Clinical outcomes and risk factors for severe COVID‐19 in patients with haematological disorders receiving chemo‐ or immunotherapy

Abstract

Haematology patients receiving chemo-or immunotherapy are considered to be at greater risk of COVID-19-related morbidity and mortality. We aimed to identify risk factors for COVID-19 severity and assess outcomes in patients where COVID-19 complicated the treatment of their haematological disorder. A retrospective cohort study was conducted in 55 patients with haematological disorders and COVID-19, including 52 with malignancy, two with bone marrow failure and one immune-mediated thrombotic thrombocytopenic purpura (TTP). COVID-19 diagnosis coincided with a new diagnosis of a haematological malignancy in four patients. Among patients, 82% were on systemic anti-cancer therapy (SACT) at the time of COVID-19 diagnosis. Of hospitalised patients, 37% (19/51) died while all four outpatients recovered. Risk factors for severe disease or mortality were similar to those in other published cohorts. Raised C-reactive protein at diagnosis predicted an aggressive clinical course. The majority of patients recovered from COVID-19, despite receiving recent SACT. This suggests that SACT, where urgent, should be administered despite intercurrent COVID-19 infection, which should be managed according to standard pathways. Delay or modification of therapy should be considered on an individual basis. Long-term follow-up studies in larger patient cohorts are required to assess the efficacy of treatment strategies employed during the pandemic.

Immune checkpoint inhibitors use and effects on prognosis of COVID-19 infection: A systematic review and meta-analysis

“…This suggests that we should not easily postpone, suspend, or alter our established treatment decisions in clinical practice, especially for patients who are undergoing ICI-containing regimens, because ICI has irreplaceable performance in certain antitumor treatments (8). Delay or modi cation of therapy should be considered on a case-by-case basis (52).…”

COVID-19 in a Patient with Advanced Merkel Cell Carcinoma Receiving Immunotherapy

“…Shared decision making with physicians and patients about delays in the oncologic treatment must occur, considering an individual’s risk of COVID-19 complications against the worse prognosis from postponed cancer therapy [ 23 ]. Retrospective data suggest that chemo–immunotherapy can be safely delivered even in this pandemic scenario, but sometimes may require regimen modifications or alternative schedules that should also be determined on an individual basis [ 25 ].…”

Response to ‘Impact of immunosuppression on mortality in critically ill COVID‐19 patients’

“…We analysed outcomes for patients on systemic immunosuppression (corticosteroids, ciclosporin or mycophenolate mofetil) against those that were not. Patients in our cohort who had received systemic immunosuppression within 14 days of COVID‐19 diagnosis had numerically increased risk of both severe disease and death, but this was not statistically significant {odds ratio (OR) for death 1·79 [95% confidence interval (CI) 0·56‐5·66] P = 0·32} 1 . Thus, although the immunosuppressed patients in our two studies likely differ substantially in the degree of immunosuppression, the findings are broadly in agreement (although given both sample sizes are small this requires validation in a larger cohort).…”