key: cord-0713223-g2i96lmc authors: Foà, Robin; Bonifacio, Massimiliano; Chiaretti, Sabina; Curti, Antonio; Candoni, Anna; Fava, Carmen; Ciccone, Maria; Pizzolo, Giovanni; Ferrara, Felicetto title: Ph+ Acute Lymphoblastic Leukaemia in Italy During the Covid‐19 Pandemic. A Campus ALL Study date: 2020-05-05 journal: Br J Haematol DOI: 10.1111/bjh.16758 sha: a07927bc34de5f4dba00cfd57e42c7c016199de3 doc_id: 713223 cord_uid: g2i96lmc The recent spread of the Covid‐19 infection has raised important questions within the haematology community on how best to manage and treat patients with haematological malignancies, particularly acute leukaemias. Italy has witnessed a dramatic raise in infections and death rates, that has hit in particular certain areas of the most populated Northern regions of the country (Lombardia, Veneto, Piemonte, Emilia Romagna). Within the nationwide Campus ALL programme in the last week of March we sent a questionnaire addressing different issues related to the management of adult ALL patients during the Covid‐19 pandemic to 40 haematology centres located on the entire territory. The recent spread of the Covid-19 infection has raised important questions within the haematology community on how best to manage and treat patients with haematological malignancies, particularly acute leukaemias. Italy has witnessed a dramatic raise in infections and death rates, that has hit in particular certain areas of the most populated Northern regions of the country (Lombardia, Veneto, Piemonte, Emilia Romagna). Within the nationwide Campus ALL programme in the last week of March we sent a questionnaire addressing different issues related to the management of adult ALL patients during the Covid-19 pandemic to 40 haematology centres located on the entire territory. Twenty-four centres were based in Northern Italy (North of Rome), mostly affected by the Covid-19 outbreak. So far, in the large majority of centres throughout the country patients are screened prior to being admitted as inpatients, while this procedure is not routinely carried in most centres for outpatients, unless they present symptoms potentially ascribable to the Covid-19 infection. In this analysis, we focused on Philadelphia (Ph)+ ALL, for which a second questionnaire was sent at the beginning of April. The interest in Ph+ ALL relates to its incidence that increases with age accounting for about 50% of B-lineage ALL patients over 50 1 , to the key role played by tyrosine kinase inhibitors (TKI) and to the approach taken in Italy to treat adult Ph+ ALL. We got information on a total of 267 adult Ph+ ALLs currently managed at these centres. One hundred and twenty-eight patients came from the 4 regions most affected by Covid-19; 62.2% of patients were aged 18-60 and 37.8% were >60 years (20 >70, 7 >80). So far, only 1 patient has proven Covid-19+. Because of pneumonitis and cellulitis, this patient was transferred to the ICU and from there to a department of internal medicine that developed a Covid-19 outbreak and where he got infected. He is now well and asymptomatic. Only 1 patient proved symptomatic but tested negative. This information refers to all Ph+ ALL patients managed at the different centres. The obvious question is how Ph+ ALL patients should be treated during the Covid-19 pandemic, The possibility that TKIs may play a role in protecting patients from the Covid-19 infection has been suggested pre-clinically 6 and a randomized study aimed at verifying the effect of imatinib in preventing pulmonary vascular leak in patients with severe Covid-19 disease is ongoing (EudraCT 2020-001236-10). Finally, an immunosuppressed status may not be a risk factor for Covid-19 adverse events 7-9 , as documented also in liver transplanted patients 10 . It becomes increasingly important that Ph+ ALL patients are rapidly identified at diagnosis and we once again advocate for a chemo-free induction strategy. It is worth recalling that with dasatinib (and steroids) alone 20-25% of patients can become molecularly negative 4, 5 and that with the addition of blinatumomab this increases to 60% 5 . Under such a TKI-based strategy, in Italy adult Ph+ ALL of all ages could continue to be managed as before even during the outbreak and peak of the Covid-19 epidemics. Clinico-biological features of 5202 patients with acute lymphoblastic leukemia enrolled in the Italian AIEOP and GIMEMA protocols and stratified in age cohorts Management of adult Ph-positive acute lymphoblastic leukemia Imatinib plus steroids induces complete remissions and prolonged survival in elderly Philadelphia chromosomepositive patients with acute lymphoblastic leukemia without additional chemotherapy: results of the Gruppo Italiano Malattie Ematologiche dell'Adulto (GIMEMA) LAL0201-B protocol Dasatinib as first-line treatment for adult patients with Philadelphia chromosome-positive acute lymphoblastic leukemia Dasatinib-blinatumomab combination for the front-line treatment of adult Ph+ ALL patients. Updated results of the GIMEMA LAL2116 D-Alba trial Accepted Article This article is protected by copyright. All rights reserved Potentially highly potent drugs for 2019-nCoV COVID-19, cytokines and immunosuppression:what can we learn from severe acute respiratory syndrome? COVID-19: the new challenge for rheumatologists COVID-19: consider cytokine storm syndromes and immunosuppression Coronaviruses and immunosuppressed patients. The facts during the third epidemic Accepted Article Acknowledgments. The authors wish to thank all the Campus ALL colleagues who provided data of their patients. Partly supported by Associazione Italiana Ricerca sul Cancro (AIRC), Special 5x1000 Program Metastases (21198), Milan (Italy) to RF.