational challenges posed by the COVID-19 pandemic at selected American and European institutions and offer our current view of the key elements of a response. While the peak of the pandemic may be past us, in the absence of a vaccine risks remain, and our alertness and response to future challenges need to be refined and consolidated.
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Affiliation(s)
- Alessandro Isidori
- Hematology and Stem Cell Transplant Center, AORMN Hospital, Pesaro, Italy
| | - Laurence de Leval
- Institute of Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Usama Gergis
- Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Pellegrino Musto
- Unit of Hematology and Stem Cell Transplantation, Department of Emergency and Organ Transplantation, “Aldo Moro” University School of Medicine, AOU Consorziale Policlinico, Bari, Italy
| | - Pierluigi Porcu
- Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States
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17
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Ferrari F, Visconti F, De Amici M, Guglielmi A, Colombo CN, Belliato M, Ronco C. Coronavirus disease 2019 in critically ill patients: can we re-program the immune system? A primer for Intensivists. Minerva Anestesiol 2020; 86:1214-1233. [PMID: 32755094 DOI: 10.23736/s0375-9393.20.14663-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In December 2019, Coronavirus disease 2019 (COVID-19) emerged in Wuhan and rapidly spread around the word. The immune response is essential to control and eliminate CoV infections, however, multiorgan damage might be due to direct SARS-CoV2 action against the infected organ cells, as well as an imbalanced host immune response. In effect, a "cytokines storm" and an impaired innate immunity were found in the COVID-19 critically ill patients. In this review, we summarized the virus immune response steps, underlying the relevance of introducing the measurement of plasma cytokine levels and of circulating lymphocyte subsets in clinical practice for the follow-up of critically ill COVID-19 patients and support new therapy.
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Affiliation(s)
- Fiorenza Ferrari
- Department of Anesthesia and Intensive Care Unit, IRCCS San Matteo Hospital, University of Pavia, Pavia, Italy - .,Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy -
| | - Federico Visconti
- Department of Anesthesia and Intensive Care Unit, IRCCS San Matteo Hospital, University of Pavia, Pavia, Italy
| | - Mara De Amici
- Immuno-Allergology Laboratory of the Clinical Chemistry Unit, IRCCS Polyclinic San Matteo Foundation, Pavia, Italy
| | - Angelo Guglielmi
- Department of Anesthesia and Intensive Care Unit, IRCCS San Matteo Hospital, University of Pavia, Pavia, Italy
| | - Costanza N Colombo
- Department of Anesthesia and Intensive Care Unit, IRCCS San Matteo Hospital, University of Pavia, Pavia, Italy
| | - Mirko Belliato
- Department of Anesthesia and Intensive Care Unit, IRCCS San Matteo Hospital, University of Pavia, Pavia, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy.,Unit of Nephrology, University of Padua, Padua, Italy.,Department Nephrology Dialysis and Transplant, AUSSL 8 Regione Veneto, San Bortolo Hospital, Vicenza, Italy
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18
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Fakhouri EW, Peterson SJ, Kothari J, Alex R, Shapiro JI, Abraham NG. Genetic Polymorphisms Complicate COVID-19 Therapy: Pivotal Role of HO-1 in Cytokine Storm. Antioxidants (Basel) 2020; 9:E636. [PMID: 32708430 PMCID: PMC7402116 DOI: 10.3390/antiox9070636] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 12/15/2022] Open
Abstract
Coronaviruses are very large RNA viruses that originate in animal reservoirs and include severe acute respiratory distress syndrome (SARS) and Middle East respiratory syndrome (MERS) and other inconsequential coronaviruses from human reservoirs like the common cold. SARS-CoV-2, the virus that causes COVID-19 and is believed to originate from bat, quickly spread into a global pandemic. This RNA virus has a special affinity for porphyrins. It invades the cell at the angiotensin converting enzyme-2 (ACE-2) receptor and binds to hemoproteins, resulting in a severe systemic inflammatory response, particularly in high ACE-2 organs like the lungs, heart, and kidney, resulting in systemic disease. The inflammatory response manifested by increased cytokine levels and reactive oxygen species results in inhibition of heme oxygenase (HO-1), with a subsequent loss of cytoprotection. This has been seen in other viral illness like human immunodeficiency virus (HIV), Ebola, and SARS/MERS. There are a number of medications that have been tried with some showing early clinical promise. This illness disproportionately affects patients with obesity, a chronic inflammatory disease with a baseline excess of cytokines. The majority of the medications used in the treatment of COVID-19 are metabolized by cytochrome P450 (CYP) enzymes, primarily CYP2D6. This is further complicated by genetic polymorphisms of CYP2D6, HO-1, ACE, and ACE-2. There is a potential role for HO-1 upregulation to treat/prevent cytokine storm. Current therapy must focus on antivirals and heme oxygenase upregulation. Vaccine development will be the only magic bullet.
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Affiliation(s)
- Eddie W. Fakhouri
- New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY 11215, USA; (E.W.F.); (J.K.)
| | - Stephen J. Peterson
- New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY 11215, USA; (E.W.F.); (J.K.)
- Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Janish Kothari
- New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY 11215, USA; (E.W.F.); (J.K.)
| | - Ragin Alex
- Department of Pharmacology, New York Medical College, Valhalla, NY 10595, USA;
| | - Joseph I. Shapiro
- Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25701, USA;
| | - Nader G. Abraham
- Department of Pharmacology, New York Medical College, Valhalla, NY 10595, USA;
- Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25701, USA;
- Department of Medicine, New York Medical College, Valhalla, New York, NY 10595, USA
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19
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Ranger A, Haji R, Kaczmarski R, Danga A. Interleukin-6 blockade treatment for COVID-19 associated cytokine release syndrome in a patient with poorly controlled chronic myeloid leukaemia. Br J Haematol 2020; 190:e128-e130. [PMID: 32480422 PMCID: PMC7301007 DOI: 10.1111/bjh.16901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Amita Ranger
- Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Ruby Haji
- Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | | | - Akila Danga
- Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
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20
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Hultcrantz M, Richter J, Rosenbaum C, Patel D, Smith E, Korde N, Lu S, Mailankody S, Shah U, Lesokhin A, Hassoun H, Tan C, Maura F, Derkacs A, Diamond B, Rossi A, Pearse RN, Madduri D, Chari A, Kaminetsky D, Braunstein M, Gordillo C, Davies F, Jagannath S, Niesvizky R, Lentzsch S, Morgan G, Landgren O. COVID-19 infections and outcomes in patients with multiple myeloma in New York City: a cohort study from five academic centers. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.06.09.20126516. [PMID: 32577667 PMCID: PMC7302217 DOI: 10.1101/2020.06.09.20126516] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Importance New York City is a global epicenter for the SARS-CoV-2 outbreak with a significant number of individuals infected by the virus. Patients with multiple myeloma have a compromised immune system, due to both the disease and anti-myeloma therapies, and may therefore be particularly susceptible to coronavirus disease 2019 (COVID-19); however, there is limited information to guide clinical management. Objective To assess risk factors and outcomes of COVID-19 in patients with multiple myeloma. Design Case-series. Setting Five large academic centers in New York City. Participants Patients with multiple myeloma and related plasma cell disorders who were diagnosed with COVID-19 between March 10th, 2020 and April 30th, 2020. Exposures Clinical features and risk factors were analyzed in relation to severity of COVID-19. Main Outcomes and Measures Descriptive statistics as well as logistic regression were used to estimate disease severity reflected in hospital admissions, intensive care unit (ICU) admission, need for mechanical ventilation, or death. Results Of 100 multiple myeloma patients (male 58%; median age 68, range 41-91) diagnosed with COVID-19, 74 (74%) were admitted; of these 13 (18%) patients were placed on mechanical ventilation, and 18 patients (24%) expired. None of the studied risk factors were significantly associated (P>0.05) with adverse outcomes (ICU-admission, mechanical ventilation, or death): hypertension (N=56) odds ratio (OR) 2.3 (95% confidence interval [CI] 0.9-5.9); diabetes (N=18) OR 1.1 (95% CI 0.3-3.2); age >65 years (N=63) OR 2.0 (95% CI 0.8-5.3); high dose melphalan with autologous stem cell transplant <12 months (N=7) OR 1.2 (95% CI 0.2-7.4), IgG<650 mg/dL (N=42) OR=1.2 (95% CI 0.4-3.1). In the entire series of 127 patients with plasma cell disorders, hypertension was significantly associated with the combined end-point (OR 3.4, 95% CI 1.5-8.1). Conclusions and Relevance Although multiple myeloma patients have a compromised immune system due to both the disease and therapy; in this largest disease specific cohort to date of patients with multiple myeloma and COVID-19, compared to the general population, we found risk factors for adverse outcome to be shared and mortality rates to be within the higher range of officially reported mortality rates.
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Affiliation(s)
- Malin Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joshua Richter
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cara Rosenbaum
- Center for Myeloma, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA
| | - Dhwani Patel
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eric Smith
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Neha Korde
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sydney Lu
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Urvi Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexander Lesokhin
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hani Hassoun
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carlyn Tan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Francesco Maura
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andriy Derkacs
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Benjamin Diamond
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Adriana Rossi
- Center for Myeloma, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA
| | - Roger N. Pearse
- Center for Myeloma, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA
| | - Deepu Madduri
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ajai Chari
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Kaminetsky
- Dpt. of Medicine, Multiple Myeloma Research Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Marc Braunstein
- Dpt. of Medicine, Multiple Myeloma Research Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Christian Gordillo
- Division of Hematology and Oncology, Columbia University Medical Center, New York, NY, USA
| | - Faith Davies
- Dpt. of Medicine, Multiple Myeloma Research Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Sundar Jagannath
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ruben Niesvizky
- Center for Myeloma, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA
| | - Suzanne Lentzsch
- Division of Hematology and Oncology, Columbia University Medical Center, New York, NY, USA
| | - Gareth Morgan
- Dpt. of Medicine, Multiple Myeloma Research Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Ola Landgren
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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