Hospitalized COVID-19 Patients with Active Lymphoma Have Eight Times Higher Risk of Death Than COVID-19 Controls

Abstract

BACKGROUND: Over 790,000 patients in the United States are currently living with or are in remission from lymphoma. It is established that lymphoma patients are at greater risk for both bacterial and viral infections. While there is limited research examining the risk of COVID-19 infection in patients with an active malignancy, even fewer studies have examined those with active lymphoma. This study aimed to examine the all-cause mortality of COVID-19 patients with active lymphoma compared to hospitalized COVID-19 control patients. METHODS: We performed a retrospective case-control and cohort study of adult inpatients diagnosed with COVID-19 infection in a tertiary, academic referral center in Richmond, Virginia. We analyzed the unadjusted and adjusted association of patients with active lymphoma diagnosis and all-cause hospital mortality. We performed multiple logistic regressions adjusting for age, gender, race, the month at presentation, which captures the health system's adaptation, and the remaining 30 individual diagnostic categories of the Elixhauser comorbidity index. We externally validated our findings using compiled data from 657 institutions across the United States on patients with lymphoma hospitalized for COVID-19. RESULTS: Among 628 inpatients with COVID-19, 1.1% (7) had active lymphoma. The unadjusted mortality of patients with lymphoma was 57.1% compared to 8.4% of the corresponding patients without lymphoma. The unadjusted OR for hospital death was 15.6 (95% CI 3.2 to 67, P=0.001). The adjusted OR of death in patients with lymphoma was 79.5 (95% 6.4 to 983, P= 0.001). The average adjusted mortality in patients with lymphoma was 65% compared with 8.4% among patients of equivalent age, gender, race, month of presentation and comorbidities. From aggregate data of COVID-19 patients across 657 US institutions, the average mortality for patients with lymphoma was 41.07% (95% CI 36.8 to 45.3) and for patients without lymphoma was 12.11% (95% CI 12.7 to 11.5). CONCLUSION: Our results show that, of those patients hospitalized for COVID-19 infection, the patients with active lymphoma have a nearly 8-fold increased risk of death compared to their non-lymphoma counterparts when adjusted for age, gender, race, month of presentation, and other comorbidities. External validation data demonstrated a greater than 3-fold increased risk of death in COVID-19 patients with active lymphoma compared to non-lymphoma patients. This research highlights the importance of mitigation strategies, such as social distancing and masking, to decrease the risk of COVID-19 infection in lymphoma patients and may have implications for prioritizing vaccines or therapies in the future. FIGURE:.