Clinical outcomes and risk factors for severe COVID-19 in patients with haematological disorders receiving chemo- or immunotherapy

Abstract

Haematology patients receiving chemo- or immunotherapy are considered to be at greater risk of COVID-19-related morbidity and mortality. We aimed to identify risk factors for COVID-19 severity and assess outcomes in patients where COVID-19 complicated the treatment of their haematological disorder. A retrospective cohort study was conducted in 55 patients with haematological disorders and COVID-19, including 52 with malignancy, two with bone marrow failure and one immune-mediated thrombotic thrombocytopenic purpura (TTP). COVID-19 diagnosis coincided with a new diagnosis of a haematological malignancy in four patients. Among patients, 82% were on systemic anti-cancer therapy (SACT) at the time of COVID-19 diagnosis. Of hospitalised patients, 37% (19/51) died while all four outpatients recovered. Risk factors for severe disease or mortality were similar to those in other published cohorts. Raised C-reactive protein at diagnosis predicted an aggressive clinical course. The majority of patients recovered from COVID-19, despite receiving recent SACT. This suggests that SACT, where urgent, should be administered despite intercurrent COVID-19 infection, which should be managed according to standard pathways. Delay or modification of therapy should be considered on an individual basis. Long-term follow-up studies in larger patient cohorts are required to assess the efficacy of treatment strategies employed during the pandemic.

Keywords: Covid-19; chemotherapy; risk factors.

Fig 1

Consort diagram.

Fig 2

Receiver operating characteristic (ROC) analysis of C‐reactive protein. (A) Death; for a cut‐off of 100, sensitivity 71·5% and specificity 65·4%. (B) Severe disease; for a cut‐off of 100, sensitivity 65·0% and specificity 71·4%.

Fig 3

Cumulative incidence of event (severe disease) for (A) whole cohort, (B) by treatment group (intensive/non‐intensive) and (C) by treatment time. Patients who had recovered without severe disease were recorded as not having an event and last follow‐up time was censored at day 35 (the day after last reported COVID severe event in the cohort). (D) Kaplan–Meier survival curve of the whole cohort, (E) treatment intensity and (F) treatment time. Patients who had recovered were censored at day 35 (the day after the last reported COVID death). [Colour figure can be viewed at wileyonlinelibrary.com]