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. 2025 Jun 22;17(6):e86534.
doi: 10.7759/cureus.86534. eCollection 2025 Jun.

Factors Associated With Mortality in Leukemia and Lymphoma With COVID-19: A National Inpatient Sample Analysis (2020-2021)

Saketh Palasamudram Shekar  1 , Barath Prashanth Sivasubramanian  2 , Diviya Bharathi Ravikumar  3 , Husna Qadeer  3 , Ibthisam Ismail Sharieff  3 , Rhea Prasad  3 , Sindhu Chandra Pokhriyal  4 , Amulya Bellamkonda  5 , Mamtha Balla  6 , Rutul Dalal  7
Affiliations

Factors Associated With Mortality in Leukemia and Lymphoma With COVID-19: A National Inpatient Sample Analysis (2020-2021)

Saketh Palasamudram Shekar et al. Cureus. .

Abstract

Background Patients with hematological malignancies face a substantially increased mortality from COVID-19. Although the peak of the COVID-19 pandemic has passed, the virus remains common, and understanding its impact on vulnerable groups such as those with hematologic malignancies remains crucial. Limited research exists on mortality patterns in leukemia and lymphoma patients during the pandemic. Studying these outcomes provides important insights into how different waves of COVID-19 affected immunocompromised individuals and supports the development of strategies for prevention, patient care, and risk reduction, which are essential both for managing emerging variants and preventing future pandemics. We aimed to identify the mortality risk of COVID-19 in leukemia (LekCov-19) and lymphoma (LymCov-19) in the United States and the mortality trends between each quartile from 2020 to 2021. Methods We analyzed the National Inpatient Sample database (2020-2021) to include adults (≥18 years) having leukemia and lymphoma admitted for COVID-19. Descriptive analysis, propensity matching, and multivariate regression were performed, with the p-value at ≤0.05 considered statistically significant. The risk of mortality was compared between each outcome. Results Among 8,191 LekCov-19 patients, 1,200 (14.7%) experienced mortality, whereas 507 out of 2,578 LymCov-19 patients (19.7%) experienced mortality. Multivariate regression showed a two-fold increase in mortality among LekCOV-19 and LymCOV-19 (p < 0.001). In both cohorts, several organ dysfunctions, including pulmonary, renal, and cardiac dysfunctions, were associated with increased mortality (p ≤ 0.0001). Similarly, in both cohorts, signs of bone marrow dysfunction, such as pancytopenia and thrombocytopenia, showed increased odds of mortality (p < 0.01). Both cohorts exhibited varying mortality trends, peaking during October-December 2020, January-March, July-September, and October-December 2021 (p ≤ 0.01). Hematopoietic stem cell transplantation recipients had lower odds of mortality in both cohorts, but did not attain statistical significance (p > 0.05). Conclusion COVID-19 was associated with increased mortality in leukemia and lymphoma patients. Surges in COVID-19-related mortality were identified from October 2020 to March 2021, and these trends could be pivotal in forecasting future mortality risks in cancer patients. Clinicians should refine treatment regimens and prioritize advancing clinical trials to address the effects of COVID-19 and the multiple comorbidities associated with hematological malignancies.

Keywords: covid-19; hematological malignancy; hsct; immunocompromised; leukemia; lymphoma; mortality; trends.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Mortality in different quartiles of the pandemic (2020-2021).
* Significant value. AML: acute myeloid leukemia; CML: chronic myeloid leukemia; CLL: chronic lymphocytic leukemia.
See this image and copyright information in PMC

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