Id |
Subject |
Object |
Predicate |
Lexical cue |
T3 |
0-14 |
Sentence |
denotes |
To the Editor: |
T4 |
15-143 |
Sentence |
denotes |
We read with interest the article by Li et al. first to report on COVID-19 in patients with chronic myeloid leukaemia (CML) [1]. |
T5 |
144-306 |
Sentence |
denotes |
They found an increased COVID-19 prevalence in CML patients of the Hubei region in China when compared to the prevalence of the general population of that region. |
T6 |
307-428 |
Sentence |
denotes |
Unfortunately, in this retrospective study, follow-up data were not provided and a direct control group was not included. |
T7 |
429-757 |
Sentence |
denotes |
We report preliminary results of a prospective Dutch observational cohort study that assessed differences in susceptibility for COVID-19 and severity of the disease course in adult CML patients and their adult housemates during the SARS-CoV2 pandemic (the first COVID-19 case was identified on February 27th in the Netherlands). |
T8 |
758-901 |
Sentence |
denotes |
Patients were invited to participate via CMyLife [2], a nationwide web-based portal focused on Dutch CML patients, from April 6th 2020 onwards. |
T9 |
902-1047 |
Sentence |
denotes |
If available, their adult housemates (e.g., spouses) were included as control group, providing a better representation of the general population. |
T10 |
1048-1118 |
Sentence |
denotes |
Surveys were performed at baseline and at a 2-weekly follow-up period. |
T11 |
1119-1235 |
Sentence |
denotes |
CML patients receiving TKI treatment or having a discontinuation of their TKI treatment were invited to participate. |
T12 |
1236-1382 |
Sentence |
denotes |
The study was approved by the Radboudumc institutional ethics committee and digital informed consent was obtained from both patients and partners. |
T13 |
1383-1635 |
Sentence |
denotes |
At inclusion, information was gathered on demographics, self-reported comorbidity, vaccinations, health rating, COVID-19 related symptoms and hospital admissions and additional for patients; CML course, patients’ perceptions regarding CML and COVID-19. |
T14 |
1636-1801 |
Sentence |
denotes |
Every 2 weeks a truncated shorter version of the questionnaire was conducted, focusing on TKI intake, preventive measures, testing, symptoms and hospital admissions. |
T15 |
1802-2048 |
Sentence |
denotes |
At time of submission, 167 patients have registered for the study and 148 CML patients (median age, 57.5 years; range 26–82 years; 48% males) and 123 housemates (median age 60 years, range 24–88 years) were included, with enrolment still ongoing. |
T16 |
2049-2117 |
Sentence |
denotes |
The baseline characteristics are presented in Supplementary Table 1. |
T17 |
2118-2161 |
Sentence |
denotes |
The majority (88.4%) had taken TKI therapy. |
T18 |
2162-2269 |
Sentence |
denotes |
Approximately half of the CML patients versus a third of controls had comorbidity that required medication. |
T19 |
2270-2375 |
Sentence |
denotes |
The annual influenza vaccination was received by 58.0% of the CML patients and 35.8% of their housemates. |
T20 |
2376-2530 |
Sentence |
denotes |
If a coronavirus vaccine would become available, both patients and their housemates would be largely willing to take this (76.3% and 68.9%, respectively). |
T21 |
2531-2684 |
Sentence |
denotes |
The majority applied preventive measures as recommended by national institutes (e.g., not shaking hands, frequently washing hands and social distancing). |
T22 |
2685-2747 |
Sentence |
denotes |
Patients’ perceptions regarding COVID-19 are shown in Table 1. |
T23 |
2748-2816 |
Sentence |
denotes |
Table 1 Reported perceptions of patients on COVID-19 related to CML. |
T24 |
2817-2835 |
Sentence |
denotes |
Patients (N = 148) |
T25 |
2836-2841 |
Sentence |
denotes |
% (n) |
T26 |
2842-2898 |
Sentence |
denotes |
Thinks to be more susceptible to COVID-19 because of CML |
T27 |
2899-2914 |
Sentence |
denotes |
Yes 32.4 (48) |
T28 |
2915-2929 |
Sentence |
denotes |
No 35.8 (53) |
T29 |
2930-2953 |
Sentence |
denotes |
Do not know 31.8 (47) |
T30 |
2954-3007 |
Sentence |
denotes |
Thinks COVID-19 course will be more severe due to CML |
T31 |
3008-3023 |
Sentence |
denotes |
Yes 35.8 (53) |
T32 |
3024-3038 |
Sentence |
denotes |
No 20.3 (30) |
