Ishodi liječenja bolesnika s hematološkim zloćudnim bolestima za vrijeme COVID-19 pandemije

master's thesis

• Title (english): Treatment outcomes of patients with malignant hematological diseases during the COVID-19 pandemic
• Author: Irma Zdilar
• Mentor: Slobodanka Ostojić-Kolonić (mentor)
• Committee member: Tajana Filipec Kanižaj (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Slobodanka Ostojić-Kolonić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2022-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Hematološke zloćudne bolesti su skupina malignih novotvorina koje zahvaćaju koštanu srž, krvni i limfni sustav i uključuju: leukemije, ne-Hodgkinove limfome, Hodgkinov limfom, mijeloproliferativne neoplazme, multipli mijelom i mijelodisplastične sindrome, rjeđe hematološke neoplazme i granična stanja. COVID-19 (od eng. Coronavirus Disease 2019, koronavirusna bolest 2019.) je zarazna bolest uzrokovana virusom SARS-CoV-2 koji pripada obitelji Coronoviridae i čija je pandemija proglašena 11. ožujka 2020. To je bolest dišnog sustava koja se većinom očituje teškim respiratornim distresnim sindromom s dodatnim nerespiratornim simptoma. Pacijenti koji boluju od HZB imaju veći rizik od teže kliničke prezentacije COVID-19, duljeg trajanja bolesti i dulje hospitalizacije, veće stope prijema na JIL i veće vjerojatnosti za smrtni ishod. Različite hematološke zloćudne bolesti i modaliteti liječenja povezani su s jedinstvenim obrascima imunološkog oštećenja te dolazi do interakcija između njih, imunološkog sustava i COVID-19. Prema dosadašnjim studijama same hematološke zloćudne bolesti imaju značajniji učinak na morbiditet i mortalitet u tijeku infekcije COVID-19 u odnosu na prisustvo drugih komorbiditeta i vremenski interval između posljednje terapije hematološkog malignog oboljenja i početka infekcije. Pacijenti s hematološkim zloćudnim bolestima dugotrajno izlučuju virus i vjerojatno su duže infektivni. Smrtnost se povezuje s prestankom primjene terapije u JIL-u. Pacijenti s HZB imaju veću smrtnost od COVID-19 (37-42%) u odnosu na opću populaciju, uz veći rizik kod starije dobi, teške infekcije ili neke progresivne bolesti pa je bolnička skrb opravdana. Pacijenti s Hodgkinovim limfomom imaju nešto bolje ishode. Neposredno liječenje COVID-19 ima primarni prioritet u odnosu na hematološke zloćudne bolesti. U terapiji se koriste antivirusne ljekove, infuzija rekonvalescentne plazme, imunomodulatorni ljekovi, antiinflamatorni ljekovi i antikoagulantna terapija. S obzirom da pandemija COVID-19 i dalje traje i da danas postoje cjepiva za ovu infekciju, vakcinacija zajedno s preventivnim mjerama na svim razinama predstavljaju najvažniju mjeru u borbi protiv infekcije COVID-19 kod pacijenata s HZB, ali njihova učinkovitost u stvaranju imunosne zaštite ostaje upitna.

Abstract (english)

Haematological malignancies are a group of malignant neoplasms that affect the bone marrow, blood and lymphatic system and include: leukemias, non-Hodgkin's lymphomas, Hodgkin's lymphoma, myeloproliferative neoplasms, multiple myeloma, myelodysplastic syndromes and less common hematologic neoplasms. COVID-19 (from Coronavirus Disease 2019, coronavirus disease 2019) is an infectious disease caused by the SARS-CoV-2 virus belonging to the family Coronoviridae and whose pandemic was declared on March 11, 2020. It is a respiratory disease that is mostly manifested by severe respiratory distress syndrome with additional nonrespiratory symptoms. Patients with haematological malignancies have a higher risk of more severe clinical presentation of COVID-19, longer disease duration and longer hospitalizations, higher rates of admission to ICU, and higher likelihood of death. Different hematological malignancies and treatment modalities are associated with unique immune system damage and there is an interaction between haematological malignancies, the immune system, and COVID-19. According to previous studies, HM alone have a more significant effect on morbidity and mortality during COVID-19 infection compared to the presence of other comorbidities and the time interval between the last treatment of haematological malignancy and the onset of infection. Patients with HM secrete the virus for a long time and are likely to be infectious longer. Mortality is associated with discontinuation of therapy in ICUs. Patients with HM have a higher mortality rate (37-42%) of COVID-19 than the general population, with a higher risk of old age, severe infection or some advanced disease, so hospital care is justified. Patients with Hodgkin's lymphoma have slightly better outcomes. Immediate treatment of COVID-19 has primary priority over hematologic malignancies. Antiviral drugs, convalescent plasma infusion, immunomodulatory drugs, anti-inflammatory drugs and anticoagulant therapy are used in the therapy. Given that the COVID-19 pandemic continues and that vaccines for this infection exist today, vaccination along with preventive measures at all levels represent the most important measure in the fight against COVID-19 infection in patients with HM, but their effectiveness in creating immune protection remains questionable.

• Keywords: hematološke zloćudne bolesti; leukemija; limfom; mijelom; COVID-19; ishodi liječenja; prevencija; cijepljenje
• Keywords (english): haematological malignancies; leukemia; lymphoma; myeloma; COVID-19; treatment outcomes; prevention; vaccination
• Language: croatian
• URN:NBN: urn:nbn:hr:105:042030
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-03-23 09:35:34