Abstract
BackgroundPrognostic factors of poor outcome in patients with hematological malignancies and COVID-19 are poorly defined.Patients and methodsThis was a Spanish transplant group and cell therapy (GETH) multicenter retrospective observational study, which included a large cohort of blood cancer patients with laboratory-confirmed SARS-CoV-2 infection through PCR assays from March 1st 2020 to May 15th 2020.ResultsWe included 367 pediatric and adult patients with hematological malignancies, including recipients of autologous (ASCT) (n = 58) or allogeneic stem cell transplantation (allo-SCT) (n = 65) from 41 hospitals in Spain. Median age of patients was 64 years (range 1–93.8). Recipients of ASCT and allo-SCT showed lower mortality rates (17% and 18%, respectively) compared to non-SCT patients (31%) (p = 0.02). Prognostic factors identified for day 45 overall mortality (OM) by logistic regression multivariate analysis included age > 70 years [odds ratio (OR) 2.1, 95% confidence interval (CI) 1.2–3.8, p = 0.011]; uncontrolled hematological malignancy (OR 2.9, 95% CI 1.6–5.2, p < 0.0001); ECOG 3–4 (OR, 2.56, 95% CI 1.4–4.7, p = 0.003); neutropenia (< 0.5 × 109/L) (OR 2.8, 95% CI 1.3–6.1, p = 0.01); and a C-reactive protein (CRP) > 20 mg/dL (OR 3.3, 95% CI 1.7–6.4, p < 0.0001). In multivariate analysis of 216 patients with very severe COVID-19, treatment with azithromycin or low dose corticosteroids was associated with lower OM (OR 0.42, 95% CI 0.2–0.89 and OR 0.31, 95% CI 0.11–0.87, respectively, p = 0.02) whereas the use of hidroxycloroquine did not show significant improvement in OM (OR 0.64, 95% CI 0.37–1.1, P = 0.1).ConclusionsIn most patients with hematological malignancies COVID-19 mortality was directly driven by older age, disease status, performance status, as well as by immune (neutropenia) parameters and level of inflammation (high CRP). Use of azithromycin and low dose corticosteroids may be of value in very severe COVID-19.
Highlights
Prognostic factors of poor outcome in patients with hematological malignancies and COVID-19 are poorly defined
21 cases were excluded due to negative results for SARS-CoV-2 PCR testing, irrespective of being classified as “probable COVID-19” by their hospital or regional epidemiologists based on a compatible clinical presentation and the large numbers of infections in the community
By multivariate analysis we identified 3 conditions associated with stage IIB or severe COVID-19; history of hypertension [Odds ratio (OR) 2, 95% confidence interval (CI) 1.3–3.2, p = 0.02], baseline lymphopenia (< 0.5 × 109/ mL) and baseline C-reactive protein (CRP) > 20 mg/dL
Summary
Prognostic factors of poor outcome in patients with hematological malignancies and COVID-19 are poorly defined. Risk factors for COVID-19 severity and death include older age, diabetes, hypertension, or cardiac disease [1,2,3,4]. Initial reports suggested that patients with cancer had an estimated two-fold increased risk of contracting SARS-CoV-2 than the general population and, if infected, had a higher risk of severe events [intensive care unit (ICU) admission, invasive ventilation, or death] compared to patients without cancer [7,8,9].
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