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Blood Cancer & COVID-19

Most blood cancers, also called hematologic cancers, begin in the blood-forming tissues such as the bone marrow or in the cells of the immune system.¹ Blood cancers occur when the normal blood cell development process is interrupted by uncontrolled abnormal blood cell growth, preventing functions such as fighting off infections or stopping serious bleeding.²

The three main types of blood cancers are²:

1. Leukemia – a type of cancer that occurs in your blood and bone marrow due to rapid production of abnormal white blood cells. The high level of abnormal white blood cells are not able to fight off infections and cause impairment in the production of red blood cells and platelets in the bone marrow.

2. Lymphoma – a type of blood cancer that affects the lymphatic system; which removes excess bodily fluids and produces immune cells. Lymphocytes are white blood cells that fight off infection. Abnormal lymphocytes turn into lymphoma cells that multiply and collect in your lymph nodes and other tissue which overtime, will impair your immune system.

3. Myeloma – cancer of the plasma cells. Plasma cells are white blood cells that produce antibodies to fight off diseases and infections in your body. Myeloma cells prevent the normal production of antibodies causing the body’s immune system to be weakened and susceptible to infection.

Blood cancer & COVID-19

As COVID-19 emerged, patients with blood cancers are at increased risk of severe COVID-19 infection and high mortality rate due to their compromised immune system and inability to receive necessary care in time.^{3, 4, 5, 6} Medical practitioners have to assess whether treatment plans should begin on schedule or delayed until a certain time.^{5, 6}  Studies have shown that patients with blood cancers are more susceptible to severe COVID-19 infection than patients with solid cancers or healthy people, likely due to the immunosuppressive nature of their disease and/or treatments. However, researchers sought to discover if immunosuppression caused patients with blood malignancies to have a decreased immune response to the COVID-19 vaccines that are now being provided around the world.⁶   

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References

1- hematologic cancer. (n.d.). National Cancer Institute (NIH). Retrieved May 4, 2021, from https://www.cancer.gov/publications/dictionaries/cancer-terms/def/hematologic-cancer

2- Blood Cancers. (n.d.). American Society of Hematology. Retrieved May 4, 2021, from https://www.hematology.org/education/patients/blood-cancers

3- Ferrara, F., Zappasodi, P., Roncoroni, E., Borlenghi, E., & Rossi, G. (2020). Impact of Covid-19 on the treatment of acute myeloid leukemia. Leukemia, 34(8), 2254-2256.

4- He, W., Chen, L., Chen, L., Yuan, G., Fang, Y., Chen, W., … & Gale, R. P. (2020). COVID-19 in persons with haematological cancers. Leukemia, 34(6), 1637-1645.

5-  Burki, T. K. (2020). Cancer guidelines during the COVID-19 pandemic. The Lancet Oncology, 21(5), 629-630.

6- American Association for Cancer Research. (2021, February). Survival Factors ID’d for Patients with Blood Cancer + COVID-19. Cancer Discovery. https://cancerdiscovery.aacrjournals.org/content/11/2/214.2

Increase the Success Rate of IVF via PGS

In Vitro Fertilization (IVF) is an assisted reproductive technology (ART) to achieve pregnancy, where the process of fertilization is manually performed in a laboratory dish by combining extracted eggs and retrieved sperms. Once the fertilized eggs have multiplied, the embryos are then transferred to the uterus for a pregnancy to begin.^{1, 2, 3} This procedure is commonly conducted in couples who have difficulty in achieving pregnancy through unprotected regular intercource.²

Figure 1: The process of In Vitro Fertilisation (IVF).⁴

Who needs IVF treatment?

IVF can be used to treat infertility in the following cases¹:

• Unexplained infertility
• Women with ovulation disorders; premature ovarian failure, uterine fibroids
• Blocked or damaged fallopian tubes
• Male factor infertility; reduced sperm count or motility
• Individuals with genetic disorder

What is Preimplantation Genetic Screening (PGS)?

PGS is a specialised testing to screen whether cells from a cultured embryo contain any chromosomal abnormalities or balance number of chromosomes prior to implantation. PGS is highly recommended for patients with history of repeated unexplained miscarriages, recurrent IVF failures or couples with known abnormality in their chromosomal who worry passing it on to their offspring.

Common chromosomal abnormality PGS screens for are:

1. Down Syndrome
2. Patau Syndrome
3. Edwards Syndrome
4. Sex chromosomes abnormality

The process of PGS requires a small number of cells from the cultured embryos typically at day 5 (blastocyst stage) and cells are screened for normal number of chromosomes which is 46 (23 chromosomes inherited from each parents). If all chromosomes are intact with no abnormalities observed (called euploidy) then the embryo is suitable for implantation.^{6, 7, 10, 11, 12} Your fertility doctors will consult of the best embryos to implant in order to yield a successful pregnancy.

Figure 2: How Preimplantation Genetic Screening (PGS) Works.⁸

Reference

1- IVF – In Vitro Fertilization. (2019, April 24). American Pregnancy Association. https://americanpregnancy.org/getting-pregnant/infertility/in-vitro-fertilization-70966/

2- Brezina, P. R., & Zhao, Y. (2014). In Vitro Fertilization. ELSEVIER, 2014(3), 1–9. https://doi.org/10.1016/B978-0-12-801238-3.00262-2

3- Infertility FAQs. (n.d.). Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion. Retrieved April 8, 2021, from https://www.cdc.gov/reproductivehealth/infertility/index.htm

4- In Vitro Fertilisation. (2019, April). [Photograph]. Women’s Health Arm of Singapore Medical Group. https://smgwomenshealth.sg/news-articles/pgd-pgs-testing/

5- Harper, J. C., Geraedts, J., Borry, P., Cornel, M. C., Dondorp, W., Gianaroli, L., … & Macek, M. (2013). Current issues in medically assisted reproduction and genetics in Europe: research, clinical practice, ethics, legal issues and policy. European Journal of Human Genetics, 21(2), S1-S21.

6- De Rycke, M., & Sermon, K. (2010). Preimplantation Genetic Diagnosis. In Molecular Diagnostics (pp. 485-500). Academic Press.

7- Illumia. (2015). The STAR Trial [Brochure]. https://www.illumina.com/content/dam/illumina-marketing/documents/clinical/rgh/star-one-pager-web.pdf

8- Improving IVF outcomes with PGS. (n.d.). [Photograph]. Illumina. https://www.illumina.com/clinical/reproductive-genetic-health/preconception-fertility/pgs.html

9- Kimelman, D., Confino, R., Confino, E., Shulman, L. P., Zhang, J. X., & Pavone, M. E. (2018). Do patients who achieve pregnancy using IVF-PGS do the recommended genetic diagnostic testing in pregnancy?. Journal of assisted reproduction and genetics, 35(10), 1881–1885. https://doi.org/10.1007/s10815-018-1289-z

10- Improving IVF outcomes with PGS. (n.d.-b). Illumina. Retrieved April 9, 2021, from https://www.illumina.com/clinical/reproductive-genetic-health/preconception-fertility/pgs.html

11- Yang, Z., Liu, J., Collins, G. S., Salem, S. A., Liu, X., Lyle, S. S., Peck, A. C., Sills, E. S., & Salem, R. D. (2012). Selection of single blastocysts for fresh transfer via standard morphology assessment alone and with array CGH for good prognosis IVF patients: results from a randomized pilot study. Molecular cytogenetics, 5(1), 24. https://doi.org/10.1186/1755-8166-5-24