Risk factors and outcome of COVID-19 in patients with hematological malignancies
José Luis Piñana, Rodrigo Martino, Irene García-García, Rocío Parody, María Dolores Morales, Gonzalo Benzo, Irene Gómez-Catalan, Rosa Coll, Ignacio De La Fuente, Alejandro Luna, Beatriz Merchán, Anabelle Chinea, Dunia De Miguel, Ana Serrano, Carmen Pérez, Carola Diaz, José Luis Lopez, Adolfo Jesús Saez, Rebeca Bailen, Teresa Zudaire, Diana Martínez, Manuel Jurado, María Calbacho, Lourdes Vázquez, Irene Garcia-Cadenas, Laura Fox, Ana I Pimentel, Guiomar Bautista, Agustin Nieto, Pascual Fernandez, Juan Carlos Vallejo, Carlos Solano, Marta Valero, Ildefonso Espigado, Raquel Saldaña, Luisa Sisinni, Josep Maria Ribera, Maria Jose Jimenez, Maria Trabazo, Marta Gonzalez-Vicent, Noemí Fernández, Carme Talarn, Maria Carmen Montoya, Angel Cedillo, Anna Sureda
Experimental Hematology & Oncology, doi:10.1186/s40164-020-00177-z
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 × 10 9 /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, 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).
Authors' contributions JLP, and RM designed the study and drafted the manuscript. All authors participated in the revision of the manuscript. All authors read and approved the final manuscript.
Ethics approval and consent to participate All patients gave their informed consent. Local ethics committee approved the study protocol (reference code 2020-113-1), registered by the Spanish Agency of Medicines and Health Products with the reference code GET-CLO-2020-01 and by the European Medicines Agency with the reference code EUPAS34365EBMT.
Consent for publication The participants provided informed consent for the publication of the study.
Competing interests The author(s) declare that they have no conflict of interests. Author details Piñana et al. Exp Hematol Oncol (2020) 9:21 • thorough peer review by experienced researchers in your field • rapid publication on acceptance • support for research data, including large and complex data types • gold Open Access which fosters wider collaboration and increased citations maximum visibility for your research: over 100M website views per year
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"abstract": "<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Prognostic factors of poor outcome in patients with hematological malignancies and COVID-19 are poorly defined.</jats:p></jats:sec><jats:sec><jats:title>Patients and methods</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>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 × 10<jats:sup>9</jats:sup>/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).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>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.</jats:p></jats:sec>",
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