Fatality rate of COVID-19 in patients with malignancies: a sytematic review and meta-analysis Dear Editor, With great interest, we read the recently published letter by Ma et al. (2020) 1 who describe the demographics, clinical features, and prognosis of cancer patients with COVID-19 infection. In this study fatality rate of the COVID-19 in patients with malignancies reported as 13.5%. To have a better estimation of fatality rate, in this letter, we aimed to summarize the fatality rate among cancer patients with COVID-19 infection using meta-analysis. It is currently well known that one of the most important risk factors for COVID-19 morbidity and mortality is comorbid conditions, of which, immunosuppression might be the most challenging one. There are limited evidences about the relationship between COVID-19 severity and cancer. However, few available publications indicated more fatality rate and poorer prognosis of this novel virus in cancer patients compared to general population. Also, it has been observed that patients with cancer are more likely to be admitted to the intensive care unit (ICU), to require invasive ventilation, and even more likely to die. 2 Case fatality rate (CFR) is the likelihood of an infection to result in death. We conducted a systematic search on published studies limited to ones between December 30, 2019 and May 7, 2020 in PubMed, EMBASE, and Scopus. EndNote X8.0 0 0 software was used to manage the records and exclude duplicates. We used the search MeSH terms and relevant text-words including (2019 novel coronavirus OR COVID-19 OR SARS-CoV-2 OR nCoV-2019) AND (cancer OR neoplasms OR malignancy OR tumor OR carcinoma) AND (mortality OR fatality OR death). Eligible articles were those that described the case fatality rate (CFR) of COVID-19 in cancer patients. The two investigators (MN, Z MA), independently extracted data from the literature. We extracted the following variables: author, date, age, sex, number of total patients with malignancy, the proportion of death among them in each study. Case fatality was calculated as percentage of patients with cancer and infected by COVID-19 who died within hospitalization period. The meta-analysis was performed using R version 3.2.3. Pooled case fatality rates and their 95% confidence intervals (95% CIs) were used to summarize the weighted effect size for each study grouping variable using the random-effects model. Publication bias was assessed by funnel plot and Egger's test of asymmetry. From all 122 papers, 9 studies reported fatality rate of cancer patients with COVID-19 in hospital. A total of 805 patients from three countries including Iran (n = 1), 3 China (n = 7), 1 , 2 , 4-8 and USA (n = 1) 9 were studied. The most frequent malignancies was breast cancer (n = 95). Two studies didn't report the type of the malignancies. Seven studies reported the mean age of the patients. Among