COVID-19 susceptibility may be increased in patients with hematological malignancies compared to solid organ tumours

1. Patients with hematological malignancies were found to be at an increased risk of COVID-19 and were more likely to require admission to the intensive care unit for ventilation.

2. Among adult cancer patients with confirmed SARS-CoV-2 infection, the case-fatality rate was higher in male patients compared to female patients.

 Evidence Rating Level: 2 (Good)

Study Rundown: Since the start of the COVID-19 pandemic, patients with active cancers were identified as a susceptible, high-risk group of individuals. However, given the heterogeneity of cancer, further investigations are warranted to stratify risk according to tumour subtype and patient demographics. This multicenter cohort study described clinical outcomes of COVID-19 among adult patients enrolled in the UK Coronavirus Cancer Monitoring Project (UKCCMP). From March 18 to May 8, 2020, 1044 patients with active cancer were enrolled in the UKCCMP database and compared with a parallel non-COVID-19 UK cancer control population. The majority of deaths in the UKCCMP cohort were due to COVID-19 and the risk of mortality was substantially increased among those greater than 80. In addition, the susceptibility to SARS-CoV-2 was higher in patients with hematological malignancies (leukemia, lymphoma, and myeloma) compared to those with solid organ tumours. Among patients with hematological malignancies, having recent chemotherapy bore an increased risk of mortality. This study was limited by an over-representation of patients with advanced disease and those undergoing active oncological follow-up. Furthermore, the UKCCMP population consisted of patients with active cancer as of March 2020, whereas the control population comprised patients with a cancer diagnosis as far back as 2017. Nevertheless, the presence of a general cancer population control group is a strength of this study.

Click to read the study in The Lancet Oncology

Relevant Reading: COVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments: a prospective cohort study

In-depth [prospective cohort]: This multicenter, prospective cohort study included 1044 adult cancer patients across 66 participating centers in the UKCCMP network. Enrollment occurred between March 18 and May 8, 2020. Eligibility criteria for this study included the following: above the age of 18; those with active cancer; presenting to the UKCCMP network between March 18 and May 8, 2020; and having a confirmed SARS-CoV-2 infection. 595 of 1044 (57%) patients were male and the median age was 70 years (IQR 60-77). Compared to the control group, patients with cancer and COVID-19 in the UKCCMP cohort were more likely to be men (Odds ratio [OR] 1.26, 95% CI 1.12-1.43, p=0.0002).

This study investigated the effect of tumour subtype, patient age, and sex on the prevalence of and mortality from COVID-19. Patients with hematological malignancies, such as leukemia (OR 2.82, 95% CI 2.21-3.55, p<0.0001), myeloma (OR 2.03, 95% CI 1.42-2.83, p=0.0001), and lymphoma (OR 1.63, 95% CI 1.28-2.06; p<0.0001), were at a significantly increased risk of COVID-19. These patients were also more likely to require high flow oxygen (OR 1.82, 95% CI 1.11-2.94, p=0.015), non-invasive ventilation (OR 2.10, 95% CI 1.14-3.76, p=0.014), intensive care unit admission for ventilation (OR 2.73, 95% CI 1.43-5.11, p=0.0019), and have a critical disease course (OR 1.57, 95% CI 1.15-2.15, p=0.0043). Compared to solid organ tumours, patients with hematological malignancies had a more severe COVID-19 trajectory (OR 1.57, 95% CI 1.125-2.15). In total, 319 (31%) patients died during the study period and COVID-19 was the direct cause of death for 295 (93%) patients. An association existed between sex and case-fatality rate as male (36%) cancer patients were more likely to contract COVID-19 than their female (24%) counterparts (OR 1.92, 95% CI 1.51-2.45, p<0.0001). On multivariable analysis, a significantly elevated case-fatality rate was reported in patients with leukemia (OR 2.25, 95% CI 1.13-4.57, p=0.023). Finally, patients with hematological malignancies who had recent chemotherapy had an increased risk of death compared to the control population (OR 2.09, 95% CI 1.09-4.08, p=0.028). The findings of this study illustrate a high case-fatality rate from COVID-19 in UK patients with hematological malignancies.

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