TY - JOUR
T1 - Risk factors and outcome of COVID-19 in patients with hematological malignancies
AU - Piñana, José Luis
AU - Martino Bofarull, Rodrigo
AU - García-García, Irene
AU - Parody Porras, Rocío
AU - Morales, María Dolores
AU - Benzo, Gonzalo
AU - Gómez-Catalan, Irene
AU - Coll, Rosa
AU - De La Fuente, Ignacio
AU - Luna, Alejandro
AU - Merchán, Beatriz
AU - Chinea, Anabelle
AU - De Miguel, Dunia
AU - Serrano, Ana
AU - Pérez, Carmen
AU - Diaz, Carola
AU - Lopez, José Luis
AU - Saez, Adolfo Jesús
AU - Bailén, Rebeca
AU - Zudaire, Teresa
AU - Martínez, Diana
AU - Jurado, Manuel
AU - Calbacho, Maria
AU - Vázquez, Lourdes
AU - Garcia Cadenas, Irene
AU - Fox, Maria Laura
AU - Pimentel, Ana I.
AU - Bautista, Guiomar
AU - Nieto, Agustín
AU - Fernandez, Pascual
AU - Vallejo, Juan Carlos
AU - Solano, Carlos
AU - Valero, Marta
AU - Espigado, Ildefonso
AU - Saldaña, Raquel
AU - Sisinni, Luisa
AU - Ribera, Jose-Maria
AU - Jiménez, María José
AU - Trabazo del Castillo, María
AU - González Vicent, Marta
AU - Fernández, Noemí
AU - Talarn, Carme
AU - Montoya, Maria Carmen
AU - Cedillo, Angel
AU - Sureda, Anna
PY - 2020
Y1 - 2020
N2 - 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 × 109/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). Conclusions: 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.
AB - 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 × 109/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). Conclusions: 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.
KW - COVID-19
U2 - 10.1186/s40164-020-00177-z
DO - 10.1186/s40164-020-00177-z
M3 - Article
C2 - 32864192
SN - 2162-3619
VL - 9
JO - Experimental Hematology & Oncology
JF - Experimental Hematology & Oncology
IS - 1
ER -