T33 |
3039-3062 |
Sentence |
denotes |
Do not know 43.9 (65) |
T34 |
3063-3092 |
Sentence |
denotes |
Worries about the coronavirus |
T35 |
3093-3113 |
Sentence |
denotes |
Not at all 5.4 (8) |
T36 |
3114-3134 |
Sentence |
denotes |
A little 54.7 (81) |
T37 |
3135-3158 |
Sentence |
denotes |
Quite a bit 30.4 (45) |
T38 |
3159-3179 |
Sentence |
denotes |
Very much 9.5 (14) |
T39 |
3180-3256 |
Sentence |
denotes |
Next we analysed symptoms of patients and housemates at inclusion (Table 2). |
T40 |
3257-3371 |
Sentence |
denotes |
Among patients, rhinitis was the most reported symptom (16.9%), followed by coughing (14.2%) and dyspnoea (10.8%). |
T41 |
3372-3395 |
Sentence |
denotes |
Fever was not reported. |
T42 |
3396-3446 |
Sentence |
denotes |
Many (69.6%) patients reported to be symptom free. |
T43 |
3447-3566 |
Sentence |
denotes |
Among the housemates, rhinitis was reported in 8.9% of cases, and coughing and dyspnoea in 6.5% and 2.4%, respectively. |
T44 |
3567-3597 |
Sentence |
denotes |
Again, fever was not reported. |
T45 |
3598-3651 |
Sentence |
denotes |
The majority (84.6%) reported to be free of symptoms. |
T46 |
3652-3823 |
Sentence |
denotes |
Only two patients had been tested for SARS-CoV2 at study inclusion, of whom one tested positive and reported to have been admitted to the hospital (without ICU admission). |
T47 |
3824-3946 |
Sentence |
denotes |
This patient was a 62 year male without comorbidity, who received imatinib therapy since the CML diagnosis 2 years before. |
T48 |
3947-4010 |
Sentence |
denotes |
No housemates were tested nor reported any hospital admissions. |
T49 |
4011-4137 |
Sentence |
denotes |
Table 2 Information on preventive measures, symptoms and hospital admissions related to COVID-19 in CML patients at inclusion. |
T50 |
4138-4177 |
Sentence |
denotes |
Patients (N = 148) Housemates (N = 124) |
T51 |
4178-4189 |
Sentence |
denotes |
% (n) % (n) |
T52 |
4190-4228 |
Sentence |
denotes |
Visited affected areaa 3.4 (5) 4.1 (5) |
T53 |
4229-4249 |
Sentence |
denotes |
Preventive measuresb |
T54 |
4250-4262 |
Sentence |
denotes |
None 0 N/A |
T55 |
4263-4299 |
Sentence |
denotes |
Avoid shaking hands 85.1 (126) N/A |
T56 |
4300-4334 |
Sentence |
denotes |
Clean hands often 84.5 (125) N/A |
T57 |
4335-4365 |
Sentence |
denotes |
Use of face mask 2.7 (4) N/A |
T58 |
4366-4433 |
Sentence |
denotes |
Working from home, just as same-function colleagues 31.8 (47) N/A |
T59 |
4434-4507 |
Sentence |
denotes |
Working from home, in contrary to same-function colleagues 6.8 (10) N/A |
T60 |
4508-4538 |
Sentence |
denotes |
Self-isolation 41.2 (61) N/A |
T61 |
4539-4560 |
Sentence |
denotes |
Other 14.9 (22) N/A |
T62 |
4561-4570 |
Sentence |
denotes |
Symptomsb |
T63 |
4571-4600 |
Sentence |
denotes |
Rhinitis 16.9 (25) 8.9 (11) |
T64 |
4601-4629 |
Sentence |
denotes |
Coughing 14.2 (21) 6.5 (8) |
T65 |
4630-4659 |
Sentence |
denotes |
Sore throat 4.1 (6) 2.4 (3) |
T66 |
4660-4688 |
Sentence |
denotes |
Dyspnoea 10.8 (16) 2.4 (3) |
T67 |
4689-4708 |
Sentence |
denotes |
Fever 0 (0) 0 (0) |
T68 |
4709-4744 |
Sentence |
denotes |
No symptoms 69.6 (103) 84.6 (104) |
T69 |
4745-4762 |
Sentence |
denotes |
SARS-CoV2 testing |
T70 |
4763-4793 |
Sentence |
denotes |
Tested, positive 0.7 (1) 0.0 |
T71 |
4794-4824 |
Sentence |
denotes |
Tested, negative 0.7 (1) 0.0 |
T72 |
4825-4858 |
Sentence |
denotes |
Not tested 98.0 (145) 100 (123) |
T73 |
4859-4878 |
Sentence |
denotes |
Unknown 0.7 (1) 0 |
T74 |
4879-4914 |
Sentence |
denotes |
Hospital admissionc 0.7 (1) 0.0 (0) |
T75 |
4915-4962 |
Sentence |
denotes |
Intensive Care Unit admission 0.0 (0) 0.0 (0) |
T76 |
4963-5002 |
Sentence |
denotes |
Lives with adult housemate 85.9 (128) – |
T77 |
5003-5018 |
Sentence |
denotes |
N = 131 N = 106 |
T78 |
5019-5030 |
Sentence |
denotes |
% (n) % (n) |
T79 |
5031-5039 |
Sentence |
denotes |
Vaccines |
T80 |
5040-5069 |
Sentence |
denotes |
Annual influenza vaccination |
T81 |
5070-5095 |
Sentence |
denotes |
Yes 58.0 (76) 35.8 (38) |
T82 |
5096-5120 |
Sentence |
denotes |
No 42.0 (55) 64.1 (68) |
T83 |
5121-5161 |
Sentence |
denotes |
If available, would take corona vaccine |
T84 |
5162-5189 |
Sentence |
denotes |
Yes 76.3 (100) 68.9 (73) |
T85 |
5190-5211 |
Sentence |
denotes |
