COVID-19 Severity and Survival over Time in Patients with Hematologic Malignancies: A Population-Based Registry Study

Abstract

Mortality rates for COVID-19 have declined over time in the general population, but data in patients with hematologic malignancies are contradictory. We identified independent prognostic factors for COVID-19 severity and survival in unvaccinated patients with hematologic malignancies, compared mortality rates over time and versus non-cancer inpatients, and investigated post COVID-19 condition. Data were analyzed from 1166 consecutive, eligible patients with hematologic malignancies from the population-based HEMATO-MADRID registry, Spain, with COVID-19 prior to vaccination roll-out, stratified into early (February–June 2020; n = 769 (66%)) and later (July 2020–February 2021; n = 397 (34%)) cohorts. Propensity-score matched non-cancer patients were identified from the SEMI-COVID registry. A lower proportion of patients were hospitalized in the later waves (54.2%) compared to the earlier (88.6%), OR 0.15, 95%CI 0.11–0.20. The proportion of hospitalized patients admitted to the ICU was higher in the later cohort (103/215, 47.9%) compared with the early cohort (170/681, 25.0%, 2.77; 2.01–3.82). The reduced 30-day mortality between early and later cohorts of non-cancer inpatients (29.6% vs. 12.6%, OR 0.34; 0.22–0.53) was not paralleled in inpatients with hematologic malignancies (32.3% vs. 34.8%, OR 1.12; 0.81–1.5). Among evaluable patients, 27.3% had post COVID-19 condition. These findings will help inform evidence-based preventive and therapeutic strategies for patients with hematologic malignancies and COVID-19 diagnosis.

SARS-CoV-2 Infection, Hospitalization, and Mortality in Adults With and Without Cancer

“…This critical finding demonstrates that all efforts must be made to prevent SARS-CoV-2 infection and decrease the hospitalization rate in individuals with cancer and SARS-CoV-2 infection. The rapid expansion of the COVID-19 pandemic caused a considerable, continuous, and prolonged inflow of patients with severe COVID-19 and underlying cancer at substantial risk of death . We found that the 21-day ICU admission rates in hospitalized patients with hematologic malignant neoplasms or solid tumors were not significantly different from the rate observed in the noncancer population.…”

COVID-19 Outcomes in Patients with Hematologic Malignancies in the Era of COVID-19 Vaccination and the Omicron Variant

“…HEMATO-MADRID COVID-19 is an ongoing, observational, multicenter, and registrybased study with prospective data collection that is sponsored by the Madrid Society of Hematology (Asociación Madrileña de Hematología y Hemoterapia, AMHH) [11]. Full methodological details for this study have been reported previously [5].…”

“…Therefore, changes in outcomes over time during the vaccination era and the multiple waves driven by SARS-CoV-2 variants and subvariants are not fully understood. Epidemiologic data from the pre-vaccination era showed that the mortality rate among HM patients was in the range of 13-37% overall and 19-46% for those hospitalized with COVID-19, with high rates reported particularly for patients aged ≥60 years, those with a diagnosis of acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS), and patients receiving active treatment with conventional chemotherapy or monoclonal antibodies [11].…”

Recommendations on prevention of infections during chimeric antigen receptor T‐cell and bispecific antibody therapy in multiple myeloma

“…In addition to the lack of universal uptake of COVID‐19 vaccination, suboptimal vaccines response has been demonstrated in recipients of CAR T‐cell and BsAb therapy 26,52 . Additionally, COVID‐19 remains a significant concern to patients with MM with mortality as high as 14% in recipients of BCMA directed T‐cell therapy 53–55 . Given the high rate of US COVID19 infection, and reasonable uptake of vaccination in some geographical areas, high titers of COVID19 neutralizing antibodies are now reported in IVIG products.…”

“…26,52 Additionally, COVID-19 remains a significant concern to patients with MM with mortality as high as 14% in recipients of BCMA directed T-cell therapy. [53][54][55] Given the high rate of US COVID19 infection, and reasonable uptake of vaccination in some geographical areas, high titers of COVID19 neutralizing antibodies are now reported in IVIG products. It is therefore possible that IVIG, as recommended above, could also provide protection against severe COVID-19 infection in these patients.…”