key: cord-0863821-70hysznv authors: Tralongo, Antonino C.; Extermann, Martine title: Older patients with cancer and febrile neutropenia in the COVID-19 era: A new concern date: 2020-06-18 journal: J Geriatr Oncol DOI: 10.1016/j.jgo.2020.06.021 sha: 6c3158e142e819f4b4503903c64de41b62ea3454 doc_id: 863821 cord_uid: 70hysznv nan patients under febrile neutropenia does not seem to influence mortality. However, it shows a reduction in hospitalization time and a faster recovery of neutrophils count 3 . Both of these factors could be important for older patients because a prolonged neutropenic status and hospitalization could compromise the outcome. In this background, the clinicians, based on the clinical situation, use to consider the administration of G-CSF in older patients with cancer affected by febrile neutropenia. Nevertheless, the care of older populations with cancer could be compromised by a new infection, provided by a new type of virus and named coronavirus disease 2019 (COVID-19). The mechanism of action of this virus is not clearly understood and it is still under investigation. The central hypothesis is the association among virus replication, over-response of the immune system, and hypercoagulability state, compromising the respiratory function and, in some cases, leading to death 4 . Although this infection could affect individuals of any age, it predominantly occurs in adults and persons with comorbidities, and in particular older adults are more likely to develop severe disease. Recent studies identified older age as a risk factor for high mortality in patients affected by COVID-19 5,6 . Febrile neutropenia in this setting could represent a harder challenge for the oncologists. Moreover, binding the G-CSFr with a monoclonal antibody, neutrophils count, the protein levels in the bronchoalveolar lavage (BAL), and fluid (a marker of edema) are significantly reduced, decreasing the inflammation, without affecting pathogen clearance 8 . Therefore, a correlation between the administration of G-CSF and a worsening of pneumonia could be more than just a suggestion. This kind of event could be fatal in this setting, and if true, especially for the older patients, it could change the actual recommendations about the administration of G-CSF as a therapeutic intent. To avoid the COVID-19 related complications in these patients, testing for COVID-19 all cancer patients with febrile neutropenia, before the G-CSF administration, could be an option. To know the status of every single patient in this scenario could make the difference, considering that, in the experience mentioned above, the outcome was fatal. This is particularly important for the frailer cancer patients, in particular the oldest old. Starting to think about a potential solution and collect more data about this issue is becoming crucial, as presently COVID-19 is a pandemic likely to last for a while. The authors declare that there is not conflict of interest. Management of chemotherapyinduced neutropenia in patients with cancer: 2019 guidelines of the Italian Medical Oncology Association (AIOM) Neutropenia Guidelines in the Cancer Patient Population Colony-stimulating factors for chemotherapy-induced febrile neutropenia The procoagulant pattern of patients with COVID-19 acute respiratory distress syndrome Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the Granulocyte-colony stimulating factor in COVID-19: Is it stimulating more than just the bone marrow?