Recently, Oncology Central had the opportunity to speak with Giovanna Lucchini (Great Ormond Street Hospital; GOSH, London, UK) about Anthony Nolan‘s recently announced IMPACT trial investigating the impact of severe COVID-19 infection on stem cell transplant patients with blood cancer. Lucchini has been working at GOSH as a pediatric consultant since 2014. She qualified in pediatrics in Italy in 2012, moved to Germany for a BMT fellowship and then moved to GOSH in London. Since then she has been involved in clinical and research work in stem cell transplantation.
As part of her research, Lucchini has been interested in the COVID-19 pandemic, which has provided the background for a study investigating the impact of severe COVID-19 infection on patients who receive stem cell transplants for blood cancers and non-malignant disorders. There is very limited information with regard to how COVID-19 will impact on the health of stem cell transplanted patients. Therefore it is really important to investigate this area, due to the likelihood that COVID-19 will remain in the community.
What is currently known about how blood cancer patients respond to COVID-19 infection?
Data has been collected from single institutions in Europe and the United States as well as through scientific societies internationally. Those data are nevertheless very preliminary and lack both detail and long-term follow-up as expected given the pace at which things have been happening. Overall, it looks like there is an increased risk of severe viral related disease in patients receiving stem cell transplantation, whereas it is still very unclear whether the lack of immune system due to primary conditions or due to immunosuppression has any impact on the COVID related symptoms. In our study we are trying to understand how – by which mechanisms – COVID-19 interacts with the inflammatory and immune response of the transplanted patients, and the factors associated with a potential adverse outcome in this population of patients.
How will the recently announced IMPACT trial help gain further understanding?
This trial focuses on inflammatory and immunological biomarkers that we will measure in the blood of stem cell transplant recipients who have developed COVID-19 infection. The patients included in the study will have their inflammatory response to the virus analyzed and we will hopefully be able to draw conclusions on whether a potentially enhanced inflammatory response to COVID-19 is detrimental to stem cell recipients. We are focusing on early inflammatory response, and we are trying to work out how that impacts the long-term outcomes of transplant patients.
What impact do you hope the trial will have on the cancer field?
We believe it is really important to assess if and by which mechanism the virus is endangering stem cell transplant recipients. Indeed COVID-19 is likely to keep circulating in the population long-term, and as such having a proper assessment of the risks it poses to a vulnerable population will inform future behaviors and risk assessment for our patients.
How will these results be translated into other COVID-19 vulnerable populations?
If we were able to understand that certain subgroups of transplanted patients are at higher risk of complications due to increased inflammatory response (as it has been reported by preliminary data in the general population) that would allow considering specific treatment options which may otherwise be discarded due to possible side effects on the immune system. Similar considerations could potentially be extended to other groups of immunocompromised patients.
What other work into COVID-19 and cancer have you seen that you think will help to advance the field?
There is a great effort in both pediatric and adults in trying to achieve reliable data on serology post-COVID-19 and its impact on protection for further re-exposure. This would be paramount in the cancer/transplant field as well given the ability of cancer patients to mount an appropriate immune response to a pathogen can be limited. Digging further into this field will allow us to stratify risk for cancer/transplant patients going forward.
How do you see cancer research changing over the next few years in response to the pandemic?
It was really incredible to see how all research procedures and study set up could be sped up at a significant level in response to the pandemic. It would be great to understand if any of the mechanisms that have been put in place for this purpose could stay in place on the longer run to facilitate rapid transferal of research ideas into practice. At the same time it is concerning to think of whether in the global economic uncertainties, funding for research in general will take a medium/long term hit, preventing important questions being answered.
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The opinions expressed in this interview are those of the interviewee and do not necessarily reflect the views of Oncology Central or Future Science Group.