Risk factors and outcome of COVID-19 in patients with hematological malignancies

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.

Fig. 1

Number of cases and mortality rate according to the severity of COVID-19 and the date of diagnostic

Fig. 2

Day 45 overall mortality. a In the entire cohort, according to the COVID-19 stage, mortality was 8% in patients with stage I, 18% in those with stage IIA and 53% in those who evolved to stage IIB ((p < 0.0001). b Mortality rate in non-SCT patients was 10% vs. 23% vs. 53% in patients with stage I, stage IIA and Stage IIB, respectively (p < 0.0001). c Mortality in autologous SCT recipients was 13%, 11% and 50% in patients with stage I, stage IIA and Stage IIB, respectively (p < 0.09). d Mortality in allo-SCT recipients was 0%, 17% and 47% in patients with stage I, stage IIA and Stage IIB, respectively (p < 0.01)

Fig. 3

COVID-19-related mortality according to the presence of 0-1, 2 and > 2 risk factors. a In the entire cohort. Mortality rate was 18% vs. 35% vs. 54%, respectively (p < 0.0001). b In patients with lower respiratory involvement (stages IIA and IIB), the mortality was 22% vs. 40% vs. 58%, respectively (p < 0.0001). c In patients with uncontrolled hematological malignancy at the time of COVID-19 the mortality was 33% vs. 63% vs. 80%, respectively (p < 0.0001). d In patients with controlled hematological disease at the time of COVID-19 the mortality was 7% vs. 22% vs. 44%, respectively (p < 0.0001). e In stem cell transplant (SCT) recipients the mortality was 17% vs. 34% vs. 56%, respectively (p < 0.0001). f In non-stem cell transplant (SCT) patients the mortality was 19% vs. 34% vs. 54%, respectively (p < 0.0001)