tetano
Editor, Senior Moderator
J Hematol Oncol
. 2020 Oct 8;13(1):133.
doi: 10.1186/s13045-020-00970-7.
Impact of hematologic malignancy and type of cancer therapy on COVID-19 severity and mortality: lessons from a large population-based registry study
Julio Garc?a-Su?rez[SUP] 1 [/SUP], Javier de la Cruz[SUP] 2 [/SUP], ?ngel Cedillo[SUP] 3 [/SUP], Pilar Llamas[SUP] 4 [/SUP], Rafael Duarte[SUP] 5 [/SUP], V?ctor Jim?nez-Yuste[SUP] 6 [/SUP], Jos? ?ngel Hern?ndez-Rivas[SUP] 7 [/SUP], Rodrigo Gil-Manso[SUP] 8 [/SUP], Mi Kwon[SUP] 9 10 [/SUP], Pedro S?nchez-Godoy[SUP] 11 [/SUP], Pilar Mart?nez-Barranco[SUP] 12 [/SUP], Blanca Col?s-Lahuerta[SUP] 13 [/SUP], Pilar Herrera[SUP] 14 [/SUP], Laurentino Benito-Parra[SUP] 15 [/SUP], Adri?n Alegre[SUP] 16 [/SUP], Alberto Velasco[SUP] 17 [/SUP], Arturo Matilla[SUP] 18 [/SUP], Mar?a Concepci?n Al?ez-Us?n[SUP] 19 [/SUP], Rafael Martos-Mart?nez[SUP] 20 [/SUP], Carmen Mart?nez-Chamorro[SUP] 21 [/SUP], Keina Susana-Quiroz[SUP] 22 [/SUP], Juan Francisco Del Campo[SUP] 23 [/SUP], Adolfo de la Fuente[SUP] 24 [/SUP], Regina Herr?ez[SUP] 25 [/SUP], Adriana Pascual[SUP] 26 [/SUP], Elvira G?mez[SUP] 27 [/SUP], Jaime P?rez-Oteyza[SUP] 28 [/SUP], Elena Ruiz[SUP] 29 [/SUP], Arancha Alonso[SUP] 30 [/SUP], Jos? Gonz?lez-Medina[SUP] 4 [/SUP], Luc?a N??ez Mart?n-Buitrago[SUP] 5 [/SUP], Miguel Canales[SUP] 6 [/SUP], Isabel Gonz?lez-Gasc?n[SUP] 7 [/SUP], Mar?a Carmen Vicente-Ayuso[SUP] 11 [/SUP], Susana Valenciano[SUP] 1 [/SUP], Mar?a Garc?a Roa[SUP] 12 [/SUP], Pablo Estival Monteliu[SUP] 13 [/SUP], Javier L?pez-Jim?nez[SUP] 14 [/SUP], Cristi?n Escolano Escobar[SUP] 15 [/SUP], Javier Ortiz-Mart?n[SUP] 16 [/SUP], Jos? Luis Diez-Martin[SUP] 9 10 [/SUP], Joaqu?n Martinez-Lopez[SUP] 31 32 [/SUP], Asociaci?n Madrile?a de Hematolog?a y Hemoterapia (AMHH)
Collaborators, Affiliations
Abstract
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.
Keywords: COVID-19; Hematologic neoplasms; Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
. 2020 Oct 8;13(1):133.
doi: 10.1186/s13045-020-00970-7.
Impact of hematologic malignancy and type of cancer therapy on COVID-19 severity and mortality: lessons from a large population-based registry study
Julio Garc?a-Su?rez[SUP] 1 [/SUP], Javier de la Cruz[SUP] 2 [/SUP], ?ngel Cedillo[SUP] 3 [/SUP], Pilar Llamas[SUP] 4 [/SUP], Rafael Duarte[SUP] 5 [/SUP], V?ctor Jim?nez-Yuste[SUP] 6 [/SUP], Jos? ?ngel Hern?ndez-Rivas[SUP] 7 [/SUP], Rodrigo Gil-Manso[SUP] 8 [/SUP], Mi Kwon[SUP] 9 10 [/SUP], Pedro S?nchez-Godoy[SUP] 11 [/SUP], Pilar Mart?nez-Barranco[SUP] 12 [/SUP], Blanca Col?s-Lahuerta[SUP] 13 [/SUP], Pilar Herrera[SUP] 14 [/SUP], Laurentino Benito-Parra[SUP] 15 [/SUP], Adri?n Alegre[SUP] 16 [/SUP], Alberto Velasco[SUP] 17 [/SUP], Arturo Matilla[SUP] 18 [/SUP], Mar?a Concepci?n Al?ez-Us?n[SUP] 19 [/SUP], Rafael Martos-Mart?nez[SUP] 20 [/SUP], Carmen Mart?nez-Chamorro[SUP] 21 [/SUP], Keina Susana-Quiroz[SUP] 22 [/SUP], Juan Francisco Del Campo[SUP] 23 [/SUP], Adolfo de la Fuente[SUP] 24 [/SUP], Regina Herr?ez[SUP] 25 [/SUP], Adriana Pascual[SUP] 26 [/SUP], Elvira G?mez[SUP] 27 [/SUP], Jaime P?rez-Oteyza[SUP] 28 [/SUP], Elena Ruiz[SUP] 29 [/SUP], Arancha Alonso[SUP] 30 [/SUP], Jos? Gonz?lez-Medina[SUP] 4 [/SUP], Luc?a N??ez Mart?n-Buitrago[SUP] 5 [/SUP], Miguel Canales[SUP] 6 [/SUP], Isabel Gonz?lez-Gasc?n[SUP] 7 [/SUP], Mar?a Carmen Vicente-Ayuso[SUP] 11 [/SUP], Susana Valenciano[SUP] 1 [/SUP], Mar?a Garc?a Roa[SUP] 12 [/SUP], Pablo Estival Monteliu[SUP] 13 [/SUP], Javier L?pez-Jim?nez[SUP] 14 [/SUP], Cristi?n Escolano Escobar[SUP] 15 [/SUP], Javier Ortiz-Mart?n[SUP] 16 [/SUP], Jos? Luis Diez-Martin[SUP] 9 10 [/SUP], Joaqu?n Martinez-Lopez[SUP] 31 32 [/SUP], Asociaci?n Madrile?a de Hematolog?a y Hemoterapia (AMHH)
Collaborators, Affiliations
- PMID: 33032660
- DOI: 10.1186/s13045-020-00970-7
Abstract
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.
Keywords: COVID-19; Hematologic neoplasms; Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).