乌鸦传媒

Patients with hematologic malignancies and COVID-19 seemed to be at a higher risk for severe infection and death, according to analysis of data from the international ASH Research Collaborative.

COVID-19 severity was strongly tied to malignancy status at the time of diagnosis, with 69% of those receiving initial treatment for a hematologic malignancy having moderate or severe disease versus 50% in remission, and 79% with relapsed or refractory disease, reported William A. Wood, MD, of the University of North Carolina at Chapel Hill.

Overall, 62% of patients with known severity status had moderate or severe COVID-19 infection. Among those ages <19 years, 47% had moderate or severe disease versus 43% of those ages 19-39 years, 62% of those ages 40-69, and 70% ages ≥70.

Overall mortality among the first 250 patients in the registry was about 28%, but that figure dropped to 20% in 656 patients to date, Wood said at a press conference at the American Society of Hematology (ASH) virtual meeting.

The risk for death appeared highest among those who were older, had more severe infection, opted to forego more intensive treatment, and/or had a poorer cancer prognosis before COVID-19 infection, according to the analysis.

A third of patients who required hospital- or ICU-level care died, Wood reported, but pointed out to 乌鸦传媒 that "One important finding is that we did report that many patients with underlying hematological conditions, who did receive intensive-level care, did survive their COVID-19 infection."

"If it is appropriate with patient/provider preferences, we do think that maximal intensive supportive care may well be appropriate as long as it aligns with patient preferences," he stressed.

Wood and co-authors reported that lack of ICU care was strongly associated with age, with a 73% mortality rate among those who declined ICU-level care compared with 13% among those who did not.

The registry launched in April and includes voluntary contributions of clinical data from more than 100 international study sites. Wood noted that the registry offers near real-time data to hematologists, and other clinicians, during the pandemic, and provides insights into which patients are most vulnerable to severe illness and death.

"We have seen and continue to see that individuals with hematologic malignancies and COVID-19 infection appear to have more severe illness and a higher likelihood of death compared to the general population," Wood stated. "This heightened risk of severe infection or death among these patients is concentrated in certain groups of individuals, and data from our global registry has helped to understand this more clearly."

For the study, the authors pooled data from the registry on 656 patients (most around age 40; 60% men; 43% white) with various hematologic malignancies and laboratory-confirmed or presumed COVID-19 diagnosis. Among the participants, 57% had comorbidities, including hypertension (50%) and diabetes (30%).

In terms of their cancers, 57% had leukemia, 25% had lymphoma, and 18% had plasma cell neoplasms. Prior to the COVID-19 infection, 80% had an expected survival of >12 months.

The authors reported that mortality rates differed by prognosis, with 51% of patients with a pre-COVID-19 expected survival of <12 months dying versus 13% of patients with expected survival of >12 months. Mortality rates also differed by malignancy status: 11% mortality among those starting treatment, 13% for those in remission, and 36% for those with relapsed/refractory disease.

Also, the most common COVID-19-associated symptoms were fever (65%) followed by cough (56%); 11% were asymptomatic.

The majority of patients received azithromycin (n=143) followed by hydroxychloroquine (n=137) as COVID-19 treatment. Remdesivir (Veklury) was given to 44 patients, according to the authors.

"This analysis highlights that patients with hematologic diseases are a medically vulnerable population when it comes to COVID-19 infection," Wood said. "It underscores the need for us to continue to encourage our patients to take appropriate precautions to limit exposure to COVID-19; to continue to take precautions in our healthcare delivery environment to protect these patients; and to prioritize these patients for COVID-19 testing as well as vaccine distribution, once efficacious and safe vaccines are available."

Robert Glatter, MD, of Lenox Hill Hospital/Hofstra University Northwell in New York City, told 乌鸦传媒 that "While the prognosis and outcome of patients with COVID-19 and hematologic malignancies can be worse or similar compared to other high-risk medical conditions, it's always essential to have a discussion regarding goals of care with the patient and family."

"In this context, it's especially important to identify and treat reversible conditions such as anemia, thrombocytopenia, coagulopathy, electrolyte, and other nutritional deficiencies," said Glatter, who was not involved in the study. "Informed decision-making is essential when developing a care plan, especially in light of the higher morbidity and mortality associated with COVID-19, as well as all underlying and high-risk medical conditions."

"Honoring wishes expressed on a MOLST [medical orders for life-sustaining treatment] form is critical in this regard," he noted. "I agree with the researchers conclusions that [there is no reason] 'to withhold intensive therapies from patients with underlying hematologic malignancies and favorable prognoses, if aggressive supportive care is consistent with patient preferences.'"

Wood highlighted the "collaborative, global effort" of the registry. "We were able to launch this resource quickly and with a spirit of volunteerism and collaboration from around the world. Hematologists recognize the value of these data and continue to contribute cases," he said.

While the current analysis is limited to patients with hematologic malignancies, data from patients with non-malignant blood disorders is also being collected by the registry, Wood added.

Comment