Clinical profile and outcome of COVID-19 in haematological malignancies: experience from tertiary care centre in India

Abstract

There is limited evidence on various clinical aspects of SARS-CoV-2 infection in patients with haematological cancers. The risk factors, prognosis, and outcome of patients with haematological cancers with coexistent COVID-19 need to be explored in different subsets of population. A single-institutional prospective observational study was conducted at a tertiary level medical institute in North India. The clinical details of the recruited patients having haematological malignancies and diagnosed with COVID-19 between 15 March 2020 and 31 May 2021 were prospectively collected through the electronic patient database system. The outcomes with respect to 28-day and 56-day mortality and the associated risk factors for prognostication were analysed. Of the 5750 hospital admissions (inpatient and day-care) during the study period, two hundred and forty-two patients (4.2%) were diagnosed with COVID-19. Acute leukaemia was the most common haematological malignancy, seen in 117 (48.3%) patients. Eighty-nine (36.8%) patients had moderate-to-severe COVID-19 while 153 (63.2%) patients presented with mild infection. The 28-day and 56-day mortality rates in our cohort were 13.3% and 19.8% respectively. Amongst the risk factors associated with poor outcome, the severity of COVID-19 (HR = 1.8, 95% CI 1.16–10.35; p = 0.04), presence of secondary infection (HR = 2.1, 95% CI 2.45–21.3; p = 0.023), and need for invasive mechanical ventilation (HR = 2.3, 95% CI 1.8–18.43; p = 0.01) were prognostically significant on multivariate log rank analysis. The risk of SARS-CoV-2 infection does not increase with haematological malignancies; however, the outcome remains poor in patients with severe COVID-19, requirement of invasive mechanical ventilation, and pre-existing bacterial/fungal infection at presentation.

COVID-19 in Patients with Hematologic Malignancies: Clinical Manifestations, Persistence, and Immune Response

“…In a multivariate cox regression, the following types of HM were shown to bear the greatest risk for death from COVID-19: acute myeloid leukemia (3.49, 1.56–7.81), multiple myeloma (2.48, 1.31–4.69), and non-Hodgkin’s lymphoma (2.19, 1.07–4.48). Data reported in other studies [6, 14-16, 19] were similar. Interestingly, while age, HM severity, and shorter time from HM diagnosis were strongly associated with increased mortality, other comorbidities and time interval between last HM treatment and COVID-19 infection were not [6].…”

“…These differences were even more pronounced when looking only at patients with newly diagnosed (<1 year) HM (HR 6.18 [4.31–8.86] than the general population and 2.24 [1.34–3.76] than patients with SM). The increased risk of patients with HM to have severe COVID-19 at presentation, to have a longer duration of hospital admission, and be more likely to die is consistent in reported studies across the globe when compared to all patients [14-16], patients with SM [13, 17], and patients treated with immunosuppressive medications [18]. In a large survey performed by the Scientific Working Group Infection in Hematology of the European Hematology Association, including 3,801 HM patients with COVID-19, 64% of patients developed severe or critical disease, 18% were admitted to an intensive care unit, and 31% died [6].…”

“…While time from infection to symptom onset seems to be similar to the general population, time from symptom onset to maximal required O 2 supplementation is significantly longer (HR 1.48, 95% CI [1.04-1.92]) [20]. Interestingly, while thrombocytopenia seems to be much more prevalent in HM patients with COVID-19 [7], we found no reported evidence of an increased risk of disseminated intravascular coagulopathy or superinfection in this population compared to HM unaffected by COVID-19 [6,[14][15][16][18][19][20][21]. Conversely, some reports show increased venous thromboembolism in HM, although whether CO-VID-19 actually increases venous thromboembolism risk among patients with HM, already at an increased risk due to their malignancy, is unknown [22].…”

“…Second, there is mounting evidence supporting the utmost importance of effective humoral response for viral clearance. This has been the accepted explanation of the observation that patients with HM in which humoral immunity is most impaired, i.e., chronic lymphocytic leukemia (CLL) and multiple myeloma, bear an exceptionally poor prognosis when infected with SARS-CoV-2 [16, 117, 118]. A cohort of 31 patients with severely impaired B-cell function (mainly due to prior anti-B-cell therapy and X-linked agammaglobulinemia) had much longer clinical courses and viral shedding, as well as increased propensity of recurrent COVID-19 [119].…”

Convalescent plasma treatment in severely immunosuppressed patients hospitalized with COVID-19: an observational study of 28 cases

“…Besides the French study reporting a mortality rate of 21% [ 7 ], one small study of thirteen patients (of which eight were hospitalized) reported a mortality rate of 23% [ 32 ]. One study on hospitalized haematological patients with severe COVID-19 reported a mortality rate of 54%, where all were given dexamethasone and remdesivir, and 45% also received CCP [ 33 ].…”