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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.

ABSTRACT: The ongoing COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 is a global public health crisis. Multiple observations indicate poorer post-infection outcomes for patients with cancer than for the general population. Herein, we highlight the challenges in caring for patients with acute leukaemias and myeloid neoplasms amid the COVID-19 pandemic. We summarise key changes related to service allocation, clinical and supportive care, clinical trial participation, and ethical considerations regarding the use of lifesaving measures for these patients. We recognise that these recommendations might be more applicable to high-income countries and might not be generalisable because of regional differences in health-care infrastructure, individual circumstances, and a complex and highly fluid health-care environment. Despite these limitations, we aim to provide a general framework for the care of patients with acute leukaemias and myeloid neoplasms during the COVID-19 pandemic on the basis of recommendations from international experts.

SUBMITTER: Zeidan AM

PROVIDER: S-EPMC7302757 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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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.

Zeidan Amer M AM Boddu Prajwal C PC Patnaik Mrinal M MM Bewersdorf Jan Philipp JP Stahl Maximilian M Rampal Raajit K RK Shallis Rory R Steensma David P DP Savona Michael R MR Sekeres Mikkael A MA Roboz Gail J GJ DeAngelo Daniel J DJ Schuh Andre C AC Padron Eric E Zeidner Joshua F JF Walter Roland B RB Onida Francesco F Fathi Amir A DeZern Amy A Hobbs Gabriela G Stein Eytan M EM Vyas Paresh P Wei Andrew H AH Bowen David T DT Montesinos Pau P Griffiths Elizabeth A EA Verma Amit K AK Keyzner Alla A Bar-Natan Michal M Navada Shyamala C SC Kremyanskaya Marina M Goldberg Aaron D AD Al-Kali Aref A Heaney Mark L ML Nazha Aziz A Salman Huda H Luger Selina S Pratz Keith W KW Konig Heiko H Komrokji Rami R Deininger Michael M Cirici Blanca Xicoy BX Bhatt Vijaya Raj VR Silverman Lewis R LR Erba Harry P HP Fenaux Pierre P Platzbecker Uwe U Santini Valeria V Wang Eunice S ES Tallman Martin S MS Stone Richard M RM Mascarenhas John J

The Lancet. Haematology 20200618 8

The ongoing COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 is a global public health crisis. Multiple observations indicate poorer post-infection outcomes for patients with cancer than for the general population. Herein, we highlight the challenges in caring for patients with acute leukaemias and myeloid neoplasms amid the COVID-19 pandemic. We summarise key changes related to service allocation, clinical and supportive care, clinical trial participation, and ethical ...[more]

PMID: 32563283

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Project description:Evidence-based smoking cessation guidelines recommend nicotine replacement therapy (NRT), bupropion SR and varenicline as first-line therapy in combination with behavioural interventions. However, there are limited data to guide clinicians in recommending one form over another, using combinations, or matching individual smokers to particular forms.To develop decision rules for clinicians to guide differential prescribing practices and tailoring of pharmacotherapy for smoking cessation.A Delphi approach was used to build consensus among a panel of 37 international experts from various health disciplines. Through an iterative process, panellists responded to three rounds of questionnaires. Participants identified and ranked "best practices" used by them to tailor pharmacotherapy to aid smoking cessation. An independent panel of 10 experts provided cross-validation of findings.There was a 100% response rate to all three rounds. A high level of consensus was achieved in determining the most important priorities: (1) factors to consider in prescribing pharmacotherapy: evidence, patient preference, patient experience; (2) combinations based on: failed attempt with monotherapy, patients with breakthrough cravings, level of tobacco dependence; (3) specific combinations, main categories: (a) two or more forms of NRT, (b) bupropion + form of NRT; (4) specific combinations, subcategories: (1a) patch + gum, (1b) patch + inhaler, (1c) patch + lozenge; (2a) bupropion + patch, (2b) bupropion + gum; (5) impact of comorbidities on selection of pharmacotherapy: contraindications, specific pharmacotherapy useful for certain comorbidities, dual purpose medications; (6) frequency of monitoring determined by patient needs and type of pharmacotherapy.An algorithm and guide were developed to assist clinicians in prescribing pharmacotherapy for smoking cessation. There appears to be good justification for "off-label" use such as higher doses of NRT or combination therapy in certain circumstances. This practical tool reflects best evidence to date of experts in tobacco cessation.

Dataset Information

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.

Publications

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.

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