COVID-19 Morbidity and Mortality in Patients with Hematologic Malignancies

A study presented at the 2020 ASH Annual Meeting found that patients with hematologic malignancies experience significant morbidity and mortality from COVID-19 infection. However, the researchers caution that the study’s findings do not suggest “withholding intensive therapies from patients with underlying hematologic malignancies and favorable prognoses, if aggressive supportive care is consistent with patient preferences.”

The ASH Research Collaborative COVID-19 Registry for Hematology was developed to study features and outcomes of COVID-19 infection in patients with underlying blood disorders. The registry opened for data collection on April 1, 2020. The registry is a global effort and is housed on a secure data platform hosted by Prometheus Research, an IQVIA company.

The registry collects data from patients of all ages with a current or history of hematologic disease and either a laboratory-confirmed or presumptive diagnosis of SARS-CoV-2 infection. For this study, researchers presented data only relevant to malignant hematologic diseases. 

At the time of this analysis, data from 250 patients with blood cancers from 74 international sites had been entered into the registry. The most commonly represented malignancies were acute leukemia (33%), non-Hodgkin lymphoma (27%), and myeloma or amyloidosis (16%).

Patients presented with various symptoms, most commonly fever (73%), cough (67%), dyspnea (50%), and fatigue (40%). Many patients received COVID-19-directed therapies such as hydroxychloroquine (n=76) or azithromycin (n=59). 

Overall mortality was 28%. 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 experienced a higher proportion of moderate to severe COVID-19 disease and death. In severe cases (defined as intensive care unit [ICU] severity), 20% of patients (n=48) experienced death, while 9% (n=21) recovered (outcomes were unknown in three patients [1%]). Comparatively, in moderate cases (defined as hospitalization severity), 30% of patients recovered (n=73) and 8% (n=20) died. In mild cases (defined as outpatient severity), 30% of patients (n=72) recovered.

In some instances, death occurred after a decision was made to forego ICU admission in favor of a palliative approach.

Reference

Wood WA, Neuberg DS, Thompson JC, et al. Outcomes of Patients with Hematologic Malignancies and COVID-19 Infection: A Report from the ASH Research Collaborative Data Hub. Abstract 215. Presented at the 62nd American Society of Hematology Annual Meeting & Exposition, Dec. 2-11, 2020.