COVID-19 in adult acute myeloid leukemia patients: a long-term follow-up study from the European Hematology Association survey (EPICOVIDEHA)

Abstract

Patients with acute myeloid leukemia (AML) are at high risk of mortality from coronavirus disease 2019 (COVID-19). The optimal management of AML patients with COVID-19 has not been established. Our multicenter study included 388 adult AML patients with COVID-19 diagnosis between February 2020 and October 2021. The vast majority were receiving or had received AML treatment in the prior 3 months. COVID-19 was severe in 41.2% and critical in 21.1% of cases. The chemotherapeutic schedule was modified in 174 patients (44.8%), delayed in 68 and permanently discontinued in 106. After a median follow-up of 325 days, 180 patients (46.4%) had died; death was attributed to COVID-19 (43.3%), AML (26.1%) or to a combination of both (26.7%), whereas in 3.9% of cases the reason was unknown. Active disease, older age, and treatment discontinuation were associated with death, whereas AML treatment delay was protective. Seventy-nine patients had a simultaneous AML and COVID-19 diagnosis, with an improved survival when AML treatment could be delayed (80%; p

COVID-19 and Adult Acute Leukemia: Our Knowledge in Progress

“…Interestingly, Marchesi et al showed that a treatment delay was protective in a multivariate analysis for the clinical course of COVID-19, whereas therapy discontinuation was associated with worse outcomes. These results were also applicable to patients with newly diagnosed AML in whom a treatment delay was possible [ 31 ]. The Latin American study investigating 83 patients with AL reported therapy modifications in 49% of patients; the main modification was a delay of treatment, followed by a change in therapy scheme and a dose reduction (no data available about discontinuation).…”

“…Overall, across all COVID-19 waves, the SARS-CoV-2-associated mortality ranged from 20–52% in patients with AL [ 31 , 32 , 33 ]. However, no comprehensive data are yet available for the Omicron variant.…”

“…One of the largest multi-center trials investigating the impact of COVID-19 in adult AML patients was recently published by the European Hematology Association [ 31 ]. The EPICOVIDEHA registry included 388 adult AML patients with a COVID-19 diagnosis between February 2020 and October 2021.…”

“…Ongoing or recent AML treatment (defined as less than three months before SARS-CoV-2 infection) was associated with higher mortality rates due to COVID-19, as well as active leukemic disease, older age, and treatment discontinuation. Significantly lower overall survival was observed in patients diagnosed between January 2020 and August 2020 (first wave), compared to those after September 2020 (41% vs. 25%, p < 0.0001) [ 31 ]. This is the only more extensive data set that allows a comparison between the different SARS-CoV-2 waves.…”

“…In the most recently published cohort of 388 adult AML patients, chemotherapeutic schedules were modified in 45% of patients. Of those, therapy was delayed in 39% and treatment was discontinued in 61% [ 31 ]. Interestingly, Marchesi et al showed that a treatment delay was protective in a multivariate analysis for the clinical course of COVID-19, whereas therapy discontinuation was associated with worse outcomes.…”