In an analysis of data from the first 250 patients enrolled in the ASH Research Collaborative (ASH RC) COVID-19 Registry for Hematology, researchers found that the mortality rate is approximately 28% among patients with hematologic malignancies and COVID-19. The rate was highest in those who are older, have severe infection, opt to forego more intensive treatment, or have poorer prognosis prior to infection. These findings were published in Blood Advances and presented at the 2020 ASH Annual Meeting.
Lead study author William Wood, MD, of the University of North Carolina at Chapel Hill, told ASH Clinical News that “because patients with blood cancers are medically vulnerable, we think it is important for these patients and for the health care system to continue to take appropriate precautions to limit the risk of acquiring COVID-19.”
The ASH RC COVID-19 Registry for Hematology is a global public reference tool that captures data on individuals with a hematologic condition (past or present) and a laboratory confirmed or presumptive diagnosis of infection with SARS-CoV-2, the coronavirus responsible for COVID-19. In this analysis, researchers looked specifically at patients with malignant hematologic diseases. Individual-level data were entered into the registry on a voluntary basis. The registry also collected information about whether there was a decision to forgo admission to the intensive care unit (ICU) in favor of a palliative approach.
Data for 250 patients with blood cancers from 74 global sites had been entered into the registry at the time of this report. Approximately 78% of the patients were over the age of 40 at time of COVID-19 diagnosis, and 36% were older than 70. Diagnoses included:
- acute leukemia (33%)
- non-Hodgkin lymphoma (27%)
- myeloma or amyloidosis (16%)
The most frequently reported symptoms in these patients included fever (73%), cough (67%), dysp-nea (50%), and fatigue (40%). Hydroxychloroquine (n=76) or azithromycin (n=59) were the most commonly used COVID-19-directed therapies.
The overall mortality rate was 28% (30% when excluding the 20 patients under the age of 19). The mortality rate was higher among patients with moderate or severe COVID-19 disease (42%).
Patients who were over the age of 40 were more likely to have moderate or severe COVID-19 (p<0.001), decide to forego ICU admission for a palliative approach (p<0.001), and have higher mortality (p=0.01). Men were also more likely to opt for a palliative approach (p=0.03) and have higher mortality (p=0.008). Among those with severe disease, most deaths occurred in those over the age of 40, “despite maximal supportive management or in the context of a decision to pursue a palliative approach,” the authors added.
Of the 37 patients with at least moderately severe COVID-19 for whom a palliative approach was used, 33 died (89%). The mortality rate was considerably lower among the 131 patients with at least moderate-severity infection who did not forgo ICU admission (n=35; 27%). (FIGURE)
In patients with moderate-severity infection, most deaths occurred when ICU-level care was forgone in favor of a palliative approach. Patients with a physician-estimated prognosis from the underlying hematologic malignancy of less than 12 months at the time of COVID-19 diagnosis and those with relapsed/refractory disease also experienced a higher proportion of moderate/severe COVID-19 disease and death.
While the relatively high mortality rate in this population is concerning, the researchers noted that most patients who acquired the COVID-19 infection recovered from it. In addition, several patients who survived also had severe disease and required care in the ICU. “Thus, providing maximal care to patients with blood cancers and COVID-19 infection appears appropriate if it is consistent with patient and family preferences,” added Dr. Wood. “As the data mature, the registry may be able to better inform specific risks from specific treatments and specific underlying diseases, which could have an impact upon treatment decision-making.”
Considering the findings were made based on a voluntary reporting registry, the estimates from the registry may not be identical to a true population-based registry. Dr. Wood suggested this highlights the need for enhanced data collection systems involving patients with underlying hematologic diseases.
“The Research Collaborative Data Hub is building programs that will help to address this gap, starting in sickle cell disease and multiple myeloma, and expanding to other diseases in the future,” stated Dr. Wood. “In the meantime, though, we encourage continued data collection to the ASH Research Collaborative COVID-19 registry from hematologists around the world, so that the data resource we are building can be used to address further questions about COVID-19 and blood cancer that are relevant to hematologists.”
Wood WA, Neuberg DS, Thompson JC, et al. Outcomes of patients with hematologic malignancies and COVID-19: a report from the ASH Research Collaborative Data Hub. Blood Adv. 2020;4:5966-5975.