Patients with acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), and myelodysplastic syndrome (MDS) who contracted COVID-19 have had a higher mortality rate than those without cancer, according to data from the American Society of Hematology Research Collaborative (ASH RC) data hub for hematology.
The overall mortality from COVID-19 in the cohort of 257 patients with AML / ALL / MDS was 21%. A total of 60 percent of patients were hospitalized for COVID-19 infection; 1% of deceased patients did not have to be hospitalized because of COVID-19, compared to 34% who did. In patients who went to the intensive care unit (ICU), the death rate was 68%.
In addition, the results presented during the 2021 ASH Annual Meeting showed that patients with both active disease and neutropenia were more likely to have severe COVID-19 infection at diagnosis. However, no increased mortality from the virus was noted in those with active disease.
“The two factors influencing COVID-19 mortality were a primary disease prognosis of less than 6 months and the postponement of the intensive care unit,” senior study author Pinkal Desai, MD, assistant professor of medicine at Weill Cornell Medical College and assistant doctor at New York- Presbyterian Hospital said in a press conference during the meeting. “Only among hospitalized patients did those with a pre-COVID-19 prognosis of less than 6 months and a move to the intensive care unit have a higher COVID-19 mortality.”
There is currently a lack of data on predictors of severe infection and the consequences of COVID-19 in patients with AML, ALL, and MDS. However, it is believed that patients with active disease may experience poorer results because of cytopenias and their overall prognosis. Additionally, Pinkal found that single-center studies have shown higher rates of COVID-19 infection severity and mortality in patients with acute leukemia.
Using the ASH RC Data Hub for Hematology, researchers attempted to identify risk factors for severe COVID-19 infection and mortality in patients with AML, ALL, and MDS by using the ASH RC COVID-19 Registry for Hematology.
The registry includes the characteristics and results of confirmed or suspected COVID-19 diagnoses in adult patients with existing or history of haematological disorders. Data collection began internationally on April 1, 2020 via a platform hosted by Prometheus Research, with data being regularly updated on the ASH website.
Researchers analyzed patient characteristics, outcomes, and predictors, and stratification factors included disease status (active initial diagnosis vs. relapsed / refractory vs. remission) and the type of hematologic cancer; Variables were age, comorbidities, type of haematological cancer (AML, ALL, or MDS), neutrophil and lymphocyte count, and active treatment at the time of COVID-19 diagnosis. The severity of COVID-19 was rated as mild (no hospitalization), moderate (hospitalization), or severe (ICU admission).
The primary endpoint of the research was mortality from COVID-19; The severity of COVID-19 served as the secondary endpoint.
The data included a total of 257 patients with AML (n = 135; 53%), ALL (n = 82; 32%) and MDS (n = 40; 16%); 46% of the patients were in remission and 44% had active disease; 10% of the patients had an unknown status. Almost half (49%) of the patients were younger than 60 years, 55% were male, and most of the patients (74%) had severe comorbidity. 75% of the patients had received systemic therapy in the previous year and 72% had an estimated prognosis of more than 6 months. In addition, most of the patients (78%) did not have a deferred intensive care unit.
In multivariate analyzes, the results showed that patients with active disease were independently associated with severe COVID-19 (odds ratio [OR], 2,23; 95%-KI 1,18-4,29; P = 0.014). In addition, the occurrence of neutropenia at diagnosis was also an independent association with severe COVID-19 (OR 4.00; 95% CI 2.24-10.60; P <.0001).
In addition, 67% of patients with severe COVID-19 had active disease compared to 33% who were in remission. In non-severe COVID-19 cases, 43% of patients had active disease and 57% of patients were in remission.
The variables associated with mortality in hospitalized patients with ALL / AML / MDS who had COVID-19 had an estimated pre-COVID-19 diagnosis due to primary disease of less than 6 months (OR, 6.49 ; 95% CI, 2.12-22.57.). ; P <0.001) and with delayed intensive care status (OR, 4.12; 95% CI, 1.53-11.63; P = 0,005).
“If patients so choose, aggressive support for hospitalized patients with COVID-19 regardless of remission status is appropriate,” concluded Pinkal.
Desai P, Goldberg AG, Anderson KC et al. Clinical Predictors of Outcome in Adult Patients with Acute Leukemia and Myelodysplastic Syndrome and COVID-19 Infection: Report from the American Society of Hematology Research Collaborative (ASH RC) Data Hub. Presented at: 2021 ASH Annual Meeting & Exposition; 10-14 December 2021; Atlanta, GA. Summary 280.