Table 4 Summary of ECIL-2021 recommendations on the treatment of SARS-CoV-2 infection and COVID-19 in haematology patients.

From: Recommendations for the management of COVID-19 in patients with haematological malignancies or haematopoietic cell transplantation, from the 2021 European Conference on Infections in Leukaemia (ECIL 9)

 

Pre-exposure prophylaxis

Post-exposure prophylaxis

Mild COVID-19

Moderate COVID-19

Severe COVID-19

Critical COVID-19

COVID-19 signs or symptoms?

No

No

Mild or moderate, no dyspnoea, no need for COVID-19-related admission

Yes, clinical or radiological evidence of LRTD, O2 saturation >90%, but hospitalised and receiving O2

Yes, respiratory failure

O2 saturation <90% and/or RR > 30/min, but some studies considered severe if O2 saturation <94% or <92%

ARDS, sepsis, septic shock, MV (invasive or non-invasive) or vasopressor therapy

Treatment

long-acting anti-SARS-CoV-2 Mabs (AZD7442) in non-immunised patients at risk for severe COVID-19

Anti-S MAbs in patients at high risk for COVID-19 progression (not vaccinated, vaccine non-responders or not expected to respond to vaccine)

Anti-S MAbs

or

High-titre CVPa

or

Inhaled IFN b-1a

or

Molnupiravir

or

Remdesivir

or

Ritonavir/nirmatrelvir

Colchicine (in the absence of other therapeutic options)

Dexamethasone not indicated

Remdesivir

C/I or CVP if seronegativea

Dexamethasone

C/I if seronegative (in NIV, no data in MIV)

Dexamethasone

Remdesivir not indicated

If worsening despite dexamethasone and present severe COVID-19-related inflammationb, add the 2nd immunosuppressant anti-IL-6 (tocilizumab, sarilumab)

or

anti-IL1 (anakinra)

or

JAK–inhibitor (baracitinib/tofacinib)

If severe COVID-19- related inflammation presentb,

add the 2nd immunosuppressant:

Anti-IL-6 (tocilizumab, sarilumab)

or

anti-IL1 (anakinra)

or

JAK-inhibitor (baracitinib/tofacinib)

If COVID-19-related inflammation presentb, add the 2nd immunosuppressant,

Anti-IL-6 (tocilizumab, sarilumab)

  1. Anti-S MAbs monoclonal antibodies against spike protein of SARS-CoV-2, C/I casirivimab/imdevimab, CVP convalescent plasma, LRTD lower respiratory tract disease, MV mechanical ventilation: MIV invasive, NIV non-invasive, RR respiratory rate.
  2. aIf Anti-S MAbs not available, preferably within 72 h from symptom onset.
  3. be.g. CRP >75 mg/dl in the absence of bacterial coinfection or other available inflammation parameters or scores (if not altered due to the underlying haematological disease). The effects of immunomodulatory therapies targeting COVID-19 on the course of disease in already immunosuppressed patients are poorly understood and deserve special consideration.
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