A Multicenter Analysis of the Outcome of Cancer Patients with Neutropenia and COVID-19 Optionally Treated with Granulocyte-Colony Stimulating Factor (G-CSF): A Comparative Analysis

María Sereno,Enrique Casado,Javier Baena-Espinar,Gonzalo Colmenarejo,Rosa Álvarez-Álvarez,Raquel Molina,Luis Enrique Chiara,Ana Collazo-Lorduy,Ana López-Alfonso,A Pertejo ,Ana López Martín ,C Aguado ,Alain Martin ,Ana Ramı́rez De Molina ,Xabier Mielgo ,Ana María Jiménez-Gordo ,B Hernandez ,J López ,Miriam Leandro Dorta ,Ana Sánchez Sánchez

doi:10.3390/cancers13164205

Abstract

Simple SummaryInfections with COVID-19 in neutropenic cancer patients are related to poor outcomes. A G-CSF treatment used in neutropenic cancer with SARS-CoV-2 infections is related to a higher rate of respiratory failure according to progressive and growing evidence. In this small retrospective non-randomized study, we found an association between G-CSF treatment and the parameters predisposing for worse infections with COVID-19 and neutropenia compared with patients not treated with G-CSF. We also found that the number of days on G-CSF treatment was related to a higher risk of mortality in a multivariable analysis among patients treated with G-CSF.Background: Approximately 15% of patients infected by SARS-CoV-2 develop a distress syndrome secondary to a host hyperinflammatory response induced by a cytokine storm. Myelosuppression is associated with a higher risk of infections and mortality. There are data to support methods of management for neutropenia and COVID-19. We present a multicenter experience during the first COVID-19 outbreak in neutropenic cancer patients infected by SARS-CoV-2. Methods: Clinical retrospective data were collected from neutropenic cancer patients with COVID-19. Comorbidities, tumor type, stage, treatment, neutropenia severity, G-CSF, COVID-19 parameters, and mortality were analyzed. A bivariate analysis of the impact on mortality was carried out. Additionally, we performed a multivariable logistic regression to predict respiratory failure and death. Results: Among the 943 cancer patients screened, 83 patients (11.3%) simultaneously had neutropenia and an infection with COVID-19. The lungs (26%) and breasts (22%) were the primary locations affected, and most patients had advanced disease (67%). In the logistic model, as adjusted covariates, sex, age, treatment (palliative vs. curative), tumor type, and the lowest level of neutrophils were used. A significant effect was obtained for the number of days of G-CSF treatment (OR = 1.4, 95% CI [1,1,03,92], p-value = 0.01). Conclusions: Our findings suggest that a prolonged G-CSF treatment could be disadvantageous for these cancer patients with infections by COVID-19, with a higher probability of worse outcome.

Highlights

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic
The baseline characteristics and different parameters related to cancer are presented in Table 1, both as totals and split by growth colony stimulating factor (G-CSF) treatment
Focusing on infections with COVID-19, in this series, we found that those patients with any type of pneumonia and neutropenia presented higher mortality compared with those without it: 19 (82.6%) versus 4 (17.3%), p = 0.0027

Summary

Introduction

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic. Approximately 15% of patients infected by COVID-19 develop severe lung disease and multiorgan failure, which are major causes of mortality [2]. Most of the patients with comorbidities such as hypertension, diabetes, obesity, chronic obstructive pulmonary disease (COPD), tobacco consumption, vascular disease, advanced age, and other chronic diseases require frequent visits to the hospital, which is correlated with a higher risk of severe complications in the case of infection with SARS-CoV-2 [9,10]. 15% of patients infected by SARS-CoV-2 develop a distress syndrome secondary to a host hyperinflammatory response induced by a cytokine storm. Comorbidities, tumor type, stage, treatment, neutropenia severity, G-CSF, COVID-19 parameters, and mortality were analyzed. Conclusions: Our findings suggest that a prolonged G-CSF treatment could be disadvantageous for these cancer patients with infections by COVID-19, with a higher probability of worse outcome

Results

Discussion

Conclusion