COVID-19 in Adult Patients with Hematological Malignancies-Lessons Learned after Three Years of Pandemic

Simple Summary The COVID-19 pandemic significantly affected the clinical outcomes and management of patients with hematological malignancies, who are especially vulnerable to infections. At the time of the pandemic outbreak, when a highly virulent wild-type strain of SARS-CoV-2 (B.1) was responsible for the majority of infections, mortality rates among hematology-oncology patients was high. As no specific prevention or treatment was available at the time, patients were strictly advised to wear masks and practice physical distancing and hand hygiene. When anti-cancer treatment was needed, protocols with oral drugs on an outpatient basis were preferred to avoid hospitalization whenever possible. Despite this, many hemato-oncological patients died from COVID-19, secondary bacterial or fungal infections as well as from delayed or suboptimal antineoplastic treatment. Less virulent viral variants contributed to reducing the problem with COVID-19 in the general population, but patients with hematologic malignancies are still at high risk of suffering from SARS-CoV-2 or COVID-19 infection with a severe or long clinical course. These patients are advised to get vaccinated, wear a face mask and avoid poorly ventilated or crowded places. CDC guidelines recommend starting antiviral treatment as soon as possible in case of a positive SARS-CoV-2 test, i.e., within 5 days of the first symptoms. The COVID-19 pandemic is undoubtedly the most difficult health challenge of the 21st century with more than 600 million laboratory-confirmed SARS-CoV-2 infections and over 6.5 million deaths worldwide. The coronavirus pandemic contributed to rapid development of mRNA vaccines, which, along with new antiviral drugs, have been the subject of extensive research for many decades. Nevertheless, elderly, multi-morbid and immunocompromised patients continue to face a more severe clinical course and a higher risk of death from COVID-19, even now that the risk of COVID-19 in the general population is significantly reduced due to the introduction of global vaccination strategies. In this paper, we present the mechanisms of increased susceptibility to infectious complications and the evolution of the clinical course of COVID-19 in patients with hematological malignancies, taking into account the mutation of the virus and the introduction of vaccines and new antiviral drugs. We also present current recommendations for prophylactic and therapeutic management in patients with hematological malignancies.