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      Community-Acquired Respiratory Viruses in Oncology: Lessons to Be Learnt from the SARS-CoV-2 Pandemic

      a , b , *
      Oncology Research and Treatment
      S. Karger GmbH

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          As a hematologist with an interest in infectious diseases I would like to use this opportunity to repeat a long-standing message: community-acquired respiratory viruses (CARV) are potential killers, especially for cancer patients [1]. Influenza has long been famous for causing seasonal excess mortality in all populations and is therefore well known as a dangerous pathogen in cancer patients in particular [2, 3]. Other CARV with complicated names such as respiratory syncytial virus (RSV), parainfluenza, or human metapneumovirus (hMPV) have also been described as causes of pneumonia with high fatality rates in patients with hematological malignancies inside and outside the transplant setting [4, 5, 6]. It seems that shortly after the novel description of a respiratory virus oncologists have previously never heard of, there is the report of an outbreak, sometimes with fatal consequences, on a hematology/oncology unit somewhere on the globe [4, 5, 7]. So why should this be any different for SARS-CoV-2? The characteristics are the same, albeit probably aggravated, as for the other CARV: firstly, an infection with SARS-CoV-2 is per se potentially dangerous, secondly, the virus is highly contagious and has a high potential for nosocomial transmission, and lastly, clinicians are not used to and thus not sufficiently aware of this particular pathogen. In this issue of Oncology Research and Treatment, there is the report of an outbreak of SARS-CoV-2 on a hematology unit together with the description of its successful containment along with a review of a possible strategy to manage care for cancer patients in times of COVID-19. There are several lessons to be learnt from this valuable report: Outbreaks with CARV happen, and they happen to anyone, even to units of the highest standards. Outbreaks with CARV need to be recognized quickly, and effective measures need to be taken rapidly, although they may appear radical at times. If dealt with appropriately, outbreaks can be contained, and cancer care can be ensured at the highest possible standard even in times of a pandemic. The most important resource to continue cancer care in the situation of a pandemic is enough dedicated staff. So, what does it take to make sure all cancer patients receive optimal therapy during the COVID-19 crisis? We need to take the virus and the disease it causes absolutely seriously. We need to find the right balance between implementing appropriate precautions on the one hand and causing collateral damage by denying cancer patients the tumor therapy they need on the other hand. Recommendations should be as rational and evidence-based as possible (as they usually are in cancer care). For this, high-quality evidence needs to be gathered as quickly as possible, and the development of recommendations even in times of crisis should be consensus-based with critical appraisal. The aim is to care for our patients as safely and as effectively as we usually do, which has led to the well-described increase in survival and quality of life in the recent years [8, 9]. In my impression, this is exactly what the community of hematologists and oncologists has been striving for with an immense effort over the past weeks. All clinicians and healthcare workers involved in either treating COVID-19 patients or working hard to compensate potential implications on routine cancer care cannot be thanked enough. If the efforts of everyone involved are recognized and the lessons learnt from the SARS-CoV-2 pandemic kept in mind, the community is well prepared for any other upcoming crisis, including safe management of the yearly mini-crisis of seasonal CARV epidemics. Disclosure Statement Honoraria/consulting fees: Celgene, Janssen, Takeda, Amgen, Oncopeptides, Cancer Drug Development Forum, Gilead, Merck, and BMS. Research funding: Celgene, Gilead, Novartis, and Deutsche Krebshilfe.

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          Most cited references8

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          European cancer mortality predictions for the year 2020 with a focus on prostate cancer

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            Outcome of pandemic H1N1 infections in hematopoietic stem cell transplant recipients

            During 2009, a new strain of A/H1N1 influenza appeared and became pandemic. A prospective study was performed to collect data regarding risk factors and outcome of A/H1N1 in hematopoietic stem cell transplant recipients. Only verified pandemic A/H1N1 influenza strains were included: 286 patients were reported, 222 allogeneic and 64 autologous recipients. The median age was 38.3 years and the median time from transplant was 19.4 months. Oseltamivir was administered to 267 patients and 15 patients received zanamivir. One hundred and twenty-five patients (43.7%) were hospitalized. Ninety-three patients (32.5%) developed lower respiratory tract disease. In multivariate analysis, risk factors were age (OR 1.025; 1.01-1.04; P=0.002) and lymphopenia (OR 2.49; 1.33-4.67; P<0.001). Thirty-three patients (11.5%) required mechanical ventilation. Eighteen patients (6.3%) died from A/H1N1 infection or its complications. Neutropenia (P=0.03) and patient age (P=0.04) were significant risk factors for death. The 2009 A/H1N1 influenza pandemic caused severe complications in stem cell transplant recipients.
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              Risk factors and containment of respiratory syncytial virus outbreak in a hematology and transplant unit.

              Respiratory syncytial virus (RSV) usually causes self-limiting upper respiratory tract infections, but can be associated with severe lower respiratory tract infection disease (LRTID) in infants and in patients with hematologic malignancies. We have analyzed the risk factors and the measures for containment within an outbreak of nosocomial RSV infections in a hematology and SCT unit. A total of 56 patients were affected (53 RSV-A and 3 RSV-B) including 32 transplant patients (16 allogeneic and 16 autologous). Forty (71%) of the 56 patients suffered from LRTID and 14 (35%) of the patients with LRTID subsequently died. However, because of concomitant infections with fungal and bacterial pathogens, the impact of RSV on the fatal outcome was difficult to assess. Multivariate analysis showed that low levels of IgG were significantly associated with fatal outcome (P=0.007), treatment with oral ribavirin represented a protective factor (P=0.02). An extremely protracted viral shedding was observed in this cohort of patients (median=30.5 days, range: 1-162 days), especially pronounced in patients after allogeneic transplantation (P=0.002). Implementation of rigorous isolation and barrier measures, although challenged by long-term viral carriers, was effective in containment of the outbreak.

                Author and article information

                Oncol Res Treat
                Oncol Res Treat
                Oncology Research and Treatment
                S. Karger GmbH (Wilhelmstrasse 20A, P.O. Box · Postfach · Case postale, D–79095, Freiburg, Germany · Deutschland · Allemagne, Phone: +49 761 45 20 70, Fax: +49 761 4 52 07 14, information@karger.de )
                14 May 2020
                : 43
                : 6
                : 262-263
                [1 ] aAbteilung für Hämatologie und internistische Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
                [2 ] bLeibniz-Institut für Infektionsbiologie und Naturstoff Forschung, Hans-Knöll Institut, Jena, Germany
                Author notes
                *Marie von Lilienfeld-Toal, Abteilung für Hämatologie und internistische Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Am Klinikum 1, DE–07747 Jena (Germany), Marie.von_Lilienfeld-Toal@ 123456med.uni-jena.de
                Copyright © 2020 by S. Karger AG, Basel

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                : 4 May 2020
                : 5 May 2020
                : 2020
                Page count
                References: 9, Pages: 2


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