Impact of hematologic malignancy and type of cancer therapy on COVID-19 severity and mortality: lessons from a large population-based registry study
Julio García-Suárez 1 , Javier de la Cruz 2 , Ángel Cedillo 3 , Pilar Llamas 4 , Rafael Duarte 5 , Víctor Jiménez-Yuste 6 , José Ángel Hernández-Rivas 7 , Rodrigo Gil-Manso 8 , Mi Kwon 9 10 , Pedro Sánchez-Godoy 11 , Pilar Martínez-Barranco 12 , Blanca Colás-Lahuerta 13 , Pilar Herrera 14 , Laurentino Benito-Parra 15 , Adrián Alegre 16 , Alberto Velasco 17 , Arturo Matilla 18 , María Concepción Aláez-Usón 19 , Rafael Martos-Martínez 20 , Carmen Martínez-Chamorro 21 , Keina Susana-Quiroz 22 , Juan Francisco Del Campo 23 , Adolfo de la Fuente 24 , Regina Herráez 25 , Adriana Pascual 26 , Elvira Gómez 27 , Jaime Pérez-Oteyza 28 , Elena Ruiz 29 , Arancha Alonso 30 , José González-Medina 4 , Lucía Núñez Martín-Buitrago 5 , Miguel Canales 6 , Isabel González-Gascón 7 , María Carmen Vicente-Ayuso 11 , Susana Valenciano 1 , María García Roa 12 , Pablo Estival Monteliu 13 , Javier López-Jiménez 14 , Cristián Escolano Escobar 15 , Javier Ortiz-Martín 16 , José Luis Diez-Martin 9 10 , Joaquín Martinez-Lopez 31 32 , Asociación Madrileña de Hematología y Hemoterapia (AMHH)
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 tumors. Data on COVID-19 in patients with hematologic malignancies are limited. Here we characterize 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 centers 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) were associated with increased mortality; conventional chemotherapy showed borderline significance (1.50 vs no active therapy). 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.
CITATION J Hematol Oncol. 2020 Oct 8;13(1):133. doi: 10.1186/s13045-020-00970-7.