Blood Res 2022; 57(1):
Published online March 31, 2022
https://doi.org/10.5045/br.2022.2021146
© The Korean Society of Hematology
Correspondence to : Chul Soo Kim
Department of Internal Medicine, Sahmyook Medical Center, 82 Manguro, Dongdaemungu, Seoul 02500, Korea
E-mail: cskimmd@inha.ac.kr
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
TO THE EDITOR: A 62-year-old-lady visited the emergency room for diarrhea followed by fever in December 2020 when she had leukocytosis (187,400/mL with 72% neutrophils) and pneumonia predominantly at the lower lobes (Fig. 1). She looked relatively well with no respiratory distress in WHO performance score of I, but febrile up to 39.0°C. Pallor, jaundice, lymphadenopathy, and bleeding tendency were absent. Heart rate was rapid and regular without murmurs. Crackles were heard on the lung bases. The abdomen was scaphoid with a palpable spleen. The remainder of the physical exam was unremarkable. A diagnosis of chronic myeloid leukemia (CML) in the chronic phase was immediately made using peripheral blood polymerase chain reaction (PCR) for the
There has been concern about the susceptibility for contracting SARS CoV-2 and unfavorable impact on the clinical course of COVID-19 among cancer patients. The International CML Foundation collected 110 cases of COVID-19 with concurrent CML from the global network in March–July 2020 [1] and reported the clinical outcomes including incidence, severity, and mortality. Their data showed that older age, COVID-19 severity, and imatinib treatment predicts mortality. They attributed the absence of imatinib’s theoretical advantage to compounding factors caused by the inhomogeneous population of their study. Contrary to the negative impact of imatinib on survival in their report [1], Italian data suggested that imatinib possibly protects from COVID-19 in Philadelphia+ acute lymphoblastic leukemia [2] and CML [3]. This supports the
In COVID-19, concurrent with newly diagnosed CML, delayed introduction of TKI therapy is not recommended [7]. This is based on the the European Hematology Association Scientific Working Group meeting’s conclusion on 29 March 2020 that uncontrolled leukocytosis may worsen lung damage and aggravate gas exchange in cases of severe COVID-19. Delayed TKI introduction may also increase the risk of CML progression to advanced phases. An extreme caution should be practiced during the first three months of TKI treatment for the risk of severe cytopenia, aggravating the clinical course of COVID-19 in case of severe disease. Two of five cases of COVID-19 among already known CML patients in Turkey were continuously placed on imatinib with no deterioration of COVID-19 [8]. Our case aptly demonstrates that TKI could be safely used if COVID-19 is not severe and TKI induced leukopenia can be closely monitored.
No potential conflicts of interest relevant to this article were reported.
Blood Res 2022; 57(1): 74-75
Published online March 31, 2022 https://doi.org/10.5045/br.2022.2021146
Copyright © The Korean Society of Hematology.
Chul Soo Kim1, Jeong Yeon Kim2, Dae Ro Choi1
1Hematology and Oncology Service, 2Infectious Diseases Service, Department of Internal Medicine, Sahmyook Medical Center, Seoul, Korea
Correspondence to:Chul Soo Kim
Department of Internal Medicine, Sahmyook Medical Center, 82 Manguro, Dongdaemungu, Seoul 02500, Korea
E-mail: cskimmd@inha.ac.kr
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
TO THE EDITOR: A 62-year-old-lady visited the emergency room for diarrhea followed by fever in December 2020 when she had leukocytosis (187,400/mL with 72% neutrophils) and pneumonia predominantly at the lower lobes (Fig. 1). She looked relatively well with no respiratory distress in WHO performance score of I, but febrile up to 39.0°C. Pallor, jaundice, lymphadenopathy, and bleeding tendency were absent. Heart rate was rapid and regular without murmurs. Crackles were heard on the lung bases. The abdomen was scaphoid with a palpable spleen. The remainder of the physical exam was unremarkable. A diagnosis of chronic myeloid leukemia (CML) in the chronic phase was immediately made using peripheral blood polymerase chain reaction (PCR) for the
There has been concern about the susceptibility for contracting SARS CoV-2 and unfavorable impact on the clinical course of COVID-19 among cancer patients. The International CML Foundation collected 110 cases of COVID-19 with concurrent CML from the global network in March–July 2020 [1] and reported the clinical outcomes including incidence, severity, and mortality. Their data showed that older age, COVID-19 severity, and imatinib treatment predicts mortality. They attributed the absence of imatinib’s theoretical advantage to compounding factors caused by the inhomogeneous population of their study. Contrary to the negative impact of imatinib on survival in their report [1], Italian data suggested that imatinib possibly protects from COVID-19 in Philadelphia+ acute lymphoblastic leukemia [2] and CML [3]. This supports the
In COVID-19, concurrent with newly diagnosed CML, delayed introduction of TKI therapy is not recommended [7]. This is based on the the European Hematology Association Scientific Working Group meeting’s conclusion on 29 March 2020 that uncontrolled leukocytosis may worsen lung damage and aggravate gas exchange in cases of severe COVID-19. Delayed TKI introduction may also increase the risk of CML progression to advanced phases. An extreme caution should be practiced during the first three months of TKI treatment for the risk of severe cytopenia, aggravating the clinical course of COVID-19 in case of severe disease. Two of five cases of COVID-19 among already known CML patients in Turkey were continuously placed on imatinib with no deterioration of COVID-19 [8]. Our case aptly demonstrates that TKI could be safely used if COVID-19 is not severe and TKI induced leukopenia can be closely monitored.
No potential conflicts of interest relevant to this article were reported.