Browsing by Author "Čolović, Natasa (6701607753)"

Background: Patients with hematological malignancies (HM) are at high risk of mortality from SARS-CoV-2 disease 2019 (COVID-19). A better understanding of risk factors for adverse outcomes may improve clinical management in these patients. We therefore studied baseline characteristics of HM patients developing COVID-19 and analyzed predictors of mortality. Methods: The survey was supported by the Scientific Working Group Infection in Hematology of the European Hematology Association (EHA). Eligible for the analysis were adult patients with HM and laboratory-confirmed COVID-19 observed between March and December 2020. Results: The study sample includes 3801 cases, represented by lymphoproliferative (mainly non-Hodgkin lymphoma n = 1084, myeloma n = 684 and chronic lymphoid leukemia n = 474) and myeloproliferative malignancies (mainly acute myeloid leukemia n = 497 and myelodysplastic syndromes n = 279). Severe/critical COVID-19 was observed in 63.8% of patients (n = 2425). Overall, 2778 (73.1%) of the patients were hospitalized, 689 (18.1%) of whom were admitted to intensive care units (ICUs). Overall, 1185 patients (31.2%) died. The primary cause of death was COVID-19 in 688 patients (58.1%), HM in 173 patients (14.6%), and a combination of both COVID-19 and progressing HM in 155 patients (13.1%). Highest mortality was observed in acute myeloid leukemia (199/497, 40%) and myelodysplastic syndromes (118/279, 42.3%). The mortality rate significantly decreased between the first COVID-19 wave (March–May 2020) and the second wave (October–December 2020) (581/1427, 40.7% vs. 439/1773, 24.8%, p value < 0.0001). In the multivariable analysis, age, active malignancy, chronic cardiac disease, liver disease, renal impairment, smoking history, and ICU stay correlated with mortality. Acute myeloid leukemia was a higher mortality risk than lymphoproliferative diseases. Conclusions: This survey confirms that COVID-19 patients with HM are at high risk of lethal complications. However, improved COVID-19 prevention has reduced mortality despite an increase in the number of reported cases. © 2021, The Author(s).

Background: Patients with hematological malignancies (HM) are at high risk of mortality from SARS-CoV-2 disease 2019 (COVID-19). A better understanding of risk factors for adverse outcomes may improve clinical management in these patients. We therefore studied baseline characteristics of HM patients developing COVID-19 and analyzed predictors of mortality. Methods: The survey was supported by the Scientific Working Group Infection in Hematology of the European Hematology Association (EHA). Eligible for the analysis were adult patients with HM and laboratory-confirmed COVID-19 observed between March and December 2020. Results: The study sample includes 3801 cases, represented by lymphoproliferative (mainly non-Hodgkin lymphoma n = 1084, myeloma n = 684 and chronic lymphoid leukemia n = 474) and myeloproliferative malignancies (mainly acute myeloid leukemia n = 497 and myelodysplastic syndromes n = 279). Severe/critical COVID-19 was observed in 63.8% of patients (n = 2425). Overall, 2778 (73.1%) of the patients were hospitalized, 689 (18.1%) of whom were admitted to intensive care units (ICUs). Overall, 1185 patients (31.2%) died. The primary cause of death was COVID-19 in 688 patients (58.1%), HM in 173 patients (14.6%), and a combination of both COVID-19 and progressing HM in 155 patients (13.1%). Highest mortality was observed in acute myeloid leukemia (199/497, 40%) and myelodysplastic syndromes (118/279, 42.3%). The mortality rate significantly decreased between the first COVID-19 wave (March–May 2020) and the second wave (October–December 2020) (581/1427, 40.7% vs. 439/1773, 24.8%, p value < 0.0001). In the multivariable analysis, age, active malignancy, chronic cardiac disease, liver disease, renal impairment, smoking history, and ICU stay correlated with mortality. Acute myeloid leukemia was a higher mortality risk than lymphoproliferative diseases. Conclusions: This survey confirms that COVID-19 patients with HM are at high risk of lethal complications. However, improved COVID-19 prevention has reduced mortality despite an increase in the number of reported cases. © 2021, The Author(s).

