Should we delay blood cancer treatment during COVID-19 pandemic

Hyderabad: Blood cancer called acute Leukemia is ‘The most dangerous and life threatening Cancer’ where early initiation of treatment makes huge difference in patient outcome. Clinical Presentation of Blood cancer is variable ranging from Incidental detection on blood tests to breathing difficulty and fever.

These symptoms trigger Corona testing and Isolation. With the  fear of COVID19 lot of  patients tend to wait at home until symptoms worsen. In addition to the delay in diagnosis, most patients may suffer from postponement of chemotherapy, due to a shortage of isolation beds and blood products or the wish to avoid immunosuppressive treatments. Delay in chemotherapy initiation may negatively affect prognosis and miss a chance of cure particularly in young patients. Leukemia patients could progress to high-risk disease due to acquisition of additional genetic anomalies, and complications due to very high white cell count called hyperleukocytosis.

Patients with Blood related cancers who have steroids as part of their treatment mainly Myeloma Cancer patients can have high chances of severe lung infections and pneumonia with COVID19. For this reason Myeloma autologous bone marrow transplants are differed until Corona pandemic settles. In Lymphoma and Leukaemia patients need for Transplant has to be discussed on individual basis based on risk and benefit as delay in treatment can risk their life.

Delay in transplant results in the reappearance of a significant minimal residual disease (MRD), a negative impact on overall survival post-transplant is another concern.

Blood products shortage especially platelet shortage is the biggest concern during Blood cancer treatment. Volunteer donors are decreasing due to self-isolation, travel restriction and fear of virus transmission. Currently Red blood cell stocks are reasonable in most blood banks after endorsement by popular celebritiesand other political leaders.

By donating Platelets donor saves life immediately as platelets are given with in 3-4 days after donation due to their short shelf life unlike in Blood donation they are not stored for long duration.

No doubt there is all time need for more regular voluntary donors for platelets. We need more co-ordinated programme for blood donors and end users. Treating Hospitals should have dedicated units with good Isolation rooms, separation of COVID patients and strict screening protocols. Risk of COVID 19 infection in hospitalised patients is very low. 

In General Leukemia treatment should be initiated without delay and continued even during Corona Pandemic as the price to pay on delay in treatment could mean disease relapse and loss of life. The decision to treatment be made on an individual basis after discussing with their treating physician based on their risk and benefits and on the local Incidence of Coronavirus.

MBBS, MD, MRCP, FRCP (Haematology) CCT
Consultant Haemato-oncology and Stem cell Transplant
Apollo Hospitals, Jubilee Hills,Hyderabad,India

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