Table 5.

Considerations for treatment of leukemia during the COVID-19 pandemic

Leukemia	Induction treatment	Consolidation and maintenance therapy	R/R patient	Reference
Acute leukemia
ALL	Ph-positive: 1. TKI+minimal corticosteroid exposure 2. TKI+low-dose chemotherapy	Ph-positive: 1. Consolidation therapy is not suggested for CR patients 2. TKI+corticosteroids (for maintenance therapy)	B-ALL: 1. Inotuzumab 2. Blinatumomab or CD22 CAR-T (with enough medical resources)	Gruber et al., 2009; Gavillet et al., 2020; Stock et al., 2020
ALL	Ph-negative: 1. Standard chemotherapy 2. Reduced dose for patients with high risk of complications 3. Minimized corticosteroids to relieve symptoms 4. G-CSF to facilitate the recovery of leukocyte count	Ph-negative: 1. Consolidation therapy is not suggested for CR patients 2. Allo-HSCT 3. Vincristine+prednisone+6-MP+MTX (for maintenance therapy)	T-ALL: 1. Standard nelarabine-based regimens 2. Salvage chemotherapy and targeted therapies when necessary	Gavillet et al., 2020; NCCN, 2020; Stock et al., 2020
AML	APL: 1. Targeted oral drugs (e.g., ATO+ATRA), for low-risk patients; for high-risk patients, regimens should include a cytotoxic agent 2. Dexamethasone (to prevent DS)	APL: ATO to achieve a low relapse rate	1. Salvage intensive re-induction 2. HSCT, aggressive chemotherapy or targeted therapies	Raza et al., 2020; Tallman et al., 2020
AML	Non-APL: 1. “7+3” regimen 2. Preventive antimicrobial drugs+G-CSF 3. Targeted drugs with reduced doses 4. Adjusted blood supply standards	Non-APL: 1. High-dose cytarabine+reduced-dose cytarabine (decreased to three cycles) 2. Oral BCL-2 inhibitor alone or combined with 5-azacitidine		Gavillet et al., 2020; NCCN, 2020; Tallman et al., 2020
Chronic leukemia
CLL	1. First-line treatment like ibrutinib could be continued with less frequent follow-ups 2. Monoclonal anti-CD20 antibodies and IVIG 3. Avoid the combination of targeted therapy 4. Venetoclax should be cautiously prescribed if necessary, owing to the need for frequent hemogram monitoring			Shadman et al., 2020
CML	1. Newly diagnosed: first-line treatment of TKI with the close monitoring of hemograms 2. Accelerated phase: continuing TKI if clinical response is positive 3. For others, dose interruptions or reductions could be considered			Mauro et al., 2020

ALL, acute lymphoblastic leukemia; Allo-HSCT, allogeneic hematopoietic stem cell transplantation; AML, acute myeloid leukemia; APL, acute promyelocytic leukemia; ATRA, all-trans retinoic acid; ATO, arsenic trioxide; B-ALL, B cell-ALL; CAR-T, chimeric antigen receptor T cell; CLL, chronic lymphoblastic leukemia; CML, chronic myeloid leukemia; COVID-19, coronavirus disease 2019; CR, complete remission; DS, differentiation syndrome; G-CSF, granulocyte-colony stimulating factor; IVIG, intravenous immunoglobulin; 6-MP, 6-mercapto-purine; MTX, methotrexate; Ph, Philadelphia chromosome; R/R, relapsed or refractory; T-ALL, T-cell ALL; TKI, tyrosine kinase inhibitors