Table 3.

Risk factors, treatment considerations, and challenges during COVID-19 for treatment of acute leukemia

Disease	Risk factors for increased mortality	Treatment considerations	Challenges
AML	• Older age at diagnosis • Myelosuppression due to underlying disease and treatment • Transfusion needs • Drug toxicities: cardiac dysfunction from anthracycline exposure, pulmonary toxicity due to midostaurin	• Intensive induction chemotherapy per usual guidelines • Use lower dose cytarabine followed by pegfilgrastim • Home labs till transfusions required • HMA based regimens for induction or maintenance favored	• Delaying consolidation or maintenance • Delaying allo-SCT • Differentiate COVID-19 from other infections
ALL	• Myelosuppression due to underlying disease and treatment • Hypogammaglobinemia • Transfusion needs • Frequent clinic visits • Drug toxicities: Cardiac dysfunction due to anthracycline exposure, pulmonary impairment due to methotrexate, additive prothrombotic risk with asparaginase	• Intensive induction chemotherapy per usual guidelines • Mini-HCVAD and blinatumomab preferable • Home labs till transfusions required • May omit vincristine	• Delaying consolidation or maintenance • Delaying allogenic SCT • Differentiate COVID-19 from other infections

AML, acute myeloid leukemia; ALL, acute lymphoblastic leukemia; allo-SCT, allogenic stem cell transplantation; HCVAD, hyper fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone