key: cord-0845017-qbrffy0i authors: Papadavid, Evangelia; Scaribrick, Julia; Ortiz Romero, Pablo; Guaglino, Pietro; Vermeer, Maarten; Knobler, Robert; Stadler, Rudolf; Bagot, Martine title: Management of primary cutaneous lymphoma patients during COVID‐19 pandemic: EORTC CLTF guidelines Maarten Vermeer date: 2020-05-16 journal: J Eur Acad Dermatol Venereol DOI: 10.1111/jdv.16593 sha: 9b2e8abbebf5c8d3b4143478511c1efac1a2ef2a doc_id: 845017 cord_uid: qbrffy0i During severe inflammatory coronavirus infectious disease (CoVID‐19) pandemic and based on evidence on COVID‐19 epidemiology, patients with primary cutaneous lymphomas (PCLs) have risk for developing complicated COVID‐19 infections in consideration of their older age (majority above 60) and their potential underlying predisposing conditions (e.g. hypertension, diabetes).(1,2,3) Moreover, PCL patients with aggressive biologic behavior should be carefully monitored according to guidelines for patients with neoplastic disease. During severe inflammatory coronavirus infectious disease pandemic and based on evidence on COVID-19 epidemiology, patients with primary cutaneous lymphomas (PCLs) have risk for developing complicated COVID-19 infections in consideration of their older age (majority above 60) and their potential underlying predisposing conditions (e.g. hypertension, diabetes). 1, 2, 3 Moreover, PCL patients with aggressive biologic behavior should be carefully monitored according to guidelines for patients with neoplastic disease. 4,5 The basic effort is to really protect patients from getting the virus according to CDC guidelines and on the suggestions made by hematology and oncology groups. from a-and oligosymptomatic to full-blown influenza-like illness and primary viral pneumonia will follow. Cancer patients with CARV-infections are prone to co-infections, and bacterial/fungal superinfections are the primary cause for CARV-associated mortality in cancer patients. 6 In the absence of more specific data, potential risk factors for severe course of COVID19 disease should be assumed as for other CARV-infections: severe immunodeficiency, lymphopenia, long and profound neutropenia and older age. Severely immunosuppressed patients generally have a higher risk of developing complications in CARV infections and it should be assumed that cancer patients are at risk of a more severe course of COVID-19 as well. There are limited data on immunosuppressed hosts, but early published reports from China on the outcomes of patients with cancer infected with COVID- This article is protected by copyright. All rights reserved 19 indicated a 3.5 times higher risk of needing mechanical ventilation or ICU admission or dying compared with patients without cancer. 3 The prognosis is bad for an oncology patient with late-stage disease or comorbid health conditions, such as heart or lung dysfunction, who acquires COVID-19 and requires mechanical ventilation. 2 According to a recent retrospective study from Wuhan, China, only one patient survived among 32 who were seriously ill with confirmed COVID-19 and required mechanical ventilation. 2 PCLs are rare non-Hodgkins lymphomas, localized to the skin, without any extracutaneous involvement at the time of initial diagnosis. PCLs can originate either from T or B lymphocytes, called cutaneous T-cell lymphomas CTCL accounting for 75% of PCLs or MF is the most common PCL and is initially characterized by patches and infiltrated plaques on the skin which eventually evolve into tumors. 9 On the other hand, SS is the leukemic variant of MF, characterized by erythroderma, lymphadenopathy and the presence of a malignant T-cell clone in the peripheral blood and the skin. 9 The median age at diagnosis ranges from 52 to 62 years and all studies had a male predominance of 1.6 (male:female ratio This article is protected by copyright. All rights reserved 6:4) in accordance with previous reports. [10] [11] MF is a slowly developing, low-grade lymphoma with a progressive accumulation of atypical lymphocytes in the skin's epidermis, leading from patches and plaques to a more aggressive disease with the typical ulcerated nodules, and in later phases with migration of T-cells to lymph nodes, peripheral blood and visceral organs. Overall survival correlates with stage, advanced stages of MF and SS are comprised of stages IIB-IVB and are associated with a worse prognosis than early-stage disease: patients with stage I MF may have a long survival whereas survival is poor in advanced MF and SS with median survival quoted at about 3 years and a 5-year overall survival of between 10% and 20%. 10 Most patients die of opportunistic infections due to an incompetent immune system. [12] [13] [14] [15] [16] There is a great variation in survival within the stages of MF and SS and the importance of poor prognostic indices outside the staging system has been recognized in determining prognosis within the same stage, ie Survival in stage IB MF is significantly reduced in up to one in five patients, with death within 5 years of diagnosis. 17 In clinical practice, treatment choice depends on the type and biologic behavior of the lymphoma and is adapted to clinical stage. 19 For patients with advanced disease, prognosis is still grim, and only for a highly select subset of patients, prolonged survival can be achieved with allogeneic stem cell transplantation (alloSCT). 19 Skin-directed therapies are still the most appropriate option for early-stage MF, and most patients in stage IA will have a normal life expectancy but morbidity from skin symptoms such as itch and pain, emotional disturbance from unsightly lesions and dealing with a non curable disease reduced function ie This article is protected by copyright. All rights reserved from lesions on the hands can negatively impact on quality of life. 20 These patients could be treated with Topical potent steroids or/and Ledaga available in some European countries. In France the drug will be soon available not only in hospital pharmacy but also in local pharmacy. This article is protected by copyright. All rights reserved This article is protected by copyright. All rights reserved Clinical Characteristics of Coronavirus Disease 2019 in China Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study EORTC classification for primary cutaneous lymphomas Querfeld C Management of cutaneous T cell lymphoma: new and emerging targets and treatment options Cutaneous T cell lymphoma: epidemiology, etiology and classification Prognostic indicators for mycosis fungoides in a Greek population Cutaneous lymphoma incidence patterns in the United States: a population-based study of 3884 cases Prognostic factors, prognostic indices and staging in mycosis fungoides and Sézary syndrome: where are we now? The 2016 revision of the World Health Organization classification of lymphoid neoplasms Stage I mycosis fungoides: frequent association with a favourable prognosis but disease progression and disease-specific mortality may occur Accepted Article This article is protected by copyright. All rights reserved The PROCLIPI international registry of early-stage mycosis fungoides identifies substantial diagnostic delay in most patients Overall Survival in Mycosis Fungoides: A Systematic Review and Meta-Analysis Survival in Mycosis Fungoides and Sezary Syndrome: How can we predict outcome? European Organisation for Research and Treatment of Cancer consensus recommendations for the treatment of mycosis fungoides/Sézary syndrome -Update Characteristics associated with significantly worse quality of life in mycosis fungoides/Sézary syndrome from the Prospective Cutaneous Lymphoma International Prognostic Index (PROCLIPI) study ECIL-4): guidelines for diagnosis and treatment of human respiratory syncytial virus, parainfluenza virus, metapneumovirus, rhinovirus, and coronavirus Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents Long-Term Shedding of Influenza Virus, Parainfluenza Virus, Respiratory Syncytial Virus and Nosocomial Epidemiology in Patients with Hematological Disorders COVID-19, A Clinical Syndrome Manifesting as Hypersensitivity Pneumonitis Accepted Article