Risk Factors and Mortality of COVID-19 in Patients With Lymphoma: A Multicenter Study

Abstract

Patients with cancer are poorly represented in coronavirus disease 2019 (COVID-19) series, and heterogeneous series concerning hematology patients have been published. This study aimed to analyze the impact of COVID-19 in patients with lymphoma. We present a multicenter retrospective study from 19 centers in Madrid, Spain, evaluating risk factors for mortality in adult patients with COVID-19 and lymphoma. About 177 patients (55.9% male) were included with a median follow-up of 27 days and a median age of 70 years. At the time of COVID-19 diagnosis, 49.7% of patients were on active treatment. The overall mortality rate was 34.5%. Age >70 years, confusion, urea concentration, respiratory rate, blood pressure, and age >65 score ≥2, heart disease, and chronic kidney disease were associated with higher mortality risk ( P < 0.05). Active disease significantly increased the risk of death (hazard ratio, 2.43; 95% confidence interval, 1.23-4.77; P = 0.01). However, active treatment did not modify mortality risk and no differences were found between the different therapeutic regimens. The persistence of severe acute respiratory syndrome coronavirus 2-positive polymerase chain reaction after week 6 was significantly associated with mortality (54.5% versus 1.4%; P < 0.001). We confirm an increased mortality compared with the general population. In view of our results, any interruption or delay in the start of treatment should be questioned given that active treatment has not been demonstrated to increase mortality risk and that achieving disease remission could lead to better outcomes.

Mortality-related risk factors of COVID-19: a systematic review and meta-analysis of 42 studies and 423,117 patients

“…In the meta-analysis of eight effect sizes from eight studies [ 19 , 26 , 30 , 34 , 39 , 40 , 48 , 74 ], we noted that a significant positive association between acute kidney injury and COVID-19 mortality and the pooled OR and HR were 1.87 (95% CI 1.48–2.26) and 2.21 (95% CI 1.44–2.99), respectively (Fig. 9 A).…”

Implementation of a hospital-at-home (HAH) unit for hematological patients during the COVID-19 pandemic: safety and feasibility

“…Febrile neutropenia and engraftment syndrome rate was 0% and none of the patients were readmitted or diagnosed with SARS-CoV-2 infection. Median duration of the episodes was 18 days (range [13][14][15][16][17][18][19][20].…”

“…Furthermore, patients with hematological malignancies and hematopoietic stem cell transplant (HSCT) recipients, are a potential high-risk population due to the immune impairment from their underlying disease, the use of immunosuppressive treatments, and the need of frequent hospital visits for clinical monitoring, treatment delivery and admission. Several studies have described high mortality rates of nearly 30% in this specific population [9][10][11][12][13][14][15][16][17][18].…”

Impact of COVID-19 in patients with lymphoid malignancies

“…The overall mortality rate was 34.5%, with age > 70 years, heart disease, chronic kidney disease, CURB-65 score ≥ 2 and active disease significantly increasing the risk of death in a multivariate analysis. Interestingly they did also note that the persistence of a positive polymerase chain reaction for SARS-CoV-2 after week 6 was significantly associated with mortality, suggesting that longer term viral suppression is an important component of recovery[ 30 ].…”

“…The large meta-analysis of over 3000 patients with hematological cancers showed no association of poorer outcome with concurrent treatment, as have many smaller studies[ 17 , 22 ]. Similarly, in the two largest lymphoma-specific COVID-19 studies, there was no association of active treatment with poor outcome[ 29 , 30 ]. In particular there was no excess mortality identified with anti-CD20 treatment despite the anticipated risk of depleting the B-cell compartment and inhibiting humoral immunity.…”