Abstract

BackgroundClinical outcomes of novel coronavirus 2019 disease (COVID‐19) in onco‐hematological patients are unknown. When compared to non‐immunocompromised patients, onco‐hematological patients seem to have higher mortality rates.AimsWe describe the characteristics and outcomes of a consecutive cohort of 24 onco‐hematological patients with COVID‐19 during the first month of the pandemic. We also describe variations in healthcare resource utilization within our hematology department.Methods and ResultsData from patients between the first month of the pandemic were retrospectively collected. Clinical and logistic data were also collected and compared with the average values from the prior 3 months of activity. Prevalence of COVID‐19 in our hematological population was 0.4%. Baseline characteristics were as follows: male sex: 83%, lymphoid diseases: 46%, median age: 69 (22‐82) years. Median follow‐up in survivors was 14 (9‐28) days and inpatient mortality rate was 46%. Average time to moderate/severe respiratory insufficiency and death were 3 (1‐10) and 10 (3‐18) days, respectively. Only 1 out of every 12 patients who developed moderate to severe respiratory insufficiency recovered. Upon univariate analysis, the following factors were associated with higher mortality: age ≥ 70 years (P = .01) and D‐dimer ≥900 mcg/L (P = .04). With respect to indirect effects during the COVID‐19 pandemic, and when compared with the prior 3 months of activity, inpatient mortality (excluding patients with COVID‐19 included in the study) increased by 56%. This was associated with a more frequent use of vasoactive drugs (+300%) and advanced respiratory support (+133%) in the hematology ward. In the outpatient setting, there was a reduction in initial visits (−55%) and chemotherapy sessions (−19%). A significant increase in phone visits was reported (+581%).ConclusionCOVID‐19 pandemic is associated with elevated mortality in hematological patients. Negative indirect effects are also evident within this setting.

Highlights

  • The novel coronavirus SARS-CoV2 recently emerged as a global threat.[1]

  • In the second part of the study, we described the indirect effects of COVID-19 on inpatient and outpatient activity in our department

  • We described the number of patients without COVID-19 infection who underwent sub-intensive care procedures in the hematology ward, as well as the number of patients who required intensive care unit (ICU) admission

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Summary

| INTRODUCTION

The novel coronavirus SARS-CoV2 recently emerged as a global threat.[1]. High hospitalization (around 20% of diagnosed cases) and mortality rates (2%-3%) of patients with COVID-19 have led to an unprecedented burden on healthcare systems.[2,3] the impact of COVID-19 has even prevented healthcare professionals from continuing normal utilization practices of healthcare resources for all other health matters unrelated to the pandemic. We analyze the indirect effects of such pandemic on our hematology department in terms of inpatient and outpatient activity of a population without COVID-19 infection. For transplant and cell therapy, the following categories were considered high risk: allogeneic HCT for acute myeloid leukemia, aplastic anemia, any advanced stage of lymphoma not in complete remission, no further option of another cycle of chemotherapy, patients included in clinical trials, and chimeric antigen receptor cell candidates. Prior agreement with the ICU to have a referral intensive care specialist in the hematology ward was made This strategy was implemented with the objective to delay transfers of critical patients and assume more clinically complex cases, defined as those patients who require vasoactive drug support and/or present with rapid acute respiratory insufficiency and need noninvasive ventilation with high-flow oxygen therapy. Patients admitted to the onco-hematological ward had the same pharmacological treatments available as those admitted to the ICU, including tocilizumab and high-dose corticosteroids

| RESULTS
Findings
| DISCUSSION

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