Hematological Malignancies Worse for COVID-19 Patients

Francesco Passamonti, MD

Patients with hematological malignancies have worse outcomes than the general population with coronavirus disease 2019 (COVID-19) and those with hematological malignancies without COVID-19.

The findings of the recent study highlighted the need for aggressive infection prevention strategies to reduce the high mortality among patients with hematological malignancies hospitalized with COVID-19.

Francesco Passamonti, MD, and a team of investigators conducted a multicenter, retrospective cohort study of 66 hematology units in Italy. They included patients at least 18 years old with any comorbidity who were admitted between February 25, 2020 and May 18, 2020. Inclusion criteria included the presence of a World Health Organization-defined hematological malignancy and symptomatic and laboratory-confirmed SARS-CoV-2 infection.

The team collected data on laboratory parameters, possible complications, drug exposure, and patient outcomes. They also extracted patient characteristics and outcomes from electronic medical records. Data extracted included age, sex, Charlson Comorbidity Index, type and status of hematological malignancy to COVID-19 diagnosis, time from last hematological malignancy therapy to diagnosis, and COVID-19 severity.

Primary study outcomes were mortality among patients with hematological malignancies and COVID-19 along with the evaluation of potential predictive mortality parameters. Additional outcomes included epidemiology of patients with malignancies affected by SARS-CoV-2, evolution of hematological malignancies, and dynamics of viral load.

Passamonti and colleagues enrolled 536 patients with hematological malignancies who were admitted for inpatient or outpatient care to manage symptomatic COVID-19. The median follow-up was 20 days (IQR 10-34; range 1-98).

Of the 451 hospitalized patients, 98% completed their hospital course with a median hospital stay of 16 days. For those with severe or critical COID-19, those admitted to the ICU were younger (HR, .97; 95% CI, .96-.98) and had a lower Charlson Comorbidity Index (HR, .8; 95% CI, .71-.91).

The investigators noted the most common symptoms at the time of hospital admission for COVID-19 were fever (75% of patients), dyspnoea (51% of patients), cough (45% of patients), and malaise (39% of patients).

Among the 536 patients included, half had mild COVID-19, while 36% had severe and 14% had critical disease. In a univariate analysis, it was found patients with severe or critical disease were older (mean age, 68 years old vs 65.6 years old; P=.032), had a higher Charlson Comorbidity Index (mean 5 vs 4.4; P=.011), and a more recent diagnosis of hematological malignancy (median time from diagnosis, 0 years vs 1 year; P=.0032) than patients with mild COVID-19.

During the first study period from February 25-March 31, the mortality rate was 169.2 deaths (143.9-198.9) per 10,000 person-days. The mortality rate decreased significantly during the study period, with a rate of 111.1 deaths (84.4-146.2) per 10,000 person-days (P=.014). There was no significant difference in mortality rate detected between northern (150.8 deaths [129.4–175.9] per 10,000 person-days) and southern (141.6 deaths [101.7–197.2] per 10,000 person-days) Italy. Those with severe or critical COVID-19 had worse overall survival than those with mild disease.

The standardized mortality ratio was 2.04 (95% CI, 1.77-2.34) in the whole study population, 3.72 (95% CI, 2.86-4.64) in patients younger than 70 years old, and 1.71 (95% CI, 1.44-2.04) in those at least 70 years old. In a comparison with the non-COVID-19 cohort with hematological malignancies, 2.7% of 31,993 patients in the non-COVID-19 cohort died. The mortality rate was 2.42 deaths (2.26-2.58) per 10,000 person-days and led to a standardized mortality ratio of 41.3 (38.1-44.9).

Worse survival was associated with older age, progressive disease status, an acute myeloid leukemia diagnosis, indolent non-Hodgkin lymphoma, aggressive non-Hodgkin lymphoma, plasma cell neoplasms, and severe or critical COVID-19.

“This study adds to the evidence that patients with hematological malignancies have worse outcomes than both the general population with COVID-19 and patients with hematological malignancies without COVID-19,” the study authors wrote.

The findings suggested the need for aggressive infection prevention strategies, especially until an effective vaccination or treatment strategy becomes available.

The study, “Clinical characteristics and risk factors associated with COVID-19 severity in patients with haematological malignancies in Italy: a retrospective, multicentre, cohort study,” was published online in The Lancet Haematology.