Treating acute leukemia during the COVID-19 pandemic in an environment with limited resources: A multicenter experience in four Latin American countries

Demichelis-Gómez R.; Alvarado-Ibarra M.; Vasquez-Chávez J.; Delgado-López N.; Gómez-Cortés C.; Espinosa-Bautista K.; Cooke-Tapia A.; Milán-Salvatierra A.; Gómez-De León A.; Lee-Tsai Y.L.; Rosales-López D.; Cabrera-García Á.; Amador-Medina F.; Córdoba-Ramírez A.; Murrieta-Álvarez I.; Solís-Poblano J.C.; Apodaca-Chávez E.; Rangel-Patiño J.; Álvarez-Vera J.L.; Arana-Luna L.; de la Peña-Celaya J.A.; Espitia-Ríos M.E.; Hernández-Ruiz E.; Pérez-Zúñiga J.M.; Peña-López E.; González-Rivera R.; García-Leyva M.F.; Tejeda-Romero M.; Cruz-Rico J.; Balderas-Delgado C.; Ruíz-Argüelles G.J.; Gómez-Almaguer D. · JCO Global Oncology (2021) · DOI: 10.1200/go.20.00620

Resumen

PURPOSE The COVID-19 pandemic is a colossal challenge for global health; nonetheless, specific subgroups face considerably higher risks for infection and mortality. Among patients with malignant diseases, those with hematologic neoplasms are at a higher risk for poor outcomes. The objective of this study was to register treatment modifications associated with the COVID-19 pandemic and their short-term consequences in Latin America. METHODS Multicenter, prospective, observational, cohort study including patients older than 14 years from 14 centers in four countries (Mexico, Peru, Guatemala, and Panama) who had a confirmed diagnosis of acute leukemia, and who were undergoing active treatment since the first COVID-19 case in each country until the cutoff on July 15, 2020. RESULTS We recruited 635 patients. Treatment modifications because of the COVID-19 pandemic were reported in 40.8% of cases. The main reason for such modifications was logistic issues (55.0%) and the most frequent modification was chemotherapy delay (42.0%). A total of 13.1% patients developed COVID-19 disease, with a mortality of 37.7%. Several factors were identified as independently associated with mortality, including a diagnosis of acute myeloid leukemia (odds ratio 2.38 [95% CI, 1.47 to 3.84]; P, .001), while the use of telemedicine was identified as a protective factor (odds ratio 0.36 [95% CI, 0.18 to 0.82]; P = .014). CONCLUSION These results highlight the collateral damage of COVID-19 in oncology patients.