Introduction: Molnupiravir and nirmatrelvir/ritonavir are antivirals used to prevent progression to severe SARS-CoV-2 infections and decrease hospitalisation and mortality rates. Nirmatrelvir/ritonavir was authorised in Europe in December 2021, whereas molnupiravir is not yet licensed in Europe as of February 2022. Molnupiravir may be an alternative to nirmatrelvir/ritonavir because it is associated with fewer drug-drug interactions and contraindications. A caveat for molnupiravir is the mode of action induces viral mutations. Mortality rate reduction with molnupiravir was less pronounced than that with nirmatrelvir/ritonavir in patients without haematological malignancy. Little is known about the comparative efficacy of the two drugs in patients with haematological malignancy at high-risk of severe COVID-19. Thus, molnupiravir and nirmatrelvir/ritonavir were compared in a cohort of patients with haematological malignancies. Methods: Clinical data from patients treated with molnupiravir or nirmatrelvir/ritonavir monotherapy for COVID-19 were retrieved from the EPICOVIDEHA registry. Patients treated with molnupiravir were matched by sex, age (±10 years), and severity of baseline haematological malignancy to controls treated with nirmatrelvir/ritonavir. Results: A total of 116 patients receiving molnupiravir for the clinical management of COVID-19 were matched to an equal number of controls receiving nirmatrelvir/ritonavir. In each of the groups, 68 (59%) patients were male; with a median age of 64 years (interquartile range [IQR] 53-74) for molnupiravir recipients and 64 years (IQR 54-73) for nirmatrelvir/ritonavir recipients; 56.9% (n=66) of the patients had controlled baseline haematological malignancy, 12.9% (n=15) had stable disease, and 30.2% (n=35) had active disease at COVID-19 onset in each group. During COVID-19 infection, one third of patients from each group were admitted to hospital. Although a similar proportion of patients in the two groups were vaccinated (molnupiravir n=77, 66% vs. nirmatrelvir/ritonavir n=87, 75%), more of those treated with nirmatrelvir/ritonavir had received four vaccine doses (n=27, 23%) compared with those treated with molnupiravir (n=5, 4%) (P<0.001). No differences were detected in COVID-19 severity (P=0.39) or hospitalisation (P=1.0). No statistically significant differences were identified in overall mortality rate (P=0.78) or survival probability (d30 P=0.19, d60 P=0.67, d90 P=0.68, last day of follow up P=0.68). Deaths were either attributed to COVID-19, or the infection was judged by the treating physician to have contributed to death. Conclusions: Hospitalisation and mortality rates with molnupiravir were comparable to those with nirmatrelvir/ritonavir in high-risk patients with haematological malignancies and COVID-19. Molnupiravir is a plausible alternative to nirmatrelvir/ritonavir for COVID-19 treatment in patients with haematological malignancy. © 2023 The Author(s)

Myeloid sarcoma is a localized tumor composed of myeloblasts and other immature myeloid cells outside the bone marrow. It is usually associated with acute myeloid leukemia and rarely with chronic myeloproliferative disorders. We present a 43-year-old male who developed a solitary tumor in his left testis 6 years after an initial diagnosis of primary myelofibrosis. Four months later, another infiltrative tumor in the skin overlying his left wrist was discovered. After orchiectomy, the immunohistochemistry revealed tumor cells expressing LCA, CD34, CD117, MPO, CD15, lysozym, and CD43+, which confirmed diagnosis of myeloid sarcoma. The histologic and immunohistochemical findings were similar. The patient was treated with local radiotherapy to the skin tumor site, resulting in regression of the tumor and with chemotherapy when acute myeloblastic leukemia developed. The patient survived 21 months after initial presentation.

We present two cases of acute myeloid leukemia (AML) who developed Varicella-Zoster Virus (VZV) encephalitis after completion of standard "3 + 7" induction remission chemotherapy. A 50-year-old patient developed disseminated cutaneous Herpes Zoster (HZ) 2 days after completion of induction chemotherapy for AML. The patient was treated with intravenous acyclovir 7 days and then orally. On the second day following intravenous acyclovir discontinuation confusion, cerebelar ataxia somnolescence and VZV encephalitis was diagnosed. The other 38-year-old patient developed neuroleukemia and VZV encephalitis without skin rash after completion of induction chemotherapy. In both patients the diagnosis was confirmed by polymerase chain reaction (PCR) for VZV DNA in serum and liquor. The first patient completely recovered after reinstitution of intravenous acyclovir while the other patient a month later. This is unusual presentation of VZV encephalitis occurring in a patient with AML after standard induction remission chemotherapy which implies the significance of early diagnosis and screening for viral infections in AML patients with unusual neurologic presentation even in absence of rash. The screening for viral infections should be performed because antiviral prophylaxis is not routinely recommended for AML during standard induction chemotherapy by most clinical guidelines. © 2013 Elsevier Masson SAS.

We present two cases of acute myeloid leukemia (AML) who developed Varicella-Zoster Virus (VZV) encephalitis after completion of standard "3 + 7" induction remission chemotherapy. A 50-year-old patient developed disseminated cutaneous Herpes Zoster (HZ) 2 days after completion of induction chemotherapy for AML. The patient was treated with intravenous acyclovir 7 days and then orally. On the second day following intravenous acyclovir discontinuation confusion, cerebelar ataxia somnolescence and VZV encephalitis was diagnosed. The other 38-year-old patient developed neuroleukemia and VZV encephalitis without skin rash after completion of induction chemotherapy. In both patients the diagnosis was confirmed by polymerase chain reaction (PCR) for VZV DNA in serum and liquor. The first patient completely recovered after reinstitution of intravenous acyclovir while the other patient a month later. This is unusual presentation of VZV encephalitis occurring in a patient with AML after standard induction remission chemotherapy which implies the significance of early diagnosis and screening for viral infections in AML patients with unusual neurologic presentation even in absence of rash. The screening for viral infections should be performed because antiviral prophylaxis is not routinely recommended for AML during standard induction chemotherapy by most clinical guidelines. © 2013 Elsevier Masson SAS.