Lymphocyte may be a reference index of the outcome of cancer patients with COVID-19

Abstract

Background: The novel coronavirus infectious disease (COVID-19) is an international concern as it spreads through human populations and across national and international borders.

Methods: In this retrospective study, we consecutively included all cancer patients who had been identified as having a nucleic acid-confirmed COVID-19 from two designated hospitals in Wuhan, China. COVID-19 patients without cancer were also enrolled for comparison. The clinical data were gathered from the medical records from Jan 14 to March 12, 2020.

Results: Among the 117 cancer patients diagnosed with COVID-19, the median age was 63 years and 48.7% were male. Male sex, hematologic cancer, dyspnea on admission, and anti-cancer therapies were associated with an increased risk of mortality in cancer patients with COVID-19. We found that elevated levels of TNF-α, IL-2R, IL-6, and IL-8 were associated with a poorer prognosis in cancer patients with COVID-19, but no statistically significant association was found in patients without cancer. In addition, IL-2R and IL-6 markedly decreased in cancer patients who recovered from COVID-19. However, lymphocyte subsets were diminished in cancer patients who died from COVID-19, including total T cells, total B cells, helper T (Th) cells and suppressor T (Ts) cells.

Conclusions: Cancer patients with COVID-19 were associated with high mortality (23.9%). A decrease in lymphocyte subsets and higher levels of cytokines were associated with a higher risk of severe outcome and could be utilized as the reference index to predict the survival outcome of cancer patients with COVID-19.

Keywords: COVID-19; cancer; cytokines; lymphocytes; survival time.

Figure 1

Serum cytokines on admission of cancer patients with COVID-19. Levels of TNF-α, IL-2R, IL-6, IL-8, and IL-10 were tested on admission of cancer patients with COVID-19 divided by the outcome (A). Levels of TNF-α, IL-2R, IL-6, IL-8, and IL-10 were increased in those patients who died from COVID-19 (B). Levels of TNF-α, IL-2R, IL-6, IL-8, and IL-10 were correlated with survival time of cancer patients with COVID-19 (C).

Figure 2

Circulating immune cell subpopulation on admission of cancer patients with COVID-19. Counts of T lymphocytes, B lymphocytes, Th cells, Ts cells, and NK cells were tested on admission of cancer patients with COVID-19 divided by the outcome (A). Counts of T lymphocytes, B lymphocytes, Th cells, and Ts cells were diminished on admission of cancer patients with COVID-19 (B). Count of B lymphocytes and Th cells were correlated with survival time of cancer patients with COVID-19 (C).

Figure 3

Serum cytokines alteration in cancer patients with COVID-19 during therapy. Levels of TNF-α, IL-2R, IL-6, IL-8, and IL-10 were tested on admission and when symptom turning better (A). Levels of TNF-α, IL-2R, IL-6, IL-8, and IL-10 were changed in cancer patients who recovered from COVID-19 (B).