Impact of hematologic malignancy and type of cancer therapy on COVID-19 severity and mortality: lessons from a large population-based registry study

Journal of Hematology & Oncology

Ángel Cedillo¹  Rodrigo Gil-Manso²  Joaquín Martinez-Lopez³  Arancha Alonso⁴  Adolfo de la Fuente⁵  Mi Kwon⁶  José Luis Diez-Martin⁶  Arturo Matilla⁷  Blanca Colás-Lahuerta⁸  Pablo Estival Monteliu⁸  Pilar Martínez-Barranco⁹  María García Roa⁹  Pilar Llamas^1,10  José González-Medina^1,10  Cristián Escolano Escobar^1,11  Laurentino Benito-Parra^1,11  María Concepción Aláez-Usón^1,12  Jaime Pérez-Oteyza^1,13  Juan Francisco Del Campo^1,14  Adriana Pascual^1,15  Isabel González-Gascón^1,16  José Ángel Hernández-Rivas^1,16  Regina Herráez^1,17  Miguel Canales^1,18  Víctor Jiménez-Yuste^1,18  Adrián Alegre^1,19  Javier Ortiz-Martín^1,19  Keina Susana-Quiroz^2,20  Julio García-Suárez^2,21  Susana Valenciano^2,21  Lucía Núñez Martín-Buitrago^2,22  Rafael Duarte^2,22  Carmen Martínez-Chamorro^2,23  Javier López-Jiménez^2,24  Pilar Herrera^2,24  Alberto Velasco^2,25  María Carmen Vicente-Ayuso^2,26  Pedro Sánchez-Godoy^2,26  Elvira Gómez^2,27  Elena Ruiz^2,28  Rafael Martos-Martínez^2,29  Javier de la Cruz^3,30 

[1] Asociación Madrileña de Hematología Y Hemoterapia (AMHH), Madrid, Spain;Hematology Department, CNIO-ISCIII, CIBERONC, Complutense University, Hospital 12 de Octubre, imas12, Madrid, Spain;Hematology Department, CNIO-ISCIII, CIBERONC, Complutense University, Hospital 12 de Octubre, imas12, Madrid, Spain;i+12, CNIO-ISCIII, Hospital 12 de Octubre, Servicio de Hematología, Centro de Actividades Ambulatorias, Planta Tercera Bloque D, Univ. Complutense, Avd de Cordoba s/n, 28041, Madrid, Spain;Hematology Department, Hospital Ruber, Madrid, Spain;Hematology Department, MD Anderson Cancer Center Madrid, Madrid, Spain;Hematology Department, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain;Department of Medicine, Complutense University, Madrid, Spain;Hematology Department, University Hospital Central de La Defensa Gómez Ulla, Madrid, Spain;Hematology Department, University Hospital Clínico San Carlos, Madrid, Spain;Hematology Department, University Hospital Fundación Alcorcón, Madrid, Spain;Hematology Department, University Hospital Fundación Jiménez Díaz, Madrid, Spain;Hematology Department, University Hospital Getafe, Madrid, Spain;Hematology Department, University Hospital HLA Moncloa, Madrid, Spain;Hematology Department, University Hospital HM Sanchinarro, Madrid, Spain;Hematology Department, University Hospital Henares, Coslada, Madrid, Spain;Hematology Department, University Hospital Infanta Elena, Valdemoro, Madrid, Spain;Hematology Department, University Hospital Infanta Leonor, Madrid, Spain;Hematology Department, University Hospital Infanta Sofía, San Sebastián de Los Reyes, Madrid, Spain;Hematology Department, University Hospital La Paz, Madrid, Spain;Hematology Department, University Hospital La Princesa, Madrid, Spain;Hematology Department, University Hospital Móstoles, Madrid, Spain;Hematology Department, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain;Hematology Department, University Hospital Puerta de Hierro Majadahonda, Madrid, Spain;Hematology Department, University Hospital Quirónsalud, Pozuelo de Alarcón, Madrid, Spain;Hematology Department, University Hospital Ramón Y Cajal, Madrid, Spain;Hematology Department, University Hospital Rey Juan Carlos, Móstoles, Madrid, Spain;Hematology Department, University Hospital Severo Ochoa, Madrid, Spain;Hematology Department, University Hospital Sureste, Arganda del Rey, Madrid, Spain;Hematology Department, University Hospital Tajo, Aranjuez, Madrid, Spain;Hematology Department, University Hospital Villalba, Villalba, Madrid, Spain;Research Institute imas12, University Hospital, SAMID-ISCIII, 12 de Octubre, Madrid, Spain;

关键词: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2);    COVID-19;    Hematologic neoplasms;   

DOI  :  10.1186/s13045-020-00970-7

来源: Springer

【 摘 要 】

BackgroundPatients with cancer have been shown to have a higher risk of clinical severity and mortality compared to non-cancer patients with COVID-19. Patients with hematologic malignancies typically are known to have higher levels of immunosuppression and may develop more severe respiratory viral infections than patients with solid tumors. Data on COVID-19 in patients with hematologic malignancies are limited. Here we characterize disease severity and mortality and evaluate potential prognostic factors for mortality.MethodsIn this population-based registry study, we collected de-identified data on clinical characteristics, treatment and outcomes in adult patients with hematologic malignancies and confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection within the Madrid region of Spain. Our case series included all patients admitted to 22 regional health service hospitals and 5 private healthcare centers between February 28 and May 25, 2020. The primary study outcome was all-cause mortality. We assessed the association between mortality and potential prognostic factors using Cox regression analyses adjusted for age, sex, comorbidities, hematologic malignancy and recent active cancer therapy.ResultsOf 833 patients reported, 697 were included in the analyses. Median age was 72 years (IQR 60–79), 413 (60%) patients were male and 479 (69%) and 218 (31%) had lymphoid and myeloid malignancies, respectively. Clinical severity of COVID-19 was severe/critical in 429 (62%) patients. At data cutoff, 230 (33%) patients had died. Age ≥ 60 years (hazard ratios 3.17–10.1 vs < 50 years), > 2 comorbidities (1.41 vs ≤ 2), acute myeloid leukemia (2.22 vs non-Hodgkin lymphoma) and active antineoplastic treatment with monoclonal antibodies (2·02) were associated with increased mortality; conventional chemotherapy showed borderline significance (1.50 vs no active therapy). Conversely, Ph-negative myeloproliferative neoplasms (0.33) and active treatment with hypomethylating agents (0.47) were associated with lower mortality. Overall, 574 (82%) patients received antiviral therapy. Mortality with severe/critical COVID-19 was higher with no therapy vs any antiviral combination therapy (2.20).ConclusionsIn this series of patients with hematologic malignancies and COVID-19, mortality was associated with higher age, more comorbidities, type of hematological malignancy and type of antineoplastic therapy. Further studies and long-term follow-up are required to validate these criteria for risk stratification.

【 授权许可】

CC BY