The CoV-2 outbreak: how hematologists could help to fight Covid-19

Galimberti, Sara; Baldini, Chiara; Baratè, Claudia; Ricci, Federica; Balducci, Serena; Grassi, Susanna; Ferro, Francesco; Buda, Gabriele; Benedetti, Edoardo; Fazzi, Rita; Baglietto, Laura; Lucenteforte, Ersilia; Di Paolo, Antonello; Petrini, Mario

COVID-19 is a medical emergency, with 20 % of patients presenting with severe clinical manifestations. From the pathogenetic point of view, COVID-19 mimics two other well-known diseases characterized by cytokine storm and hyper-activation of the immune response, with consequent organ damage: acute graft-versus-host disease (aGVHD) and macrophage activation syndrome (MAS). Hematologists are confident with these situations requiring a prompt therapeutic approach for switching off the uncontrolled cytokine release; here, we discuss pros and cons of drugs that are already employed in hematology in the light of their possible application in COVID-19. The most promising drugs might be: Ruxolitinib, a JAK1/2 inhibitor, with a rapid and powerful anti-cytokine effect, tyrosine kinase inhibitors (TKIs), with their good anti-inflammatory properties, and perhaps the anti-Cd26 antibody Begelomab. We also present immunological data from gene expression experiments where TKIs resulted effective anti-inflammatory and pro-immune drugs. A possible combined treatment algorithm for COVID-19 is here proposed.