Patients with hematological malignancies and concomitant COVID-19 have worse health outcomes

1. Older age, progressive disease status, diagnosis of acute myeloid leukemia, non-Hodgkin lymphoma, or plasma cell neoplasms, and severe or critical COVID-19 at admission were predictive of worse overall survival.

2. Compared to the general population with COVID-19, the mortality rate was four times higher among COVID-positive patients with concomitant hematological malignancies.

Evidence Rating Level: 2 (Good) 

Study Rundown: Few studies have explored health outcomes in patients with hematological malignancies and the novel SARS-CoV-2 infection. This multicentre, retrospective cohort study assessed the clinical trajectory of adult hematology patients with laboratory-confirmed COVID-19 In Italy. The primary outcome for this study was patient mortality and predictive parameters of mortality, including biochemical parameters (hemoglobin, hematocrit, platelets, leucocytes, lymphocytes, clotting tests, serum lactate dehydrogenase, and C-reactive protein), hematological malignancy characteristics, and COVID-19 severity. In comparison to the general Italian population with COVID-19 and patients with hematological malignancies without COVID-19, the mortality rate was significantly elevated in patients with concomitant COVID-19 and hematologic malignancies. Additionally, severe or critical COVID-19 diagnoses were more frequent in patients with hematological malignancies. This study was limited by a retrospective design and lack of generalizability. Asymptomatic patients, or those who were not tested for SARS-CoV-2 infection, were excluded from this study leading to a lower mortality rate. Nevertheless, this study reported the largest series of patients with hematological malignancies and COVID-19 to date.

Click to read the study in The Lancet Haematology

Relevant Reading: Screening Strategies for COVID-19 in Patients with Hematologic Malignancies

In-depth [retrospective cohort]: This multicentre, retrospective study included 536 patients (≥18 years old) from 66 Italian hospitals enrolled between February 25, 2020 to May 18, 2020. All participants were diagnosed with a World Health Organization-defined hematological malignancy and confirmed COVID-19. The median length of hospital stay was 20 days (IQR 10-34 days, range 1-98 days).

Compared to the general population with COVID-19, the standardized mortality ratio was 2.04 (95% CI 1.77-2.34) in the study cohort and 3.72 (95% CI 2.86-4.64) among patients younger than 70 years of age. Likewise, patients with hematological malignancies and confirmed-SARS-CoV-2 infection had a standardized mortality ratio of 41.3 (95% CI 38.1-44.9) compared to non-COVID-19 cohorts with hematologic malignancies. Among 451 hospitalized patients, the most common symptoms at the time of admission included fever (75%), dyspnea (51%), cough (45%), and malaise (39%). Of the 536 individuals enrolled in this study, 194 (36%) had severe COVID-19 and 74 (14%) had critical COVID-19. By June 22, 2020, 37% of the enrolled patients had died, with a mortality rate of 153.2 deaths (95% CI 129.7-172.1) per 10 000 person-days. Factors associated with poor health outcomes included older age (Hazard ratio [HR] 1.03, 95% CI 1.01-1.05); progressive disease status (HR 2.10, 95% CI 1.41-3.12); diagnosis of acute myeloid leukemia (HR 3.49, 95% CI 1.56-7.81), indolent non-Hodgkin lymphoma (HR 2.19, 95% CI 1.07-4.48), aggressive non-Hodgkin lymphoma (HR 2.56, 95% CI 1.34-4.89), or plasma cell neoplasms (HR 2.48, 95% CI 1.31-4.69), and severe or critical COVID-19 (HR 4.08, 95% CI 2.73-6.09). Among 451 inpatients, 295 (65%) were treated with hydroxychloroquine (of whom 99 [34%] died), 188 (42%) with antiviral agents (of whom 71 [38%] died), 135 (30%) with heparins (of whom 46 [34%] died), and 40 (9%) with tocilizumab (of whom 16 [40%] died). Overall, findings of this retrospective cohort study highlight the poor health outcomes among patients with concomitant hematological malignancies and confirmed-COVID-19 diagnosis.

Image: PD

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