Risk factors and outcome of COVID-19 in patients with hematological malignancies
José Luís Piñana, Rodrigo Martino, Irene García‐García, Rocío Parody, Marı́a Dolores Morales, Gonzalo Benzo, Irene Gómez-Catalán, Rosa Coll, Ignacio de la Fuente, Alejandro Luna, Beatriz Merchán, Anabelle Chinea, Dunia de Miguel, Ana Aparicio Serrano, M. C. Pérez, C. Martinez Diaz, José López, Adolfo Sáez, Rebeca Bailén, Teresa Zudaire, Diana Martínez, Manuel Jurado, María Calbacho, Lourdes Vázquez, Irene García‐Cadenas, María Laura Fox, Ana I. Pimentel, Guiomar Bautista, Agustin Nieto, Pascual Fernández, Juan Carlos Castrillón Vallejo, Carlos Solano, Marta Valero, Ildefonso Espigado, Raquel Saldaña, Luisa Sisinni, Josep‐María Ribera, María José Jimenez, María Trabazo, Marta González‐Vicent, Noemí Fernández, Carme Talarn, María C. Montoya, Ángel Cedillo, Anna Sureda
Abstract
Abstract 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 × 10 9 /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.