Clinical characteristics and risk factors for mortality in hematologic patients affected by COVID‐19

Abstract

Background Patients with cancer are considered highly vulnerable to the recent coronavirus disease 2019 (COVID‐19) pandemic. However, there are still few data on COVID‐19 occurring in hematologic patients. Methods One hundred two patients with COVID‐19 symptoms and a nasopharyngeal swab positive for severe acute respiratory syndrome coronavirus 2 seen at 2 hematologic departments located in Lombardy, Italy, during March 2020 were studied. Risk factors for acquiring COVID‐19 were analyzed by comparisons of patients with COVID‐19 and the standard hematologic population managed at the same institutions in 2019. Thirty‐day survival was compared with the survival of matched uninfected control patients with similar hematologic disorders and nonhematologic patients affected by COVID‐19. Results Male sex was significantly more prevalent in patients with COVID‐19. The infection occurred across all different types of hematologic disease; however, the risk of acquiring a COVID‐19 infection was lower for patients with chronic myeloproliferative neoplasms, including chronic myeloid leukemia, and higher for patients with immune‐mediated anemia on immunosuppressive‐related treatments. The 30‐day mortality rate was 39.2%, which was higher than the rates for nonhematologic patients with COVID‐19 (23.5%; P = .02) and uninfected hematologic controls (3%; P < .001). The severity of the respiratory syndrome at presentation and active hematologic treatment were independently associated with a worse prognosis. Neither diagnosis nor disease status affected the prognosis. The worst prognosis was demonstrated among patients on active hematologic treatment and those with more severe respiratory syndrome at COVID‐19 presentation. Conclusions During the COVID‐19 pandemic, patients should be advised to seek medical attention at the earliest signs of dyspnea and/or respiratory infection. Physicians should perform a risk‐benefit analysis to determine the impact of temporarily deferring nonlifesaving treatments versus the risk of adverse outcomes associated with COVID‐19. Lay Summary Coronavirus disease 2019 (COVID‐19) infection occurs across all different types of hematologic disease; however, the risk of acquiring it is lower for patients with chronic myeloproliferative neoplasms, including chronic myeloid leukemia, and higher for patients with immune‐mediated anemia on immunosuppressive treatment. The 30‐day mortality rate is 39.2%, which is far higher than the rates for both uninfected hematologic controls (3%; P < .001) and nonhematologic patients with COVID‐19 (23.5%; P = .02) despite matching for age, sex, comorbidities, and severity of disease. Variables independently associated with a worse prognosis are the severity of the respiratory syndrome at presentation and any type of active hematologic treatment. Neither diagnosis nor disease status influence the prognosis.

Balance on slack line; diagnostic intensity and patient safety during the SARS-CoV-2 pandemic

“…Their subgroup analyses provide some possible clues with the highest risk for patients with lung cancer and haematological cancer, that is, patients with either severe pulmonary disease or immune dysfunction [5]. From previous studies, patients with haematological cancers and COVID-19 has had high CFRs -mostly 30% or higher [9,[13][14][15][16][17][18].…”

COVID‐19 in patients with hematological malignancies: Considering the role of tyrosine kinase inhibitors

“…In conclusion, we consider that the positive outcomes of TKI‐treated CML patients with COVID‐19, including a lower frequency of SARS‐CoV‐2 infection and a higher survival rate, strengthen the hypothesis that these drugs might be beneficial in the treatment of this disease. Hence, we believe that a more detailed description by Cattaneo et al 1 about deceased subjects with CML under TKI therapy in their study would be valuable. Finally, further clinical research should be encouraged to assess the effectiveness of imatinib and other related TKIs in COVID‐19.…”

“…In an article previously published in Cancer , Cattaneo et al 1 analyzed a cohort of patients with coronavirus disease 2019 (COVID‐19) and hematological malignancies in March 2020, and they highlighted that subjects with chronic myeloid leukemia (CML) had a lower than expected frequency of COVID‐19. The authors linked this observation to the lower level of immunodeficiency seen in CML and to a potential protective role of tyrosine kinase inhibitors (TKIs) based on the possible antiviral activity of these drugs.…”

Reply to COVID‐19 in patients with hematological malignancies: Considering the role of tyrosine kinase inhibitors

“…We thank Morales‐Ortega and his colleagues for their interest in our study 1 and particularly in patients with chronic myeloid leukemia (CML).…”

“…In our study, 1 we evaluated the incidence of coronavirus disease 2019 (COVID‐19) in March 2020 according to hematological diagnosis in the Brescia cohort, and we observed that COVID‐19 was contracted by none of the patients affected by CML in the Brescia cohort and by 2 patients in the Milan cohort. A low incidence of COVID‐19 in patients with CML has been described in other studies 2,3 .…”