Newly diagnosed leukemias during SARS-CoV-2 infection in Abidjan, Côte d′Ivoire: A case series of four patients

During the COVID-19 pandemic, various comorbidities associated with SARS-CoV-2 infection have been reported, but few cases of malignant hematological diseases diagnosed during the infection have been described. We present four cases of hematological malignancies revealed during SARS-CoV-2 infection. In all the patients, medical history did not suggest any hematological diseases prior to the COVID-19 episode. All patients presented with cough, fever, and dyspnea and were admitted for severe acute respiratory illness. During the hospitalization, blood cell counts in all patients showed hyperleukocytosis above 50,000 cells/μL, which raised suspicion of leukemia. Blood smear, bone marrow biopsy, and immunophenotyping confirmed four different hematological malignancies: acute lymphoblastic leukemia (n=1), acute myeloid leukemia (n=1), chronic lymphocytic leukemia (n=1), and adult T-cell leukemia/lymphoma (n=1). All patients received COVID-19 treatment according to national guidelines. Definitive chemotherapy was administered for CLL; for AML, chemotherapy could not be initiated because of the patient's clinical instability, and only cytoreductive therapy with hydroxycarbamide was given. Two patients died (patients 1 and 4), and two survived and were discharged after 37 days and 20 days. The comorbidity of COVID-19 and newly diagnosed leukemias presents the extraordinary challenge of treating two potentially fatal diseases simultaneously. These cases suggest that an underlying hematological malignancy should be investigated in patients with persistent or unexplained hematological abnormalities during COVID-19.