Managing a Patient with AML Who Also Has COVID-19, According to Dr. Mikkael Sekeres

Things to Know From One of the Country’s Leading Voices on Cancer Care and Survivorship

• According to Dr. Mikkael Sekeres, don’t change therapeutic recommendations for the cancer in order to minimize patient contact with the health care system
• Studies are showing that patients receiving chemotherapy are not at higher risk of bad outcomes from COVID-19
• Dr. Sekeres maintains a low threshold for admitting hematologic cancer patients to the hospital for closer monitoring or to initiate therapy in order to prevent the infection from becoming severe

Prevention and treatment of COVID-19 is not markedly different for patients with cancers of the blood and bone marrow than it is for anyone else, according to the University of Miami’s Dr. Mikkael Sekeres, who formally practiced at the Cleveland Clinic. “When I have a patient who has a hematologic malignancy who also has a COVID-19 infection, I take it seriously. . . just as I would anybody who has a COVID-19 infection,” he tells SurvivorNet Connect. Dr. Sekeres says he recommends that patients who have mild symptoms stay at home, “but I have a very low threshold for bringing them into the hospital for closer monitoring or even to initiate therapy with, for example, steroids or monoclonal antibodies, to prevent that infection from becoming severe.”

Dr. Sekeres says he’s regularly asked about the wisdom of changing therapy recommendations for malignancies like acute myeloid leukemia or myelodysplastic syndrome in order to minimize patient contact with health care settings where they might be at greater risk of contracting the novel coronavirus. “Or I’m asked if the treatment itself will mean that outcomes with COVID-19 will be worse,” he says. “My advice is that our patients who have a particularly high risk of myelodysplastic syndromes or acute leukemias need their treatments. Their risk of dying from these cancers is much higher than their risk of dying from COVID-19. We need to treat their cancer more urgently than we need to worry about their getting COVID-19.”

New studies are showing that patients receiving chemotherapy are not at higher risk of complications or bad outcomes from COVID-19. “I do feel it’s safe to initiate chemotherapy in patients with very serious cancers,” he says.

Dr. Sekeres urges his patients to take careful precautions against infection with the novel coronavirus. “I advise some of my patients to wear goggles or face shields as well as a mask. . . or two masks,” he says. He also urges frequent hand-washing “when coming into contact with anybody, nevermind health care facilities, and limiting the number of touches they have in a health care environment.”