|The following article features coverage from the American Society of Hematology 2020 meeting. Click here to read more of Cancer Therapy Advisor‘s conference coverage.|
Hematologic malignancy was associated with more severe symptoms and death from coronavirus disease 2019 (COVID-19), likely due to immunosuppression attributable to the hematologic disease, according to results of a retrospective study presented at the virtual 62nd American Society of Hematology (ASH) Annual Meeting and Exposition.
“The worse disease evolution should be taken into account for a population that is highly exposed to SARS-CoV-2 contagion due to [a] high number of hospital visits for treatment,” Cristina De Ramón, of the Hospital Universitario de Salamanca in Spain, and presenter of the study, said.
Prior studies have suggested that hematologic disease is associated with higher COVID-19 mortality rates than the general population, but the data so far are limited. The aim of this study, called ECOVIDEHE, was to assess the effect of hematologic disease and its associated treatment with the outcomes of COVID-19.
The multicenter, retrospective observational study evaluated data from 543 patients with hematologic disease who developed COVID-19 between March and June 2020. Samples and data were collected at the time of assistance in the emergency department or hospital admission.
At baseline, the median age of patients was 70 years, 57% of patients were male, and 76% had at least 1 comorbidity. There were 65% of patients in the cohort with a lymphoid malignancy, of which, 53.6% were on active anticancer treatment. SARS-CoV-2 infection was confirmed with a positive nasopharyngeal swab or serologic testing among 94% of patients, and 15% were nosocomial.
There were 89% of patients who required hospital admission, including 6.3% who were admitted to intensive care units (ICU). Overall, 65% of patients were considered to have severe COVID-19. The most common symptoms were fever, cough, dyspnea, and pneumonia.
Overall, the mortality rate was 36.3%. Patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS; 49%) were significantly more likely to die from COVID-19 than patients with other hematologic malignancies (34%) or other hemopathies (29%; P <.001). Patients with active or progressive disease were also more likely to die from COVID-19 (51%) compared with patients in complete remission (21%) or those with partial remission or stable disease (37%: P =.018).
Patients who had undergone an allogeneic (22%) or autologous hematopoietic stem cell transplant (20%) experienced improved survival compared with patients who had not undergone transplant (39%; P <.01). Ms De Ramón said that these findings may be because the patients who underwent transplant were younger and many were in complete remission.
In addition, mortality was associated with higher Charlson Comorbidity Index and Eastern Cooperative Oncology Group performance status. Mortality was also associated with low lymphocyte or platelet counts, as well as high lactate dehydrogenase, C-reactive protein, procalcitonin, and D-dimer levels. A multivariate analysis confirmed these findings, and also found that being older than 70 years was associated with mortality.
Most treatments for COVID-19 did not improve survival outcomes, except corticosteroids. Ms De Ramón suggested that this may be because the treatments were preferentially administered to patients with more severe disease.
Ms De Ramón concluded that “SARS-CoV-2 infection causes more severe disease and higher mortality rates in hematological patients, especially those with AML/MDS or active or progressive disease.”
Read more of Cancer Therapy Advisor‘s coverage of the ASH 2020 meeting by visiting the conference page.
De Ramón C, Hernandez-Rivas JA, García JAR, et al. Impact of Sars-CoV2 infection on 491 hematological patients: the Ecovidehe Multicenter Study. Presented at: 62nd American Society of Hematology (ASH) Annual Meeting and Exposition; December 5-9, 2020. Abstract 312.