Key findings from the UKCCMP cohort of 877 patients with haematological malignancy and COVID‐19: disease control as an important factor relative to recent chemotherapy or anti‐CD20 therapy

Abstract

Summary Patients with haematological malignancies have a high risk of severe infection and death from SARS‐CoV‐2. In this prospective observational study, we investigated the impact of cancer type, disease activity, and treatment in 877 unvaccinated UK patients with SARS‐CoV‐2 infection and active haematological cancer. The primary end‐point was all‐cause mortality. In a multivariate analysis adjusted for age, sex and comorbidities, the highest mortality was in patients with acute leukaemia [odds ratio (OR) = 1·73, 95% confidence interval (CI) 1·1–2·72, P = 0·017] and myeloma (OR 1·3, 95% CI 0·96–1·76, P = 0·08). Having uncontrolled cancer (newly diagnosed awaiting treatment as well as relapsed or progressive disease) was associated with increased mortality risk (OR = 2·45, 95% CI 1·09–5·5, P = 0·03), as was receiving second or beyond line of treatment (OR = 1·7, 95% CI 1·08–2·67, P = 0·023). We found no association between recent cytotoxic chemotherapy or anti‐CD19/anti‐CD20 treatment and increased risk of death within the limitations of the cohort size. Therefore, disease control is an important factor predicting mortality in the context of SARS‐CoV‐2 infection alongside the possible risks of therapies such as cytotoxic treatment or anti‐CD19/anti‐CD20 treatments.

Patients Recently Treated for B-lymphoid Malignancies Show Increased Risk of Severe COVID-19

“…While the association of therapy for B-lymphoid malignancies with increased COVID-19 severity is troublesome, we note that the association of progressive malignancy with COVID-19 severity is also independently associated with increased COVID-19 severity. This is concordant with prior publications from the CCC19 and other groups (17,25,26). The etiology of this relationship is not clear from the data; it may be that patients with progressive malignancy are disproportionately deferring aggressive care in the setting of severe COVID-19, or that improved control over the primary malignancy results in reduced disease-related immunosuppression.…”

COVID-19: Third dose booster vaccine effectiveness against breakthrough coronavirus infection, hospitalisations and death in patients with cancer: A population-based study

“…Additionally, we have previously shown that disease control in itself is important for reducing the risks of COVID-19 mortality in patients with haematological malignancy. 34 …”

COVID-19 in Patients with Hematologic Malignancies: Clinical Manifestations, Persistence, and Immune Response

“…aCD20 treatment, often used to treat some of these HM types, may further add to the protracted disease course [33, 34]. aCD20 was associated with severe disease and worse survival in some reports [33, 35] but not in others [15, 36]. In a study including 856 lymphoma patients (mostly non-Hodgkin lymphoma), 55% were hospitalized and 37% had severe or critical disease with a case fatality rate of 19.5%.…”

“…Third, patients receiving anti-CD20 therapy (aCD20), i.e., obinutuzumab or rituximab, are at increased risk for COVID-19 mortality, prolonged infection, protracted viral shedding, and decreased protection as a result of vaccination [61]. While increased mortality was not evident in all cohorts [36], other [35, 120], well-designed (albeit retrospective) studies showed increased mortality risk (HR 2.16, 95% CI [1.03–4.54]) [120]. Perhaps more importantly, aCD20 deeply impairs the immune response to COVID-19 vaccination.…”