Inpatient hospitalization, mortality high among patients with cancer, COVID-19
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Patients with cancer who contracted COVID-19 had high risk for inpatient hospital admission and death, according to study results presented during the virtual ASCO Annual Meeting.
Only one-quarter of patients admitted to the ICU received invasive mechanical ventilation, preliminary findings from the longitudinal NCI COVID-19 in Cancer Patients Study (NCCAPS) showed.
“COVID-19 in patients with solid tumors and hematologic malignancies undergoing active therapy is associated with poor outcomes, including a high risk [for] inpatient mortality,” Alok A. Khorana, MD, professor of medicine at Cleveland Clinic Lerner College of Medicine, told Healio. “Ongoing efforts at mass vaccination are essential to reduce risk to [patients with cancer].”
Individuals with cancer and COVID-19 often experience a severe disease course and elevated risk for death. Prior research suggested risks may be higher based on cancer type and presence of metastatic disease.
The NCCAPS study is designed to yield detailed prospective inpatient data that could provide insights into which patients are at highest risk for poor outcomes.
Researchers hope to accrue 2,000 adults with COVID-19 who are undergoing treatment for cancer. The cohort includes patients with solid tumors or blood cancers.
Investigators are collecting clinical data, imaging and blood samples during patients’ first COVID-19 hospitalization. They will collect additional clinical information during subsequent hospitalizations.
“Although much has been studied about COVID-19 outcomes, detailed prospective data regarding outcomes specifically [among patients with cancer] are lacking,” Khorana said. “NCI launched this major national prospective cohort study to better understand the epidemiology and outcomes of [patients with cancer] hospitalized with COVID-19.”
Researchers enrolled 757 adults from 204 sites as of Jan. 22.
By data cutoff, 124 patients (16.3%) reported at least one hospitalization for COVID-19. Investigators had discharge data for a combined 98 hospitalizations for 88 patients (median age, 67 years; range, 21-93; 40% women).
The most common malignancies among those who required COVID-19 hospitalization included lymphoma (18.2%), lung cancer (15.9%) and multiple myeloma (10.2%).
“[This suggests] susceptibility to serious illness in patients with these diagnoses,” Khorana said.
Sixteen (16.3%) of the 98 total inpatient hospitalizations ended with death, a rate Khorana described as “particularly concerning.”
“Identifying predictors of poor outcomes, especially inpatient mortality, is essential,” Khorana said.
Approximately two-thirds of patients who required hospitalization presented with shortness of breath (65%) or fatigue/malaise (64%), and nearly half (49%) presented with fever. Seventeen patients (19%) were thrombocytopenic and eight (9%) were neutropenic, defined as absolute neutrophil count less than 1,000.
Patients remained hospitalized for a median 6.5 days (range, 1-41).
Researchers obtained inpatient medication data for 63 patients (71.5%). In this subset, the most common treatments included corticosteroids (63%), remdesivir (46%) and convalescent plasma (14%).
One patient received the monoclonal antibody bamlanivimab (Eli Lilly), and two patients received the immunosuppressive drug tocilizumab (Actemra, Genentech).
Nearly three-quarters (73%) received anticoagulation, most commonly prophylactic low-molecular-weight heparin. Eleven patients (17%) received therapeutic-dose anticoagulation.
Approximately one in five hospitalized patients (22.7%) received care in the ICU or high-dependency unit (median ICU stay, 7 days; range, 1-22); 25% of those admitted to the ICU received invasive mechanical ventilation, a percentage Khorana described as lower than anticipated.
“We don’t really know [why invasive mechanical ventilation was not used more frequently],” Khorana told Healio. “One could speculate that the underlying diagnosis/stage may have led physicians [or] families to make decisions about ventilation that differ from the noncancer population.”
Perspective
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This study underscores that patients with cancer — and, in particular, those with lymphoma — are at high risk for hospitalization and death after COVID-19 infections.
The Leukemia & Lymphoma Society encourages all patients with blood cancer to get vaccinated because the side-effect profile of vaccination is no different for them than the general population.
Nevertheless, based on previously published reports, we have learned that certain patients with blood cancer do not produce antibodies to the spike protein after a full course of vaccination with the SARS-CoV-2 vaccines. This ability of patients to produce antibodies after SARS-CoV-2 vaccination is being further explored in a large study across all blood cancers using The LLS National Patient Registry, a project of the Michael J. Garil Patient Data Collective.
Further studies on other arms of the immune system — specifically T cells — as well as alternative therapies for such patients are actively being investigated.
References:
NIH. The Lymphoma and Leukemia Society COVID-19 Registry. Available at clinicaltrials.gov/ct2/show/NCT04794387. Accessed June 4, 2021.
The Leukemia & Lymphoma Society. COVID-19 vaccine safety among blood cancer patients. Available at: www.lls.org/news/covid-19-vaccine-safety-among-blood-cancer-patients. Accessed June 4, 2021.
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Mark NM, et al. Abstract 6566. Presented at: ASCO Annual Meeting (virtual meeting); June 4-8, 2021.
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