Treatment with remdesivir, dexamethasone and convalescent plasma transfusion is safe and beneficial in hospitalized covid-19 patients with hematological malignancies

Background: Adult patients (pts) with secondary immunodeficiency in the course of blood cancers are at risk of severe COVID-19 with an unprecedented 34% risk of death. So far, no standards have been established to manage pts with hematological malignancies (HM) infected with SARS-CoV-2. Rapid control of SARS-COV-2 infection and the prevention of its complicated course are essential for clinical management, especially in those pts who require urgent systemic anti-cancer therapy (SACT). The treatment with remdesivir, dexamethasone and convalescent plasma have been shown to be active in COVID-19 treatment. Aims: Here we present our experience with the use of these agents in a difficult-to-treat population with various HM (in particular aggressive lymphomas, acute leukemias and progressive indolent lymphomas) whose SACT has been disrupted due to active SARS-CoV-2 infection. Methods: The observational, single-centre study was conducted from 07 November 2020 to 26 February 2021. All pts were diagnosed with HM and active SARS-CoV-2 infection requiring hospitalization. The severity of COVID-19 was evaluated according to the World Health Organization (WHO) Clinical Progression Scale. The COVID-19 directed treatment included remdesivir (at the standard dose for 5 consecutive days), COVID-19 convalescent plasma transfusion and dexamethasone. All patients gave their written informed consent for the data collection, and ethical clearance was obtained from the Ethics Committee of the Institute of Hematology and Transfusion Medicine, Warsaw, Poland. Results: At the time of analysis thirty-six pts were included. The median age at COVID-19 diagnosis was 58.5 years (23-86), with male predominance (21 men and 15 women). All pts were diagnosed with HM: 11 pts with acute myeloid leukemia (30.5%), 3 pts with acute lymphoblastic leukemia (8.3%), 6 pts with mantle cell lymphoma (16.7%), 5 pts with chronic lymphocytic leukemia (13.9%), 2 pts with chronic myeloid leukemia (5.5%) and 2 pts with myelodysplastic syndrome (5.5%). The COVID-19 was diagnosed before and during treatment for underlying HM in 5 and 30 pts, respectively. At the time of COVID-19 diagnosis, median WBC was 3.5 G/L (0.05-165), median ANC for myeloid and lymphoid disease were 0.19 G/L (0.0 - 6.3) and 2.3 G/L (0.7-27), respectively. The median serum concentration of hemoglobin and PLT count was 9.2 g/dL (5.4-14.3) and 91 (4-800), respectively. The maximum severity of COVID-19 according to the WHO score was as follows: 4, 5-6, ≥ 7 points in 36%, 42% and 22% of pts, respectively. All pts received remdesivir with dexamethasone. The convalescent plasma transfusion was applied to 21 pts (57%). There were no transfusion related adverse events. The median time of hospitalization was 19.5 days (4-59). In total, 8 pts (22%) died;7 due to COVID-19 and 1 due to progressive HM. SACT was initiated in all COVID-19 survivors requiring treatment with the median time of 17 days (9-65). Summary/Conclusion: Treatment with remdesivir, dexamethasone and COVID-19 convalescent plasma transfusion may improve outcomes of adult HM patients infected with SARS-CoV-2 and provide the benefit of early initiation of systemic anti-cancer therapy.