Clinical course and risk factors for mortality from COVID‐19 in patients with haematological malignancies

Abstract

Background: The impact of coronavirus disease 2019 (COVID-19) in haematological patients (HP) has not been comprehensively reported. Methods: We analysed 39 patients with SARS-CoV-2 infection and haematological malignancies. Clinical characteristics and outcomes were compared to a matched control group of 53 non-cancer patients with COVID-19. Univariate and multivariate analyses were carried out to assess the risk factors associated with poor outcome. Results: The most frequent haematological diseases were lymphoma (30%) and multiple myeloma (30%). Eighty-seven % HP developed moderate or severe disease. Patients with haematological malignancies had a significantly higher mortality rate compared to non-cancer patients (35.9% vs 13.2%; P = .003 (odds ratio 6.652). The worst outcome was observed in chronic lymphocytic leukaemia patients. Only age >70 years and C reactive protein >10 mg/dl at admission were associated with higher risk of death (odds ratio 34.86, P = .003 and 13.56,P = .03). Persistent viral sheddind was detected in 5 HP. Active chemotherapy, viral load at diagnosis and COVID-19 therapy were not predictors of outcome. Conclusion: Mortality of COVID-19 is significantly higher in patients with haematological malignancies compared to non-cancer patients. The impact of persistent viral shedding must be considered in order to restart therapies and maintain infectious control measures.

The effect of anticancer treatment on cancer patients with COVID‐19: A systematic review and meta‐analysis

“…A total of 5121 patients with cancer in 29 studies were included in this meta-analysis. [6][7][8][9][10][11] The characteristics of the studies included in this meta-analysis are presented in Table 2. Of the remaining 29 studies, eight were conducted in China, six in the United States, four in the United Kingdom, three in Spain, two in France, two in Italy, and four was performed in multiple countries.…”

“…However, emerging studies suggest that COVID-19-infected cancer patients receiving systematic anticancer therapy are at a higher risk than those who receive no antitumor treatment, 8 especially hematological patients receiving chemotherapy. 9 Interestingly, there are also clinical studies strongly, indicating that anticancer treatments have no deteriorating effects on clinical outcomes. 10,11 Thus, whether COVID-19-infected cancer patients with versus without anticancer treatments have a higher risk of unfavorable clinical outcomes remains unclear.…”

Cancer patients and COVID-19: Mortality, serious complications, biomarkers, and ways forward

“…Following a nosocomial outbreak of COVID-19 in a hematological oncology unit in Central Europe, 36.8% of their patients died [7] ; nearly a third (30.6%) of the 1044 patients in the UK Cancer Coronavirus Monitoring Project died, the vast majority of whom (92.5%) had cause of death recorded as COVID-19 [18] . Another study by Sanchez-Pina et al., reported that patients with hematologic malignancies had COVID-related mortality of 35.9% versus 13.2% in COVID-positive, non-cancer, age- and illness-severity-matched controls ( p = 0.003, OR 6.652) [9] ; and in a retrospective chart review of 1878 COVID-19 patients, 52.3% (9/17) of the lung cancer patients died compared to just 10.2% COVID-19 mortality in the general population at the same center ( p <0.0001), though it should be noted that a majority of the lung cancer patients had metastatic malignancy (11/17) and comorbidities such as hypertension (10/17) and chronic obstructive pulmonary disorder (COPD) (9/17) [20] . Regardless, these numbers illustrate how severe COVID-19 infection can be for cancer patients.…”

“…Due to health anxieties and desire to avoid viral exposure, some cancer patients have delayed or paused treatments [8] . Certain key biomarkers, including C-reactive protein (CRP), interleukin-6 (IL-6), and others are being investigated for prognostic capability and treatment course determination in cancer patients with COVID-19 [9] , [10] , [11] . Guidelines are currently being developed to determine treatment priorities on the basis of risk stratifications [12] , [13] , [14] .…”

“…These levels may be especially useful in prognosis for COVID-positive cancer patients, as a study by Sanchez-Pina et al. found that CRP >10 mg/dl was significantly correlated with significantly higher odds of COVID-related mortality (13.56, p = 0.03) in patients with leukemia, myeloma, and lymphoma [9] . Therefore, CRP should be given consideration as a prognostic marker in cancer patients during the course of treatment for COVID-19 illness.…”