Higher mortality of hospitalized haematologic patients with COVID-19 compared to non-haematologic is driven by thrombotic complications and development of ARDS: An age-matched cohorts study

Sequential Treatment by Antiviral Drugs Followed by Immunosuppressive Agents for COVID-19 Patients with Hematological Malignancy

“…These worse outcomes matched the previous reports that also suggested that COVID-19 patients with hematological diseases had a poor prognosis, 5,12 and they also suggested that corticosteroids, tocilizumab, and anakinra treatment could be related to the higher mortality, compared with COVID-19 patients with hematological malignancies and non-hematological patients who survived. 5 These results and reports suggested that these underlying diseases and anticancer therapies contribute to the worse outcomes of SARS-CoV-2 infection by lymphopenia and lymphocyte dysfunction, hypercoagulability, immunometabolic deregulation related to myeloid cell dysfunction, and converge in patients with hematological malignancies. 5 Indeed, the two present cases showed worse clinical courses even though they received the appropriate regimen that combined antiviral drugs and anti-inflammatory drugs.…”

“…13 G-CSF was also used in case 1 to support the decline of viral activation, but administration of G-CSF might contribute to the reactivation and/or maintenance of a hyperinflammatory status. Fernandez-Cruz et al 5 analyzed 71 COVID-19 cases with hematological diseases and showed that non-Hodgkin's lymphoma was the most common (21 patients, 29.4%), followed by multiple myeloma (15 patients, 21.1%), similar to the present cases, 14 and the careful use of G-CSF and other related immunological agents was suggested in these cancer patients and hematopoietic stem cell transplant recipients. 13 Several series suggested that older age might contribute to the increased mortality of hematological patients.…”

“…5 These results and reports suggested that these underlying diseases and anticancer therapies contribute to the worse outcomes of SARS-CoV-2 infection by lymphopenia and lymphocyte dysfunction, hypercoagulability, immunometabolic deregulation related to myeloid cell dysfunction, and converge in patients with hematological malignancies. 5 Indeed, the two present cases showed worse clinical courses even though they received the appropriate regimen that combined antiviral drugs and anti-inflammatory drugs.…”

“…The patients with hematological malignancies have a high risk for infection due to immune compromise secondary to their underlying disease and subsequent therapy. 5 The characteristics of SARS-CoV-2 infection and COVID-19 in the patients with hematological malignancies are not yet well known, but the underlying hematological disease could affect the inflammatory response and viral clearance and modify the manifestations and outcome of the disease, similar to viral infections such as RSV or influenza that are considered mild in immunocompetent hosts, but can become life-threatening in certain patients with hematological malignancies. 10,11 In this case series, two COVID-19 patients with hematological malignancies who received systemic chemotherapy by specific regimens including obinutuzumab, such as a CD20+ B cell depleting agent, similar to rituximab, and corticosteroids were presented.…”

“…4 Furthermore, when COVID-19 patients have received immunosuppressive drugs and/or are in an immunosuppressed state, clinicians should consider factors such as the underlying disease including hematological malignancies, the specific immunosuppressants being used, the potential for drug-drug interactions, and exacerbation of COVID-19. 5 In hematological malignancies, the patients were considered at high risk of mortality from COVID-19, and large-scale surveillance has confirmed that COVID-19 patients with hematological malignancies were actually at high risk of lethal complications. 6 However, improved COVID-19 prevention has reduced mortality despite an increase in the number of reported cases.…”