|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 coronavirus disease 2019 (COVID-19) and high false-negative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rates as measured by standard reverse transcriptase–polymerase chain reaction (RT-PCR) testing, according to results of a study presented at the virtual 62nd American Society of Hematology (ASH) Annual Meeting and Exposition.
“Our research brought about 2 important points: the high mortality rate, and the high false negative rate,” Alex Niu, MD, of Tulane University in New Orleans, Louisiana, and presenter of the study, said.
Data on the outcomes of COVID-19 among patients with hematologic malignancies is limited. The purpose of this study was to evaluate the outcomes of a population of patients with hematologic malignancies and a high suspicion of COVID-19.
The prospective study included 39 patients with different hematologic malignancies who were tested for SARS-CoV-2 due to high clinical suspicion of the disease between March and October 2020.
All patients were tested for SARS-CoV-2 by PCR, and a subset of patients who were found to be negative by PCR were also tested using a clustered regularly interspaced short palindromic repeats (CRISPR) technique, which was considered to be more sensitive than RT-PCR.
The cohort included patients aged 24 to 82 years. The majority of patients had lymphoid malignancies, and several had myeloid malignancies. Of the 39 patients, 33 were tested for evidence of viral infection due to undiagnosed respiratory illness, and 6 were asymptomatic and tested prior to receiving chemotherapy. There were 20 patients undergoing active chemotherapy; 6 underwent autologous or allogeneic transplant, and 7 were under active surveillance.
There were 26 patients who tested positive for SARS-CoV-2 by standard nasopharyngeal RT-PCR testing, including the 6 patients who were asymptomatic. However, there were 13 patients who tested negative for SARS-CoV-2 by standard RT-PCR testing.
“As the clinical suspicion remained high, 8 of these patients were retested with a CRISPR test,” Dr Niu said. Of these, 7 patients were determined to be positive for SARS-CoV-2 through the use of CRISPR. The false-negative RT-PCR rate was 29%.
Among the patients who tested positive for SARS-CoV-2, 9 were treated with COVID-19–directed therapy, including hydroxychloroquine plus azithromycin, remdesivir, and/or COVID-19 convalescent plasma.
Among the patients who tested negative for SARS-CoV-2, 1 patient was treated with COVID-19–directed therapy and recovered, 3 died at other facilities of unknown causes, and 1 was asymptomatic.
The cohort had a high mortality rate of 32%, with the majority of deaths occurring within 25 days of diagnosis, Dr Niu said. Lymphodepleting chemotherapy within 30 days of COVID-19 diagnosis was significantly associated with mortality compared with not receiving lymphodepleting chemotherapy (P =.039).
Dr Niu suggested that the high mortality rate among patients with hematologic malignancies may be due to an altered immune system from both their underlying hematologic disease and its treatment, as well as the lymphopenia associated with COVID-19.
The high false-negative rates could be the result of testing before viral shedding is sufficient for detection by PCR testing, Dr Niu reasoned. He also hypothesized that the patients in this cohort were highly immunocompromised, resulting in a smaller viral load that caused symptoms but was not sufficient enough for PCR detection.
Disclosures: Some of the presenters disclosed financial relationships with the pharmaceutical industry and/or the medical device industry. For a full list of disclosures, please refer to the presentation abstract.
Read more of Cancer Therapy Advisor‘s coverage of the ASH 2020 meeting by visiting the conference page.
Niu A, Ning B, Socola F, et al. COVID-19 in patients with hematological malignancies: high false negative rate with high mortality. Presented at: 62nd American Society of Hematology (ASH) Annual Meeting and Exposition; December 5-9, 2020. Abstract 313.