Poor outcome and prolonged persistence of SARS‐CoV‐2 RNA in COVID‐19 patients with haematological malignancies; King's College Hospital experience

Shah, Vallari; Ko, Thinzar Ko; Zuckerman, Mark; Vidler, Jennifer; Sharif, Sobia; Mehra, Varun; Gandhi, Shreyans; Kühnl, Andrea; Yallop, Deborah; Avenoso, Daniele; Rice, Carmel; Sanderson, Robin; Sarma, Anita; Marsh, Judith; Lavallade, Hugues de; Krishnamurthy, Pramila; Patten, Piers; Benjamin, Reuben; Potter, Victoria; Ceesay, M Mansour; Mufti, Ghulam J.; Norton, Sam; Pagliuca, Antonio; Galloway, James; Kulasekararaj, Austin

doi:10.1111/bjh.16935

Cited by 97 publications

(156 citation statements)

References 11 publications

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“…Despite heterogeneity in our patient cohort and methodology, the mortality rate described here is consistent with those from other UK cohorts of patients with haematological malignancy and COVID-19 (39-52%). [13][14][15] While a direct comparison with a non-haematology cohort has not been performed, our data corroborate existing studies that haematology patients are at increased risk of severe disease and mortality from COVID-19, with a large UK population study reporting lower mortality of 33% of all hospitalised cases, despite an older median study age of 72 years. 2 Several risk factors for severe COVID-19 in the general population are relevant to patients with haematological disorders.…”

Section: Discussionsupporting

confidence: 87%

“…Data from other cohorts worldwide suggest mortality from COVID-19 is higher in haematology patients compared to the general population, 3,11,12 with reported mortality rates between 39% and 50% in other British haematology patient cohorts. [13][14][15] In particular, a recent UK case series reported significantly higher case fatality rates in haematology patients receiving immunosuppressive or cytotoxic therapy within three months of COVID-19 diagnosis, raising concerns about the delivery of systemic anti-cancer therapy (SACT) during the pandemic. 14 There is an ongoing need to share collective experience regarding the clinical course of COVID-19 in patients with haematological disorders, particularly regarding implications for SACT delivery, in order to enable patients to receive treatment in a timely and safe manner during the pandemic.…”

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confidence: 99%

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Clinical outcomes and risk factors for severe COVID‐19 in patients with haematological disorders receiving chemo‐ or immunotherapy

et al. 2020

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Haematology patients receiving chemo-or immunotherapy are considered to be at greater risk of COVID-19-related morbidity and mortality. We aimed to identify risk factors for COVID-19 severity and assess outcomes in patients where COVID-19 complicated the treatment of their haematological disorder. A retrospective cohort study was conducted in 55 patients with haematological disorders and COVID-19, including 52 with malignancy, two with bone marrow failure and one immune-mediated thrombotic thrombocytopenic purpura (TTP). COVID-19 diagnosis coincided with a new diagnosis of a haematological malignancy in four patients. Among patients, 82% were on systemic anti-cancer therapy (SACT) at the time of COVID-19 diagnosis. Of hospitalised patients, 37% (19/51) died while all four outpatients recovered. Risk factors for severe disease or mortality were similar to those in other published cohorts. Raised C-reactive protein at diagnosis predicted an aggressive clinical course. The majority of patients recovered from COVID-19, despite receiving recent SACT. This suggests that SACT, where urgent, should be administered despite intercurrent COVID-19 infection, which should be managed according to standard pathways. Delay or modification of therapy should be considered on an individual basis. Long-term follow-up studies in larger patient cohorts are required to assess the efficacy of treatment strategies employed during the pandemic.

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Section: Discussionsupporting

confidence: 87%

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confidence: 99%

Clinical outcomes and risk factors for severe COVID‐19 in patients with haematological disorders receiving chemo‐ or immunotherapy

et al. 2020

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“…The measurements implemented to prevent COVID‐19 were effective to allow continuing treatment. It should be noted that, unlike a recent publication that describes intensive active treatment as a risk factor for infection, 6 only one of our patients developed mild COVID‐19 while receiving front‐line therapy. No patients undergoing intensified treatments were infected by SARS‐CoV‐2.…”

Section: Discussioncontrasting

confidence: 63%

“…In this scenario, our goal was to achieve a balance between risk and benefit for the patients with lymphoid malignancies, one of the most vulnerable populations for SARS‐CoV‐2 infection. Shah et al 6 . has recently described the incidence of lymphoid malignancies among patients with haematological diseases and COVID‐19.…”

