ABSTRACT During the COVID-19 pandemic, special attention has been addressed in cancer care to mitigate the impact on the patient’s prognosis. We addressed our preparation to face COVID-19 pandemic in a Hematological and Stem Cell Transplant Unit in Brazil during the first two months of COVID-19 pandemic and described COVID-19 cases in patients and health care workers (HCW). Modifications in daily routines included a separation of area and professionals, SARS-CoV-2 screening protocols, and others. A total of 47 patients and 54 HCW were tested for COVID-19, by PCR-SARS-CoV-2. We report 11 cases of COVID-19 in hematological patients (including 2 post stem cell transplant) and 28 cases in HCW. Hematological cases were most severe or moderate and presented with several poor risk factors. Among HCW, COVID-19 were mostly mild, and all recovered without hospitalization. A cluster was observed among HCW. Despite a decrease in the number of procedures, the Transplant Program performed 8 autologous and 4 allogeneic SCT during the period, and 49 onco-hematological patients were admitted to continuing their treatments. Although we observed a high frequency of COVID-19 among patients and HCW, showing that SARS-CoV-2 is disseminated in Brazil, hematological patients were safely treated during pandemic times.

ABSTRACT: The novel Coronavirus (CoVid-19) outbreak is now consider a world pandemic, affecting more than 1,300,000 people worldwide. Cancer patients are in risk for severe disease, including a higher risk of intensive care unit (ICU) admission, need for invasive ventilation or death. Management of patients with lymphoid malignancies can be challenging during the outbreak, due to need of multiple hospital visits and admissions, immunosuppression and need for chemotherapy, radiotherapy and stem cell transplantation. In this article, we will focus on the practical management of patients with lymphoid malignancies during the COVID-19 pandemic, focusing on minimizing the risk for patients.

No final da década de 70, ocorreu o primeiro relato de sucesso com a utilização de quimioterapia de alta dose, seguida de transplante de células-tronco hematopoéticas autólogo (TCTH auto), em pacientes com linfoma não Hodgkin (LNH). Desde então, o TCTH autólogo vem se constituindo em um importante instrumento na estratégia de tratamento dos LNH. Inúmeros estudos, em vários subtipos de linfomas, têm consolidado o papel do TCTH autólogo, principalmente como resgate em recidivas de doença. O melhor momento para a incorporação desta estratégia depende do subtipo do linfoma, do status de doença previamente ao transplante (sensível ou resistente) e de fatores clínico-biológicos associados à doença. Em recidiva sensível de linfoma difuso de grandes células, o TCTH autólogo é a terapia de escolha. Nestes pacientes, o transplante promove taxas de resposta completa em até 50% dos casos, comparado a aproximadamente 15%, quando esse resgate é realizado com protocolos quimioterápicos convencionais. O seu papel como parte da terapia de indução de remissão não está totalmente estabelecido. Em linfomas indolentes, principalmente folicular, é a terapia de escolha nas recidivas sensíveis à quimioterapia de resgate. Em linfomas de células do manto, o TCTH autólogo tem se incorporado à terapia de primeira linha, como consolidação de remissão. As indicações de TCTH alogênico em LNH têm se limitado aos casos de refratariedade ao tratamento convencional e recidiva pós-transplante autólogo, em pacientes jovens e sem comorbidades, em decorrência da alta toxicidade associada à utilização de regimes de condicionamento mieloablativos. A utilização de regimes de condicionamento de intensidade reduzida tem reduzido a toxicidade e ampliado o seu uso nos LNH recidivados ou refratários.

High-dose chemotherapy (HDT) followed by autologous bone marrow transplantation (ABMT) has proved to provide significant advantage regarding event-free and overall survival in patients with chemosensitive relapses of aggressive non-Hodgkin's lymphoma (NHL) after conventional therapy. These results encouraged many investigators to use HDT as part of first-line therapy but the results are contradictory. There is no consensus regarding management of relapsed or refractory DLBCL. In follicular lymphomas, autologous stem cell transplantation (SCT) is considered the treatment of choice for young patients with relapsed disease. Autologous SCT has also been evaluated in prospective trials as first-line treatment for high risk patients at diagnosis, but the results are not yet conclusive. In mantle cell lymphoma, autologous stem cell transplantation has been employed as part of first-line therapy. Allo-SCT for patients with lymphoma was first performed in the mid-1980s. The high transplant-related mortality, seen after myeloablative conditioning, discouraged broader interest in this approach and made further research difficult. The generally lower relapse rates after allo-SCT, the association of GvHD with reduced relapse rates, the increase of relapse rates after ex vivo or in vivo T-cell depletion, and the frequent responses to DLIs all support the existence of a graft-vs.-lymphoma effect. However, further data analysis supports the view that not all lymphomas are equal. While slowly proliferating diseases such as follicular lymphoma seem particularly sensitive targets for allogeneic T-cells, results of allo-SCT with aggressive B-cell lymphomas have been less convincing. Patients with these latter diseases obviously need vigorous debulking of their tumor prior to conditioning. Reduced-intensity conditioning fueled a renaissance of allo-SCT as treatment of lymphoma because the lower expected TRM was highly attractive for a patient population where the transplant-related death rate after myeloablative conditioning had, in many instances, exceeded 50%.