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This retrospective cohort study identified risk factors for COVID-19 severity and outcomes in 55 patients with benign (N=3) and malignant (N=52) hematologic disorders and COVID-19 infection. The cohort mortality rate was 35%. A CRP of ≥100 mg/L was associated with a significant risk for severe COVID-19 infection (HR, 5.94) and death (OR, 5.63), albeit with relatively low to moderate sensitivity (death: 71.5%; severe disease: 65%) and specificity (death: 65.4%; severe disease:71.4%). Overall, 81% of patients required changes to treatment (delay or intensity reduction). The authors did not identify a statistically significant increase in severe infection or death in patients receiving therapy within 28 days of COVID-19 diagnosis and provide evidence of efficacy for using modified therapies in patients with ongoing COVID-19 infection requiring treatment for an underlying hematologic malignancy.
Mortality in patients with a hematological disorder and COVID-19 appears to be high (37%). An elevated CRP (≥100 mg/L) may accurately risk-stratify these patients compared with peripheral blood cytopenias, as the underlying hematologic disorder may confound the latter. The authors provide evidence of the safety and efficacy of modified treatments for patients with ongoing COVID-19 infection. Further investigation is needed to identify which patients and at what time in their disease course pursuing therapy is safe and effective.
– Curtis Lachowiez, MD
This abstract is available on the publisher's site.
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, 2 with bone marrow failure and 1 immune mediated thrombotic thrombocytopenic purpura (TTP). COVID-19 diagnosis coincided with a new diagnosis of a haematological malignancy in four patients. 82% of patients were on systemic anti-cancer therapy (SACT) at time of COVID-19. Of hospitalised patients, 37% (19/51) died whilst all four outpatients recovered. Risk factors for severe disease or mortality were similar to other published cohorts. Raised CRP 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 CV19 infection, which should be managed according to standard pathway. 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 efficacy of treatment strategies employed during the pandemic.
Clinical Outcomes and Risk Factors for Severe COVID-19 Infection in Patients With Haematological Disorders Receiving Chemo- or Immunotherapy
Br. J. Haematol 2020 Jul 17;[EPub Ahead of Print], TA Fox, E Troy-Barnes, AA Kirkwood, WY Chan, J Day, SJ Chavda, EA Kumar, K David, O Tomkins, E Sanchez, M Scully, A Khwaja, J Lambert, M Singer, C Roddie, EC Morris, KL Yong, KJ Thomson, KM Ardeshna