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Expert Point of View: Joseph Alvarnas, MD


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Joseph Alvarnas, MD

Joseph Alvarnas, MD

Joseph Alvarnas, MD, a hematologist/oncologist and Vice President of Government Affairs at City of Hope, Duarte, California, commented on the Reboot Rx meta-analysis.

“What has been striking about SARS-CoV-2 has been the variability of clinical symptoms among affected patients,” Dr. Alvarnas said. “For some, the virus has produced a near-asymptomatic experience, whereas for others, it has created profound disruptions in immunologic activation and regulation; profound perturbations in hemostasis and thrombosis; and irrecoverable damage to the brain, heart, lungs, liver, and kidneys.”

He continued: “Aside from some broad demographic descriptions of those patients who might be more vulnerable to [death from] the virus, including the elderly, obese, those with chronic lung and heart conditions, and patients with cancer, we have not had a more robust model for a more data-centric estimation of risk. This is particularly important for patients with cancer because decisions regarding treatment, site of care, selection of treatment regimen, and decision to delay care are being made with a paucity of data to help guide clinicians and their patients in their choices.”

Dr. Alvarnas noted that data from the Reboot COVID-Cancer Project should provide us with a deeper perspective on the relationship between cancer diagnosis and COVID-19 morbidity and mortality risk. “A comprehensive meta-analysis from the Reboot COVID-Cancer Project is now helping to fill in the blanks. The key findings from this meta-analysis included an overall COVID-19 mortality rate of 25% for patients with cancer. The level of risk, however, was not uniform across all patients or all cancer types. Those patients diagnosed with a hematologic malignancy had a risk of death that was nearly 50% greater than those with solid tumors. In addition, those with marrow failure states, B-cell malignancies, and acute leukemia had some of the highest mortality risk. Advanced age, male gender, and hospitalization all predicted a higher mortality risk,” he said.

“Among those patients with solid tumors, the risk of death was also not uniform. Those with lung cancer [a group originally identified in data from the Wuhan cohort], prostate cancer, and central nervous system tumors were all at a higher mortality risk,” he commented. He noted that the data are less clear on the impact of therapeutic modality selection on mortality risk, such as anti–B-cell therapy, immune-modulatory therapy, and cytotoxic chemotherapy.

“Based on these data, we now have the opportunity to reexamine and improve our systems for protecting those patients at highest risk and in delivering care in the safest setting possible, such as at a comprehensive cancer center like City of Hope,” Dr. Alvarnas stated. “In addition, these data should be integrated into efforts at mitigating infection risk through more effective vaccine distribution and vaccination efforts. Thus far, in a major failure of vaccine distribution efforts, patients with cancer have not been prioritized as potential vaccine recipients. These data should cause public health officials to reexamine their priority lists to ensure that they do not by design or by a lack of awareness fail to address the needs of this uniquely vulnerable set of patients.”

DISCLOSURE: Dr. Alvarnas reported no conflicts of interest.


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