No 3.8 (5) 0.9 (1) |
T86 |
5212-5246 |
Sentence |
denotes |
Do not know 19.8 (26) 30.2 (32) |
T87 |
5247-5365 |
Sentence |
denotes |
aAffected areas with high risk of COVID-19 as established by National Institute for Public Health and the Environment: |
T88 |
5366-5454 |
Sentence |
denotes |
Italy, Austria, Nordrhein Westfalen (Germany), Madrid (Spain), China, South Korea, Iran. |
T89 |
5455-5482 |
Sentence |
denotes |
bMultiple answers possible. |
T90 |
5483-5574 |
Sentence |
denotes |
cHospital/ICU admission because of the following symptoms: coughing, dyspnoea and/or fever. |
T91 |
5575-5696 |
Sentence |
denotes |
Currently, most subjects have completed their first and second 2-weekly follow-up questionnaires (Supplementary Table 2). |
T92 |
5697-5752 |
Sentence |
denotes |
No patients reported (temporarily) TKI discontinuation. |
T93 |
5753-5882 |
Sentence |
denotes |
A further six persons (two patients and four housemates) were tested for SARS-CoV2 during this follow-up and all tested negative. |
T94 |
5883-5920 |
Sentence |
denotes |
No hospital admissions were reported. |
T95 |
5921-6078 |
Sentence |
denotes |
At 2 weeks, 74.2% (n = 95) of the patients reported to be free of symptoms, compared to 79.4% (n = 100) and 88.9% (n = 16) at four and 6 weeks, respectively. |
T96 |
6079-6175 |
Sentence |
denotes |
For housemates these rates were 87.6% (n = 106), 91.6% (n = 98) and 100% (n = 15), respectively. |
T97 |
6176-6264 |
Sentence |
denotes |
To conclude, we found no significantly increased prevalence of COVID-19 in CML patients. |
T98 |
6265-6358 |
Sentence |
denotes |
Only one patient (0.7%) reported to be tested positive and has been admitted to the hospital. |
T99 |
6359-6531 |
Sentence |
denotes |
These findings are important for CML patients and professionals (prescribers of TKI) as almost 40% of patients reported to be substantially concerned about the coronavirus. |
T100 |
6532-6735 |
Sentence |
denotes |
The prevalence rate is in line with the reported 0.3% in the general Dutch population [3], and with the reported low prevalence of <1% SARS-CoV2 viral infections in CML patients in the study of Li et al. |
T101 |
6736-6892 |
Sentence |
denotes |
We included a representative control cohort of housemates of similar age and geographical spreading as the patients, of whom none were tested positive (0%). |
T102 |
6893-7125 |
Sentence |
denotes |
Similar to Li et al. (0.9% vs 0.1%), we did find a slightly higher percentage of infected patients than in the general population (0.7% vs 0.3%) based on PCR testing on clinical indication, but this is not statistically significant. |
T103 |
7126-7222 |
Sentence |
denotes |
Other studies focusing primarily on COVID-19 infection prevalence in CML population are lacking. |
T104 |
7223-7272 |
Sentence |
denotes |
There are strengths and limitations to our study. |
T105 |
7273-7594 |
Sentence |
denotes |
Although there may have been some self-selection bias in our study, the recruitment through the national CMyLife digital patient platform did allow for a substantial and geographically nationwide spread of participants, also in a time when many patients isolated themselves and hospital visits were limited when possible. |
T106 |
7595-7669 |
Sentence |
denotes |
Also, our study was performed prospectively, and included a control group. |
T107 |
7670-7812 |
Sentence |
denotes |
Furthermore, our questionnaires focused on patients’ perceptions, offering insights in the substantial level of anxiety in this patient group. |
T108 |
7813-7898 |
Sentence |
denotes |
However, the number of SARS-CoV2 tested subjects was low, limiting statistical power. |
T109 |
7899-8132 |
Sentence |
denotes |
Taken together, the report by Li et al. and our current data may offer relief to CML patients in general that the absolute risk of contracting a serious SARS-CoV2 infection in CML patients, was low (<1%) during the COVID-19 pandemic. |
T110 |
8133-8330 |
Sentence |
denotes |
However, as we did observe more upper airway symptoms and further research should focus on serological testing in the CML population to objectively assess subclinical COVID-19 infection prevalence. |
T111 |
8331-8403 |
Sentence |
denotes |
Finally, our study supports that patients can safely continue their TKI. |