Q1: Are patients with thalassemia more susceptible to serious COVID-19 disease? Does splenectomy confer a higher risk?
Thalassemia patients, especially young adults/adults, have a chronic condition potentially associated with co-morbidities impacting on the heart and lungs. Therefore, COVID-19 disease could be predicted to be more severe following SARS-CoV-2 infection. However, to date no information specifically focused on thalassemia patients has been disseminated. A small cohort of Italian patients followed in the northern part of Italy, where the pandemic has been the most widespread, experienced relatively mild to moderate disease. The number of infected thalassemia patients was lower than expected, likely due to earlier and more vigilant self-isolation compared to the general population.
Splenectomy is not known to increase the general risk of viral infection or severe viral disease, but no specific data exists for SARS-CoV-2, however splenectomized patients should be covered for secondary bacterial infections.
Q2: Should any changes in transfusion schedules or thresholds be made in the context of the COVID-19 pandemic?
At present there is no evidence that the SARS-CoV-2 virus may be transmitted through donated blood. It is advisable to maintain the individual’s chronic transfusion regimen. Clinics and infusion centers should offer patients the safest possible environment for receiving transfusions, in areas free of COVID-19 patients or those being screened for respiratory symptoms and providing health care personnel protective equipment.The local blood banks however should be preparing for potential blood shortage due to reduction of donations, and in particular should start contingency planning for chronically transfused patients requiring specialized procurement due to alloimmunization.
Q3: Should thalassemia patients continue iron chelation if they are exposed to or have confirmed COVID-19 disease?
No data are available. If a patient is exposed but asymptomatic there is no reason to interrupt iron chelation. If a patient becomes symptomatic, particularly with moderate to severe disease, then interruption of iron chelation is advisable, with immediate conversation between the treating physicians and the hematologist. Liver enzyme elevations are a marker of severe COVID-19 disease, and interpretation in the context of iron overload and chelation may be challenging.
Q4: What about treatment with the recently approved disease-modifying drug luspatercept during the COVID-19 pandemic?
No data are available to date. There are no theoretical contraindications to stop treatment. If the drug has decreased transfusion frequency, then continuing treatment would be beneficial in terms of avoiding prolonged clinic visits for transfusions and decreasing dependence on a limited blood supply.
Q5: What are the recommendations for stem cell transplantation or gene therapy for thalassemia during the COVID pandemic?
Due to high risk of infection in hospital setting and the risk of myeloablation, allogeneic stem cell transplantation and gene therapies should be postponed until the pandemic abates. If conditioning has already begun, the transplant must proceed. There is no evidence or theoretical expectation that SARS-CoV-2 could be transmitted via hematopoietic stem cell grafts.
A cura di: Maria Cappellini, Antonio Piga, Janet Kwiatkowski and Alexis Thompson
Additional resources
For patients:
Cooley Anemia Foundation https://www.thalassemia.org/covid-19-resources-for-people-with-thalassemia
Thalassemia Interionational Federation https://thalassaemia.org.cy/covid-19-pandemic/tif-material-on-covid-19/
