Simultaneous Onset of Haematological Malignancy and COVID: An Epicovideha Survey

Abstract

Background: The outcome of patients with simultaneous diagnosis of haematological malignancies (HM) and COVID-19 is unknown and there are no specific treatment guidelines. Methods: We describe the clinical features and outcome of a cohort of 450 patients with simultaneous diagnosis of HM and COVID-19 registered in the EPICOVIDEHA registry between March 2020 to February 2022. Results: Acute leukaemia and lymphoma were the most frequent HM (35.8% and 35.1%, respectively). Overall, 343 (76.2%) patients received treatment for HM, which was delayed for longer than one month since diagnosis in 57 (16.6%). An overall response rate was observed in 140 (40.8%) patients after the first line of treatment. After a median follow-up of 35 days, overall mortality was 177/450 (39.3%); 30-day mortality was significantly higher in patients not receiving HM treatment (42.1%) than in those receiving treatment (27.4%, p = 0.004), either before and/or after COVID-19, or compared to patients receiving HM treatment at least after COVID-19 (15.2%, p < 0.001). Age, severe/critical COVID-19, ≥2 comorbidities, and lack of HM treatment were independent risk factors for mortality, whereas a lymphocyte count >500/mcl at COVID-19 onset was protective. Conclusions: HM treatment should be delivered as soon as possible for patients with simultaneous diagnosis of COVID-19 and HM requiring immediate therapy.

Early combination therapy of COVID-19 in high-risk patients

“…Prolonged viral shedding delayed antineoplastic treatment in 12.2% of the patients included in this study. This is in line with a study in patients with simultaneous diagnosis of HM and COVID-19 observing frequent (17.2%) substantial delays resulting in significantly higher 30-day mortality [ 8 ].…”

“…In this way, we provide COVID-19 care mainly for patients with haematological malignancies (HM) and for patients on immunosuppressive medication after solid-organ transplantation (SOT). These patients face prolonged infectiousness that limits their participation in daily life, including access to the medical system, which can interfere with appropriate management of underlying diseases [ 8 ].…”

Need for ICU and outcome of critically ill patients with COVID-19 and haematological malignancies: results from the EPICOVIDEHA survey

“…Apart from the known risk factors for severe COVID-19 such as pre-existing lung disease, obesity or cardiopathy, the extent of immunodeficiency and iatrogenic immunosuppression may also have impacted overall prognosis [ 9 , 27 , 38 ]. Outcomes may differ depending on the underlying haematological malignancy, its activity, and its therapy [ 8 , 10 – 13 , 15 , 39 ]. The most plausible variables that may impact outcome in our patients include hypogammaglobulinemia, qualitative and quantitative B- and T-cell deficiencies, CD4 + lymphopenia, innate immune dysfunction, and neutropenia, all resulting from haematological malignancy itself and respective treatment [ 9 , 27 , 38 ].…”

Decoding the historical tale: COVID-19 impact on haematological malignancy patients—EPICOVIDEHA insights from 2020 to 2022

“…The EPICOVIDEHA registry has demonstrated its value as a valuable tool for surveillance and research in this regard. 2 , 7 , 8 , 10 , 11 , 13 , 19 , 20 , 21 , 24 , 25 , 26 , 28 , 29 , 31 , 33 As the virus continues to evolve, vigilance and adaptability are of paramount importance. In the midst of a constantly shifting landscape, continuous surveillance, research, and adaptation will be crucial to ensure that patients with hematological malignancies receive the highest quality of care.…”

“…Participating institutions (n = 152) from 41 countries ( Supplementary Fig. S1 ) documented COVID-19 episodes diagnosed between January 1, 2020, and December 31, 2022 in patients with hematological malignancies in the EPICOVIDEHA registry, accessible at www.clinicalsurveys.net (EFS Fall 2022, TIVIAN, Cologne, Germany), including both already described 2 , 7 , 8 , 10 , 11 , 13 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 and undescribed patients. EPICOVIDEHA (National Clinical Trials Identifier, NCT04733729) is an international open web-based registry dedicated to adult hematological malignancy patients infected with SARS-CoV-2, set by part of the European Hematology Association Specialized Working Group (EHA-SWG) Infections in Hematology.…”