Concurrent diagnosis of acute myeloid leukemia and symptomatic COVID-19 infection: a case report successfully treated with Azacitidine-Venetoclax combination

Main Article Content

Daniela Taurino
Marco Frigeni
Anna Grassi
Gianluca Cavallaro
Silvia Salmoiraghi
Orietta Spinelli
Alessandro Rambaldi
Federico Lussana

Keywords

acute myeloid leukemia, COVID-19, venetoclax. Azacitidine, pneumonia-

Abstract

SARS-COV2 pandemic has caused profound challenges in health care systems worldwide. Patients affected by hematological neoplasms appear to be particularly at risk of developing COVID-19 complications, with unfavorable outcomes.


Here, we present the case of a 57-years-old woman diagnosed with severe COVID-19 pneumonia and concurrent acute myeloid leukemia (AML). At the time of diagnosis, it was decided to postpone leukemia therapy to enable adequate COVID-19 pneumonia treatment. When her conditions related to pneumonia improved, the combination of Azacitidine-Venetoclax was used as first-line treatment, instead of conventional intensive chemotherapy. At the end of the first two cycles, the patient showed complete remission, and a post-remission consolidation with allogeneic hematopoietic stem cell transplantation has been planned.


This case suggests that Azacytidine-Venetoclax induction may represent a valid and safe alternative to intensive chemotherapy in the challenging setting of patients with a concomitant diagnosis of AML and severe COVID-19 infection.

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References

1. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in china: summary of a report of 72 314 cases from the chinese center for disease control and prevention. JAMA 2020; 323: 1239.
2. Liang W, Guan W, Chen R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. The Lancet Oncology 2020; 21: 335–337.
3. Döhner H, Estey E, Grimwade D, et al. Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel. Blood 2017; 129: 424–447.
4. Ferrara F, Schiffer CA. Acute myeloid leukaemia in adults. The Lancet 2013; 381: 484–495.
5. Arber DA, Orazi A, Hasserjian R, et al. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood 2016; 127: 2391–2405.
6. Mair-Jenkins J, Saavedra-Campos M, Baillie JK, et al. The Effectiveness of Convalescent Plasma and Hyperimmune Immunoglobulin for the Treatment of Severe Acute Respiratory Infections of Viral Etiology: A Systematic Review and Exploratory Meta-analysis. J Infect Dis 2015; 211: 80–90.
7. Chen L, Xiong J, Bao L, et al. Convalescent plasma as a potential therapy for COVID-19. The Lancet Infectious Diseases 2020; 20: 398–400.
8. Ferrari S, Caprioli C, Weber A, et al. Convalescent hyperimmune plasma for chemo-immunotherapy induced immunodeficiency in COVID-19 patients with hematological malignancies. Leukemia & Lymphoma 2021; 62: 1490–1496.
9. DiNardo CD, Pratz KW, Letai A, et al. Safety and preliminary efficacy of venetoclax with decitabine or azacitidine in elderly patients with previously untreated acute myeloid leukaemia: a non-randomised, open-label, phase 1b study. The Lancet Oncology 2018; 19: 216–228.
10. Chan SM, Thomas D, Corces-Zimmerman MR, et al. Isocitrate dehydrogenase 1 and 2 mutations induce BCL-2 dependence in acute myeloid leukemia. Nat Med 2015; 21: 178–184.
11. DiNardo CD, Tiong IS, Quaglieri A, et al. Molecular patterns of response and treatment failure after frontline venetoclax combinations in older patients with AML. Blood 2020; 135: 791–803.
12. Saini KS, Tagliamento M, Lambertini M, et al. Mortality in patients with cancer and coronavirus disease 2019: A systematic review and pooled analysis of 52 studies. European Journal of Cancer 2020; 139: 43–50.
13. Desai A, Gupta R, Advani S, et al. Mortality in hospitalized patients with cancer and coronavirus disease 2019: A systematic review and meta‐analysis of cohort studies. Cancer 2021; 127: 1459–1468.
14. Chen Z, John Wherry E. T cell responses in patients with COVID-19. Nat Rev Immunol 2020; 20: 529–536.
15. Aries JA, Davies JK, Auer RL, et al. Clinical outcome of coronavirus disease 2019 in haemato‐oncology patients. Br J Haematol; 190. Epub ahead of print July 2020. DOI: 10.1111/bjh.16852.
16. Zeidan AM, Boddu PC, Patnaik MM, et al. Special considerations in the management of adult patients with acute leukaemias and myeloid neoplasms in the COVID-19 era: recommendations from a panel of international experts. The Lancet Haematology 2020; 7: e601–e612.
17. Röllig C, Kramer M, Schliemann C, et al. Does time from diagnosis to treatment affect the prognosis of patients with newly diagnosed acute myeloid leukemia? Blood 2020; 136: 823–830.
18. DiNardo CD, Jonas BA, Pullarkat V, et al. Azacitidine and Venetoclax in Previously Untreated Acute Myeloid Leukemia. N Engl J Med 2020; 383: 617–629.
19. Stein EM, DiNardo CD, Fathi AT, et al. Ivosidenib or enasidenib combined with intensive chemotherapy in patients with newly diagnosed AML: a phase 1 study. Blood 2021; 137: 1792–1803.
20. Wilson AJ, Troy‐Barnes E, Subhan M, et al. Successful remission induction therapy with gilteritinib in a patient with de novo FLT3 ‐mutated acute myeloid leukaemia and severe COVID‐19. Br J Haematol; 190. Epub ahead of print August 2020. DOI: 10.1111/bjh.16962.