Age, sex, other factors impact mortality risk among patients with blood cancer, COVID-19
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Older age, male sex, pre-COVID-19 prognosis of less than 6 months and deferral of ICU care appeared associated with greater risk for mortality among patients with blood cancer and COVID-19, study results showed.
Although researchers did not observe an increased risk for COVID-19 mortality among patients with COVID-19 who had been treated for blood cancer in the previous year, those patients did have higher hospitalization rates, according to the findings, presented at ASH Annual Meeting and Exposition.
The analysis included 1,029 patients (median age, 50-59 years; 42% women) with a malignant diagnosis from the ASH Research Collaborative COVID-19 Registry for Hematology, a public-facing, volunteer registry reporting COVID-19 outcomes of patients with underlying blood disorders.
“The ASH registry was designed as a tool to quickly collect and share data on how COVID-19 impacts people with blood cancer,” Lisa K. Hicks, MD, MSc, of the division of hematology/oncology at St. Michael's Hospital in Toronto, told Healio. “Our analysis explores different patient and treatment factors associated with more serious outcomes. In particular, we were interested in whether cancer treatment would impact mortality. In our analysis, it doesn’t look like it does, which is somewhat reassuring.”
Hicks and colleagues studied the impact of cancer treatment and other variables on COVID-19 mortality within the cohort.
The key variables included age, sex, presence of a major comorbidity (heart disease, hypertension, pulmonary disease and/or diabetes), type of hematologic malignancy, estimated prognosis of less than 6 months prior to COVID-19 diagnosis, deferral of ICU care and receipt of cancer treatment in the previous year. In addition, researchers explored associations between the same variables and COVID-19 hospitalization.
About one-third of patients (34%) had acute leukemia/myelodysplastic syndrome, whereas 25% had lymphoma, 20% had plasma cell dyscrasia (myeloma/amyloid/POEMS syndrome), 11% had chronic lymphocytic leukemia and 10% had myeloproliferative neoplasm. Nearly three-quarters (71%) had received cancer treatment during the previous year, 7% had a pre-COVID-19 prognosis of less than 6 months and 9% deferred ICU care.
Researchers reported a 17% COVID-19 mortality rate among all patients in the cohort.
Results of multivariable analyses showed independent associations of age older than 60 years (OR = 1.99, 95% CI, 1.28-3.12), male sex (OR = 1.7; 95% CI, 1.12-2.62), estimated pre-COVID-19 prognosis of less than 6 months (OR = 5.76; 95% CI, 2.99-11.21) and ICU deferral (OR = 10.76; 95% CI, 6.29-18.8) with an increased risk for death.
Receipt of cancer treatment in the year prior to COVID-19 diagnosis, remission status and type of hematologic malignancy did not appear significantly associated with death.
Additional multivariable analyses revealed independent associations of age older than 60 years (OR = 2.44; 95% CI, 1.82-3.3), male sex (OR = 1.32; 95% CI, 1-1.74), estimated pre-COVID-19 prognosis of less than 6 months (OR = 3.84, 95% CI, 1.93-8.43), presence of a major comorbidity (OR = 1.54; 95% CI, 1.12-2.13), having active blood cancer (OR = 1.66; 95% CI, 1.24-2.23) and cancer treatment in the previous year (OR = 1.48; 95% CI, 1.08-2.03) with an increased risk for severe COVID-19 requiring hospitalization.
Researchers found patients with a myeloproliferative neoplasm or plasma cell dyscrasia and COVID-19 were less likely to require hospitalization for COVID-19 than patients with CLL, leukemia/myelodysplastic syndrome or lymphoma.
“Because patients with blood cancer appear to be at heightened risk for death and hospitalization from COVID-19, an ongoing commitment to preventive measures such as vaccination, masking and social distancing is very important for this population,” Hicks told Healio. “Second, in our analysis, having received cancer treatment in the previous year did not appear to impact COVID-19 mortality. This is a somewhat reassuring and important result, as in combination with reports from other groups it suggests that in most cases, blood cancer teams should continue to focus on providing the best possible cancer therapy to patients and not adjust treatments due to fear of future COVID-19 mortality.”
For more information:
Lisa K. Hicks, MD, MSc, can be reached at lisak.hicks@unityhealth.to.
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Hicks LK, et al. Abstract 3040. Presented at: ASH Annual Meeting and Exposition; Dec. 11-14, 2021; Atlanta.
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