Against daily news articles on COVID-19’s impact and possible new treatments or vaccines, it can be very hard to get a clear picture of the research landscape around the virus. Here Anthony Nolan’s Dr Jonathan Kay summarises the medical research underway to improve our understanding of COVID-19 and examines how it affects patients with blood cancer.
Jonathan also talks about IMPACT’s COVID-19 clinical trial for stem cell transplant patients which is part funded by Anthony Nolan.
How does COVID-19 affect people with blood cancer?
With almost every aspect of our daily lives impacted by the coronavirus pandemic, it’s safe to say the last few months have been a difficult time for all of us. But for people with long term health conditions like blood cancer, the current health crisis poses even greater challenges.
Many patients are at a higher risk of developing severe COVID-19 symptoms due to their illness, as well as pre-transplant chemotherapy and immunosuppressive medication during their recovery.
How do blood cancer patients respond to COVID-19?
We are still in the very early stages of determining how coronavirus affects patients with blood cancer. To date, only a handful of studies have been carried out across the world, using a relatively small number of patients.
The recurring themes from this research are that blood cancer patients are at a higher risk of becoming infected and are more likely to experience serious complications from coronavirus. According to some preliminary reports, when comparing immunocompromised patients to the general population, this risk could be as high as 10 times more likely.
When we consider the UK, one of the first studies to be conducted looked at 35 blood cancer patients who contracted coronavirus in hospitals across London. Encouragingly, roughly two thirds of patients made a successful recovery from the infection during the length of the study. This might suggest that even though blood cancer patients experience more complications than the general population after infection, the majority are able to make a full recovery relatively quickly.
Of the patients who passed away, almost all of them were aged 70 or older and all of them had at least one other long-term health complication such as high blood pressure or diabetes. This study raises the possibility of identifying patients at a higher risk of developing COVID-19-related complications who could benefit from more tailored advice and treatments compared to others. However, over time, we will need to look at more patients from across the UK to get a better understanding how important these risk factors are.
How can we treat patients with COVID-19?
One of the biggest challenges the research community has faced is how rapidly COVID-19 has spread. It has become a worldwide problem so quickly that it’s almost impossible to develop new treatments which are both safe and effective in the same timeframe.
Instead, attention has been placed on repurposing existing treatments, such as anti-viral drugs, which may prove to also work on coronavirus. Anti-cancer drugs like Remdesivir and anti-malaria treatments such as hydroxychloroquine are currently being tested but have produced mixed, and sometimes questionable, results.
A second approach to treating COVID-19 involves targeting the immune system. After infection, some patients experience sepsis-like symptoms due to a severe overreaction of their immune system. If this can be successfully controlled, it can allow the patient to clear the virus from their system and make a full recovery.
While this is possible using drugs, another way to achieve this outcome is to use cell therapy, where living cells from a volunteer are given to a patient. Mesenchymal stromal cells (MSCs) are a type of cell found in the bone marrow whose normal function is to control the immune system and prevent inflammation. This means they have the potential to stop the immune system overreacting in response to coronavirus.
The first early trials in China involving MSCs as a coronavirus treatment have shown promising results with patients generally recovering quicker and showing less symptoms compared to those who were given standard treatments.
How does COVID-19 affect stem cell transplant recipients?
It’s currently very difficult to predict how stem cell transplant recipients might react once they develop COVID-19 symptoms. Early evidence suggests that these patients could develop the uncontrolled inflammatory response described above, as well as further complications if they are taking immunosuppressants to treat GvHD. This could lead to a longer recovery period for patients, raising the risk of them passing on the virus to other people in the meantime.
To improve our understanding, a new clinical trial has been set up though the IMPACT partnership which is funded by Anthony Nolan, Leukaemia UK and NHS Blood and Transplant. It consists of 21 UK hospital and transplant centres, and allows allow the accelerated delivery of clinical trials and the sharing of knowledge to help patients benefit from innovative treatments quicker.
The study will recruit up to 60 patients who tested positive for COVID-19 and have symptoms which require oxygen treatment. Samples of their blood will then be analysed for various markers including white blood cell numbers to see how their immune systems are reacting to the virus. Patients will be examined at 30 and 100 days after diagnosis to assess how their recovery progresses. The results of the study will be published in early 2021.
COVID-19 is likely to remain an ongoing health challenge for current and future stem cell transplant patients even after the initial pandemic ends. The study’s findings will give us a deeper understanding of the illness and enable clinicians to identify better ways to monitor and treat transplant patients. Ultimately, this will improve both their chance of making a successful recovery and their quality of life post-transplant.
Anthony Nolan will continue to monitor the latest COVID-19 related research and provide relevant updates for our patients and their families. If you have any concerns about coronavirus and how it could affect your own situation, please talk to your medical team. You can also leave a question in the comments section below or contact our Patient Services team on 0303 303 0303 or patientinfo@anthonynolan.org. We’re here for you.