PDF(Pubmed)
Abstract：
The COVID-19 outbreak had a strong impact on people\'s lives all over the world. Patients with hematologic diseases have been heavily affected by the pandemic, because their immune system may be compromised due to anti-cancer or immunosuppressive therapies and because diagnosis and treatment of their baseline conditions were delayed during lockdowns. Hematologic malignancies emerged very soon as risk factors for severe COVID-19 infection, increasing the mortality rate. SARS-CoV2 can also induce or exacerbate immune-mediated cytopenias, such as autoimmune hemolytic anemias, complement-mediated anemias, and immune thrombocytopenia. Active immunization with vaccines has been shown to be the best prophylaxis of severe COVID-19 in hematologic patients. However, the immune response to vaccines may be significantly impaired, especially in those receiving anti-CD20 monoclonal antibodies or immunosuppressive agents. Recently, antiviral drugs and monoclonal antibodies have become available for pre-exposure and post-exposure prevention of severe COVID-19. As adverse events after vaccines are extremely rare, the cost-benefit ratio is largely in favor of vaccination, even in patients who might be non-responders; in the hematological setting, all patients should be considered at high risk of developing complications due to SARS-CoV2 infection and should be offered all the therapies aimed to prevent them.
摘要：
COVID-19的爆发对世界各地人们的生活产生了强烈影响。血液病患者受到大流行的严重影响，因为他们的免疫系统可能由于抗癌或免疫抑制治疗而受损，并且因为他们的基线状况的诊断和治疗在锁定期间被延迟。恶性血液病作为严重COVID-19感染的危险因素很快出现，提高死亡率。SARS-CoV2还可以诱导或加剧免疫介导的血细胞减少症，如自身免疫性溶血性贫血，补体介导的贫血，和免疫性血小板减少症。疫苗主动免疫已被证明是血液病患者严重COVID-19的最佳预防方法。然而,对疫苗的免疫反应可能显著受损，尤其是那些接受抗CD20单克隆抗体或免疫抑制剂的患者。最近,抗病毒药物和单克隆抗体已可用于严重COVID-19的暴露前和暴露后预防。由于疫苗接种后的不良事件极为罕见，成本效益比在很大程度上有利于疫苗接种，即使是可能无应答的患者；在血液学环境中，所有患者都应被视为SARS-CoV2感染导致并发症的高风险,并应提供所有旨在预防这些并发症的治疗方法.
