Risk factors and outcome of COVID-19 in patients with hematological malignancies
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Published:2020-08-25
Issue:1
Volume:9
Page:
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ISSN:2162-3619
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Container-title:Experimental Hematology & Oncology
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language:en
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Short-container-title:Exp Hematol Oncol
Author:
Piñana José LuisORCID, Martino Rodrigo, García-García Irene, Parody Rocío, Morales María Dolores, Benzo Gonzalo, Gómez-Catalan Irene, Coll Rosa, De La Fuente Ignacio, Luna Alejandro, Merchán Beatriz, Chinea Anabelle, de Miguel Dunia, Serrano Ana, Pérez Carmen, Diaz Carola, Lopez José Luis, Saez Adolfo Jesús, Bailen Rebeca, Zudaire Teresa, Martínez Diana, Jurado Manuel, Calbacho María, Vázquez Lourdes, Garcia-Cadenas Irene, Fox Laura, Pimentel Ana I., Bautista Guiomar, Nieto Agustin, Fernandez Pascual, Vallejo Juan Carlos, Solano Carlos, Valero Marta, Espigado Ildefonso, Saldaña Raquel, Sisinni Luisa, Ribera Josep Maria, Jimenez Maria Jose, Trabazo Maria, Gonzalez-Vicent Marta, Fernández Noemí, Talarn Carme, Montoya Maria Carmen, Cedillo Angel, Sureda Anna,
Abstract
Abstract
Background
Prognostic factors of poor outcome in patients with hematological malignancies and COVID-19 are poorly defined.
Patients and methods
This was a Spanish transplant group and cell therapy (GETH) multicenter retrospective observational study, which included a large cohort of blood cancer patients with laboratory-confirmed SARS-CoV-2 infection through PCR assays from March 1st 2020 to May 15th 2020.
Results
We included 367 pediatric and adult patients with hematological malignancies, including recipients of autologous (ASCT) (n = 58) or allogeneic stem cell transplantation (allo-SCT) (n = 65) from 41 hospitals in Spain. Median age of patients was 64 years (range 1–93.8). Recipients of ASCT and allo-SCT showed lower mortality rates (17% and 18%, respectively) compared to non-SCT patients (31%) (p = 0.02). Prognostic factors identified for day 45 overall mortality (OM) by logistic regression multivariate analysis included age > 70 years [odds ratio (OR) 2.1, 95% confidence interval (CI) 1.2–3.8, p = 0.011]; uncontrolled hematological malignancy (OR 2.9, 95% CI 1.6–5.2, p < 0.0001); ECOG 3–4 (OR, 2.56, 95% CI 1.4–4.7, p = 0.003); neutropenia (< 0.5 × 109/L) (OR 2.8, 95% CI 1.3–6.1, p = 0.01); and a C-reactive protein (CRP) > 20 mg/dL (OR 3.3, 95% CI 1.7–6.4, p < 0.0001). In multivariate analysis of 216 patients with very severe COVID-19, treatment with azithromycin or low dose corticosteroids was associated with lower OM (OR 0.42, 95% CI 0.2–0.89 and OR 0.31, 95% CI 0.11–0.87, respectively, p = 0.02) whereas the use of hidroxycloroquine did not show significant improvement in OM (OR 0.64, 95% CI 0.37–1.1, P = 0.1).
Conclusions
In most patients with hematological malignancies COVID-19 mortality was directly driven by older age, disease status, performance status, as well as by immune (neutropenia) parameters and level of inflammation (high CRP). Use of azithromycin and low dose corticosteroids may be of value in very severe COVID-19.
Publisher
Springer Science and Business Media LLC
Subject
Cancer Research,Oncology,Hematology
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