AML-355: Incidence and Severity of COVID-19 among Inpatients with Hematologic Malignancies

Abstract

Context:COVID-19 has become the largest health crisis in recent history, with complex healthcare challenges in frontline and critical care settings or in assisting patients with chronic diseases and cancer. Hematologic malignancies (HM) represent an additional factor for severe COVID-19, and mortality rates of 21%–62% for HM patients have been reported.Objective:To assess the incidence and severity of COVID-19 among HM inpatients.Design:We performed a retrospective analysis of electronic health charts of inpatients at Hospital Municipal São José (HMSJ) in Joinville, Brazil.Setting:This one-year period was selected considering that the first COVID-19 case in Joinville was reported on March 13. Local transmission was initially uncommon.Patients or Other Participants:Diagnosis of HM under the WHO classification and hospital stay for more than 48 hours were required. One hundred seventeen consecutive HM inpatients and 152 consecutive inpatients in the one-year period before COVID-19 in Joinville were included.Intervention:No intervention was performed.Main Outcome Measures:Mortality and incidence of COVID-19, severe disease, and thrombotic events.Results:COVID-19 cumulative incidence for HM inpatients was 25%, with one COVID-19 positive test every 73 patient hospital days. Very likely nosocomial transmission was seen in 19 cases (66%). Chemotherapy was administered within 30 days of symptom onset in 19 patients (66%). Severe neutropenia and severe thrombocytopenia were seen in 10 (34%) and 13 (45%) patients, respectively. For HM inpatients with and without COVID-19, the most common diagnoses were acute leukemia (34% and 23%, respectively; p=0.23), lymphoma (28% and 34%; p=0.65), and multiple myeloma (10% and 18%; p=0.4) Severe COVID-19 was established in 22 patients (76%), with 16 (55%) intensive care unit (ICU) admissions and 19 deaths (66%). TEs were reported in six patients. Thrombocytopenia prevented anticoagulation in 11 patients (50%). In-hospital mortality was 66% for HM inpatients versus 32% for HM inpatients without COVID-19 (p=0.002) and 23% for pre-COVID-19 HM inpatients (p<0.001).Conclusions:Cumulative incidence of COVID-19 in HM inpatients and the higher mortality over this one-year period are very alarming. As vaccination efforts are currently in expansion worldwide, it is uncertain whether hospital care for HM will carry on without inpatient transmission. Collaborative studies reporting on COVID-19 outcomes of HM inpatients are needed to guide decisions in this population.