International multicenter study comparing COVID-19 in patients with cancer to patients without cancer: Impact of risk factors and treatment modalities on survivorship

Abstract

Background: In this international multicenter study we aimed to determine the independent risk factors associated with increased 30-day mortality and the impact of cancer and novel treatment modalities in a large group of patients with and without cancer with COVID-19 from multiple countries.Methods: We retrospectively collected de-identified data on a cohort of patients with and without cancer diagnosed with COVID-19 between January and November 2020, from 16 international centers.Results: We analyzed 3966 COVID-19 confirmed patients, 1115 with cancer and 2851 nwithout cancer patients. Patients with cancer were more likely to be pancytopenic, and have a smoking history, pulmonary disorders, hypertension, diabetes mellitus, and corticosteroid use in the preceding two weeks (p≤0.01). In addition, they were more likely to present with higher inflammatory biomarkers (D-dimer, ferritin and procalcitonin), but were less likely to present with clinical symptoms (p≤0.01). By country-adjusted multivariable logistic regression analyses, cancer was not found to be an independent risk factor for 30-day mortality (p=0.18) whereas lymphopenia was independently associated with increased mortality in all patients, and in patients with cancer. Older age (≥65 years) was the strongest predictor of 30-day mortality in all patients(OR=4.47, p<0.0001). Remdesivir was the only therapeutic agent independently associated with decreased 30-day mortality ()(OR=0.64, p=0.036). Among patients on low-flow oxygen at admission, patients who received remdesivir had a lower 30-day mortality rate than those who did not (5.9% vs 17.6%; p=0.03).Conclusions: Increased 30-day all-cause mortality from COVID-19 was not independently associated with cancer but was independently associated with lymphopenia often observed in hematolgic malignancy. Remdesivir, particularly in patients with cancer receiving low-flow oxygen, can reduce 30-day all-cause mortality.Funding: National Cancer Institute, National Institutes of Health.

The Burden of COVID-19 in Adult Patients With Hematological Malignancies: A Single-center Experience After the Implementation of Mass-vaccination Programs Against SARS-CoV-2

“…In an international multicenter study of 3,966 COVID-19 patients, primarily designed to evaluate 30-day mortality in patients with (n=1,115) or without cancer (n=2,851), RDV was the only therapeutic agent that independently decreased 30-day all-cause mortality in the entire population (p=0.036), including the oncological patients [OR=0.44 (95%CI=0.20-0.96; p=0.04)]. Of note, in line with ACTT-1 findings, RDV benefit was more pronounced in patients with pneumonia and mild hypoxia who were receiving low-flow oxygen (≤6 l/min) (26,29). Lastly, the contributing factors to increased mortality in cancer patients were sought in the real-world CSOVID-19 study and 222 haemato-oncological patients (HM: n=60, other type of malignancy: n=162) with active disease were analyzed.…”

Personalized Assessment of Mortality Risk and Hospital Stay Duration in Hospitalized Patients with COVID-19 Treated with Remdesivir: A Machine Learning Approach

“…Chronic kidney disease, the incidence of acute kidney injury, and atrial fibrillation have been shown to be comorbidities associated with reduced survival in patients hospitalized for COVID-19 [73]. Other studies confirm that lymphopenia, often observed in cancer patients, is associated with a higher risk of mortality [74]. Hematological disorders are also seen as additional health conditions that can negatively impact the effectiveness of antiviral treatments such as remdesivir [75].…”

Personalized Assessment of Mortality Risk and Hospital Stay Duration in Hospitalized Patients with COVID-19 Treated with Remdesivir: A Machine Learning Approach

“…Chronic kidney disease, the incidence of acute kidney injury, and atrial fibrillation have been shown to be comorbidities associated with reduced survival in patients hospitalized for COVID-19 [77]. Other studies confirm that lymphopenia, often observed in cancer patients, is associated with a higher risk of mortality [78]. Hematological disorders are also seen as additional health conditions that can negatively impact the effectiveness of antiviral treatments such as remdesivir [79].…”