COVID-19 more severe in patients with active acute leukemia, myelodysplastic syndrome
Click Here to Manage Email Alerts
Patients with acute leukemia or myelodysplastic syndrome in an active state experienced significantly greater COVID-19 severity but not higher mortality due to the virus, according to research presented at ASH Annual Meeting and Exposition.
The findings from the ASH Research Collaborative COVID-19 Registry for Hematology also showed patients with acute myeloid leukemia, acute lymphocytic leukemia or myelodysplastic syndrome (MDS) who had neutropenia and a pre-COVID-19 prognosis of less than 6 months had higher COVID-19 mortality than those who did not and may be more likely to forgo ICU care.
“COVID-19 infection in the noncancer populations was linked to worse severity and mortality when patients presented with low blood counts or were older and had comorbidities,” Pinkal Desai, MD, MPH, assistant professor of medicine at Weill Cornell Medical College and assistant attending physician at New York-Presbyterian Hospital, told Healio. “Patients with leukemia and MDS tend to be older and have treatment or disease-related low blood counts and comorbidities. We suspected this population is at risk for adverse outcomes from COVID-19 infection, and predictors of such outcomes were not available. We conducted this study to understand these risk factors.”
The analyses included data of 257 patients, including 135 with AML, 40 with MDS and 82 with ALL. Forty-four percent had active disease, 46% were in remission and 10% had unknown disease status. Fourteen patients were removed from analyses because of missing survival outcomes. Among the 230 with available age data, 121 were aged younger than 60 years.
Researchers analyzed patient characteristics, outcomes and predictors and stratified patients by disease status (active initial diagnosis and relapsed/refractory vs. remission) and hematologic malignancy type (AML, MDS or ALL). Other variables researchers considered included age, comorbidities, and, at the time of COVID-19 diagnosis, neutrophil and lymphocyte count and active treatment.
The investigators summarized categorical patient characteristics for response groups and associations between those groups and characteristics (for example, alive vs. dead, severity vs. non-severity) by frequency. They evaluated differences between response groups and used multivariable analyses to identify independent predictors of outcomes.
Overall, 21% of patients died of COVID-19, and neither active disease status nor ongoing cancer treatment appeared associated with increased mortality among hospitalized patients.
Patients with active disease were significantly more likely to present with moderate or severe COVID-19 than those in remission (severe COVID-19, 67% active disease vs. 33% remission; moderate COVID-19, 55% vs. 45%; mild COVID-19, 67% vs. 33%; P < .001).
The difference also was significant when categorized COVID-19 infection as severe vs. not severe (P = .002).
Having an AML diagnosis, major comorbidities, and neutropenia and lymphopenia at the time of COVID-19 diagnosis all appeared associated with COVID-19 severity.
Additional univariate analyses showed a significant association of increased mortality after COVID-19 diagnosis with advanced age, male sex, pre-diagnosis survival of less than 6 months, active disease status, neutropenia, lymphopenia and forgoing ICU care. And in multivariable analyses of all patients, increased COVID-19-related mortality was significantly associated with neutropenia at diagnosis (OR = 3.15; 95% CI, 1.31-8.08), estimated pre-COVID-19 prognosis of less than 6 months (OR = 8.58; 95% CI, 3.24-24.46) and forgoing ICU care (OR = 6.66; 95% CI, 2.56-18.23).
Researchers also found that among hospitalized patients, increased COVID-19 mortality was associated with estimated pre-COVID-19 prognosis of less than 6 months (OR = 6.77; 95% CI, 2.34-22.24) and forgoing ICU care (OR = 3.98; 95% CI, 1.45-11.66).
Characteristics of those likely to forgo ICU care included male sex, older age, being a smoker, having active disease or having estimated pre-COVID-19 survival of less than 6 months. Researchers reported that forgoing ICU care (n = 37) was associated with higher COVID-19 mortality among all patients (n = 234; OR = 15.6; 95% CI, 6.4-40.9), hospitalized patients (n = 143; OR = 9.2; 95% CI, 3.5-26.5) and patients for whom ICU admission was indicated and declined (n = 61; OR= 5.6; 95% CI, 1.1-56.4).
“Patients with active disease at the time of COVID 19 infection are at risk for severe COVID-19, requiring ICU admission, and should be monitored carefully,” Desai told Healio. “Active treatment of the underlying leukemia or MDS did not affect COVID-19 severity or mortality. Patients should be offered aggressive treatment of primary disease, if needed.”
Collapse
Desai P, et al. Abstract 280. Presented at: ASH Annual Meeting and Exposition; Dec. 11-14, 2021; Atlanta.
Click Here to Manage Email Alerts