The risk factors that have been identified for severe disease from SARS-CoV-2, the cause of the coronavirus disease 2019 (COVID-19), include older age, and immunosuppressive conditions such as cancer. Patients with primary cutaneous lymphoma tend to be older and are on long-term immunosuppressant medications to maintain disease control.1
To ensure patients receive the best of care during the COVID-19 pandemic, the United States Lymphoma Consortium released guidelines for treating patients with primary cutaneous lymphoma. “We must dynamically adjust treatment plans to provide optimal care for our lymphoma patients while protecting them from COVID-19 complications,” the authors said.
They recommend the use of telemedicine visits to avoid unnecessary exposure, except for patients who require in-person evaluation and/or therapy. To help clinicians determine the best options for patients, the authors stratified types of cutaneous lymphoma and therapies by low, intermediate or high risk. Recommendations for these groups are outlined in the Table.
The risk of travel and exposure likely outweight the benefits of in-office treatments, such as ultraviolet light therapy and total body electron beam radiation therapy, the authors noted. In addition, they recommend the least frequent laboratory monitoring possible to limit exposure during travel while ensuring patients’ safety.
The authors strongly discourage the use of allogeneic stem cell transplant and treatment with CHOP, alemtuzumab, or fludarabine due to the fact that they often lead to significant cytopenias, which are known risk factors for COVID-19 complications. They recommend alternative lower-risk therapies whenever possible for patients.
Zic JA, Ai W, Akilov OE, et al. United States Cutaneous Lymphoma Consortium recommendations for treatment of cutaneous lymphomas during the COVID-19 pandemic [published online April 16, 2020]. J Am Acad Dermatol. doi:10.1016/j.jaad.2020.04.049