Characteristics and outcomes of coronavirus disease 2019 (COVID-19) patients with cancer: a single-center retrospective observational study in Tokyo, Japan

Abstract

Background Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused an international outbreak of coronavirus disease 2019 (COVID-19), data on the clinical characteristics of COVID-19 patients with cancer are limited. This study aimed to evaluate the clinical characteristics and outcomes including mortality and viral shedding period in COVID-19 patients with cancer in Japan. Methods We retrospectively analyzed 32 patients with a history of cancer who were referred to our hospital between January 31, 2020 and May 25, 2020. We evaluated the association between clinical outcomes and potential prognostic factors using univariate analyses. Results The median age was 74.5 (range 24-90) years and 22 patients (69%) were men. A total of 11 patients (34%) died. Our analyses demonstrated that the mortality was significantly associated with lymphocyte count, albumin, lactate dehydrogenase, serum ferritin, and C-reactive protein on admission. The median period between illness onset and the first effective negative SARS-CoV-2 PCR result was 22 days (interquartile range 18-25) in survivors. Of four patients with hematological malignancy who developed COVID-19 within the rest period of chemotherapy, three died and the other patient, who received bendamustine plus rituximab therapy, had the longest duration of viral shedding (56 days). Conclusion Our study suggested that the risk factors for mortality previously reported in general COVID-19 patients, including lymphocytopenia, were also effective in cancer patients. Patients who received cytotoxic chemotherapy recently or were treated with chemotherapy, which can lead to lymphocyte reduction, had poor prognosis and prolonged periods of viral shedding.

Impact of antitumor regimens on the outcomes of cancer patients with COVID-19: a pooled analysis

“…For patients with haematologic malignancies, myelosuppressive chemotherapy could disrupt the immune system and contribute to a more severe form of COVID-19 (Lin et al, 2021). Furthermore, it was conferred that lymphocytopenia following myelosuppressive chemotherapy or lymphocyte-reducing chemotherapy in patients with haematologic malignancies correlated with a greater risk of severe or even a life-threatening form of COVID-19 (Shi et al, 2020;Nakamura et al, 2021;Shumilov et al, 2021), which confirmed our finding for chemotherapy in patients with haematologic malignancies. Immunotherapy, including immune checkpoint blockage, chimeric antigen receptor (CAR) T-cell therapy, cancer vaccines, and tumor neoantigens, can reverse cancer immune evasion to eliminate cancer cells (Yang, 2015).…”

Persistent viral shedding of severe acute respiratory syndrome coronavirus 2 after treatment with bendamustine and rituximab: A case report

“…The duration of viral shedding after the onset of COVID-19 is usually 20 days [ 3 ]. However, immunocompromised patients with hematologic malignancies, those undergoing chemotherapy, and especially those treated with BR, have reportedly shed the active virus for longer periods [ [5] , [6] , [7] , [8] ].…”

Complete response in a frail patient with high-grade B-cell lymphoma to only one cycle of R-CHOP or to prolonged COVID-19?

“…Moreover, the duration of viral shedding in these patients is still unknown. In one study examining the evolution of COVID-19 infection in patients with a diagnosis of cancer, one patient treated with bendamustine and rituximab had a positive COVID-19 PCR test for 56 days [12] . Depletion of B cells in patients diagnosed with B cell lymphoma especially after treatment with an agent targeting CD-20 agent could impact the immune response and lead to persistence of SARS-CoV-2.…”