Antineoplastics

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An event is serious (based on the ICH definition) when the patient outcome is:

• * death

• * life-threatening

• * hospitalisation

• * disability

• * congenital anomaly

• * other medically important event

A case report series described three men aged 26−39 years, who experienced Covid-19 infection or re-infection during chemotherapy with bortezomib, daratumumab, dasatinib, dexamethasone, pegaspargase, pomalidomide, vincristine, unspecified anthracyclines, steroids or antineoplastics [not all routes stated; doses and durations of treatments to reactions onsets not stated].

Patient 1: A 39-year-old man, who had been receiving bortezomib, pomalidomide and weekly dexamethasone for high-risk multiple myeloma, tested positive for Covid-19 on RT-PCR performed on nasal and nasopharyngeal swab samples during routine screening, on 29 June 2020. The Covid-19 infection was attributed to the immunosuppression caused by bortezomib, pomalidomide and dexamethasone. He was asymptomatic (mild Covid-19) and remained in quarantine for 2 weeks. He was discharged following recovery (when repeat RT-PCR performed on nasal and nasopharyngeal swab samples on 8 July 2020 was found to be negative). Post discharge, he continued receiving chemotherapy, and daratumumab was added. About 3 months after he tested negative for Covid-19, he developed chills, high-grade fever and rapidly worsening shortness of breath. He was hospitalised. Chest X-ray suggested bilateral viral pneumonia. RT-PCR performed on 30 September 2020 on nasal and nasopharyngeal swab samples confirmed SARS-CoV-2 infection, which was attributed to the immunosuppression caused by bortezomib, pomalidomide, dexamethasone and daratumumab. Given the severity of the infection, he received high flow oxygen, non-invasive ventilation, remdesivir, off-label IV immune globulin and convalescent-anti-SARS-CoV-2-plasma [convalescent plasma]. He gradually made a complete recovery from the Covid-19 re-infection.

Patient 2: A 26-year-old man, who had been receiving dasatinib and unspecified oral antineoplastics [chemotherapy] for Philadelphia chromosome-positive acute lymphoblastic leukaemia (ALL), tested positive for Covid-19 during evaluation for cough and fever, on 15 June 2020. His condition clinically deteriorated. He was hospitalised and managed as severe Covid-19 pneumonia, which was attributed to the immunosuppression caused by dasatinib and the unspecified antineoplastics. Management involved non-invasive ventilation and remdesivir. He was discharged on day 20 of his illness (when repeat RT-PCR performed on nasal and nasopharyngeal swab samples on 7 July 2020 was found to be negative). He continued receiving dasatinib and oral antineoplastics. Later, in October 2020, he developed headache, submandibular lymphadenopathy, vomiting and high-grade fever. Subsequent analyses were suggestive of ALL relapse. RT-PCR performed on 6 October 2020 on nasal and nasopharyngeal swab samples confirmed SARS-CoV-2 infection. He was hospitalised and managed as severe Covid-19 pneumonia. He gradually made a complete recovery from the Covid-19 re-infection.

Patient 3: A 33-year-old man, who had T-cell ALL, tested positive for Covid-19, on 30 July 2020, during screening prior to initiating chemotherapy. He was discharged following recovery. He subsequently started receiving intensive chemotherapy, comprising vincristine, pegaspargase [pegylated L-asparginase], high-dose steroids and anthracyclines [drugs not specified]. He developed a fever in October 2020. RT-PCR performed on 8 October 2020 on nasal and nasopharyngeal swab samples confirmed SARS-CoV-2 infection, which was attributed to the immunosuppression caused by vincristine, pegaspargase, and unspecified steroids and anthracyclines. He was hospitalised and managed as a case of moderate Covid-19. He received high flow oxygen, and he gradually recovered from the Covid-19 re-infection in early November 2020.