Section: Discussionmentioning

confidence: 99%

Managing the front‐line treatment for diffuse large B cell lymphoma and high‐grade B cell lymphoma during the COVID‐19 outbreak

et al. 2020

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Summary The COVID‐19 pandemic has dramatically challenged care for cancer patients, especially those with active treatment who represent a vulnerable population for SARS‐CoV‐2 infection. Aggressive lymphoid neoplasms, such as diffuse large B cell lymphoma and high‐grade B cell lymphoma, need to be treated without delay in order to get the best disease outcome. Because of that, our clinical practice was changed to minimise the risk of SARS‐CoV‐2 infection while continuing haematological treatment. In this report, we analyse the management of front‐line therapy in 18 patients during the COVID‐19 outbreak, as well as the results of the implemented measures in their outcome.

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“…To our knowledge, this is the rst large-scale case series describing the epidemiology and outcome of COVID-19 in patients with hematologic malignancies. To date, only small case series in this setting have been reported (14,15,21,22) in mainly hospitalized patients, whereas our study included both inpatients and outpatients. Our ndings show that patients with hematologic malignancies and COVID-19 have 3-4-fold higher rates of severe/critical disease (62% vs 15%) and mortality (33% vs 10%) compared to COVID-19 cases in the general population.…”

Section: Discussionmentioning

confidence: 99%

Impact of hematologic malignancy and type of cancer therapy on COVID-19 severity and mortality: lessons from a large population-based registry study

García‐Suárez

Cruz

Cedillo

et al. 2020

Preprint

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Background Patients with cancer have been shown to have a higher risk of clinical severity and mortality compared to non-cancer patients with COVID-19. Patients with hematologic malignancies typically are known to have higher levels of immunosuppression and may develop more severe respiratory viral infections than patients with solid tumours. Data on COVID-19 in patients with hematologic malignancies are limited. Here we characterise disease severity and mortality, and evaluate potential prognostic factors for mortality.Methods In this population-based registry study, we collected de-identified data on clinical characteristics, treatment and outcomes in adult patients with hematologic malignancies and confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection within the Madrid region of Spain. Our case series included all patients admitted to 22 regional health service hospitals and 5 private healthcare centres between February 28 and May 25, 2020. The primary study outcome was all-cause mortality. We assessed the association between mortality and potential prognostic factors using Cox regression analyses adjusted for age, sex, comorbidities, hematologic malignancy and recent active cancer therapy.Results Of 833 patients reported, 697 were included in the analyses. Median age was 72 years (IQR 60–79), 413 (60%) patients were male, and 479 (69%) and 218 (31%) had lymphoid and myeloid malignancies, respectively. Clinical severity of COVID-19 was severe/critical in 429 (62%) patients. At data cutoff, 230 (33%) patients had died. Age ≥60 years (hazard ratios 3·17–10·1 vs <50 years), >2 comorbidities (1·41 vs ≤2), acute myeloid leukemia (2·22 vs non-Hodgkin lymphoma) and active antineoplastic treatment with monoclonal antibodies (2·02) or conventional chemotherapy (1·50 vs no active therapy) were associated with increased mortality. Conversely, Ph-negative myeloproliferative neoplasms (0·33) and active treatment with hypomethylating agents (0·47) were associated with lower mortality. Overall, 574 (82%) patients received antiviral therapy. Mortality with severe/critical COVID-19 was higher with no therapy vs any antiviral combination therapy (2.20).Conclusions In this series of patients with hematologic malignancies and COVID-19, mortality was associated with higher age, more comorbidities, type of hematological malignancy and type of antineoplastic therapy. Further studies and long-term follow-up are required to validate these criteria for risk-stratification.

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Poor outcome and prolonged persistence of SARS‐CoV‐2 RNA in COVID‐19 patients with haematological malignancies; King's College Hospital experience

Cited by 97 publications

References 11 publications

Clinical outcomes and risk factors for severe COVID‐19 in patients with haematological disorders receiving chemo‐ or immunotherapy

Clinical outcomes and risk factors for severe COVID‐19 in patients with haematological disorders receiving chemo‐ or immunotherapy

Managing the front‐line treatment for diffuse large B cell lymphoma and high‐grade B cell lymphoma during the COVID‐19 outbreak

Impact of hematologic malignancy and type of cancer therapy on COVID-19 severity and mortality: lessons from a large population-based registry study

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