COVID-19 Severity and Survival over Time in Patients with Hematologic Malignancies: A Population-Based Registry Study

Abstract

Mortality rates for COVID-19 have declined over time in the general population, but data in patients with hematologic malignancies are contradictory. We identified independent prognostic factors for COVID-19 severity and survival in unvaccinated patients with hematologic malignancies, compared mortality rates over time and versus non-cancer inpatients, and investigated post COVID-19 condition. Data were analyzed from 1166 consecutive, eligible patients with hematologic malignancies from the population-based HEMATO-MADRID registry, Spain, with COVID-19 prior to vaccination roll-out, stratified into early (February-June 2020; n = 769 (66%)) and later (July 2020-February 2021; n = 397 (34%)) cohorts. Propensity-score matched non-cancer patients were identified from the SEMI-COVID registry. A lower proportion of patients were hospitalized in the later waves (54.2%) compared to the earlier (88.6%), OR 0.15, 95%CI 0.11-0.20. The proportion of hospitalized patients admitted to the ICU was higher in the later cohort (103/215, 47.9%) compared with the early cohort (170/681, 25.0%, 2.77; 2.01-3.82). The reduced 30-day mortality between early and later cohorts of non-cancer inpatients (29.6% vs. 12.6%, OR 0.34; 0.22-0.53) was not paralleled in inpatients with hematologic malignancies (32.3% vs. 34.8%, OR 1.12; 0.81-1.5). Among evaluable patients, 27.3% had post COVID-19 condition. These findings will help inform evidence-based preventive and therapeutic strategies for patients with hematologic malignancies and COVID-19 diagnosis.

Keywords: COVID-19; SARS-CoV-2; acute leukemia; hematological malignancies; lymphoma; multiple myeloma.

Figure 1

Flow diagram. Patients with hematologic malignancies who were reported as having COVID-19 and who were included in the present analysis. Reporting hospitals included 25/26 Madrid regional health service centers (8/8 designated high complexity level hospitals (CLH); 12/12 intermediate CLH; 5/6 low CLH), and 6/6 private centers.

Figure 2

Survival estimates according to period of COVID-19 diagnosis and clinical severity of disease. Kaplan–Meier estimates of survival from time of COVID-19 diagnosis according to the period in which patients were diagnosed (early cohort vs. later cohort) and the clinical severity of COVID-19 (mild/moderate vs. severe/critical). p values by log rank test, with Šidák correction for multiple comparison.