High COVID-19 Mortality Risk Revealed For Haematological Malignancy Patients

Author: By Lynda Williams, Senior medwireNews Reporter 

medwireNews: Patients with haematological malignancies and COVID-19 have a high risk of mortality, indicates a review of Italian patients hospitalised between February and May 2020. 

The research “highlights the need for aggressive infection prevention strategies, at least until effective vaccination or treatment strategies are available”, write Francesco Passamonti, from the University of Insubria in Varese, Italy, and fellow of the Italian Hematology Alliance on COVID-19 investigators. 

Overall, 536 adults attended 66 hospitals with laboratory confirmed, symptomatic COVID-19 and were followed-up for a median 20 days, the majority (84%) of whom were admitted to hospital. Among the hospitalised patients, 98% were followed up until discharge or death (37%). The median hospital stay was 20 and 11 days in these groups, respectively. 

The standardised mortality ratio (SMR) was 2.04 for the study cohort compared with the general Italian population with COVID-19, rising to 3.72 when compared with general population members aged less than 70 years. 

And the SMR was 41.3 when the study cohort was compared with haematological malignancy patients without COVID-19, the researchers say in The Lancet Haematology. 

Poor overall survival was significantly associated with key factors in multivariable analysis, specifically older age (hazard ratio [HR] for death=1.03), progressive disease (HR=2.10), a diagnosis of indolent or aggressive non-Hodgkin lymphoma (HR=2.19 and 2.56, respectively), plasma cell neoplasms (HR=2.48) or acute myeloid leukaemia (HR=3.49), and severe or critical COVID-19 (HR=4.08). 

“The high mortality in this population of patients, some with the potential to receive curative treatment, has important practical implications for health-care systems: priority must be given to regular swab testing, development of specific treatment trials, and allocation of dedicated health-care resources toward this patient population”, advise Francesco Passamonti and colleagues. 

Writing in an accompanying comment, Samuel Rubinstein, from the University of North Carolina in Chapel Hill, USA, and Jeremy Warner, from Vanderbilt University Medical Center in Nashville, Tennessee, USA, agree that “[t]he magnitude of the risk has implications for medical decision making.” 

And they recommend: “Although appropriate therapy should not be withheld, patients and their physicians can take precautions to reduce risks of COVID-19, such as choosing oral over intravenous regimens where there is equipoise, using growth factor support more judiciously, or reducing surveillance laboratory and radiographical evaluations when possible.” 

Nevertheless, the commentators say that the mortality rate in the study should be “interpreted cautiously”, as it could be an overestimate for the global population as the cohort mainly included patients with severe disease but with a low rate of intensive care unit admissions, and there was no adjustment for risk factors such as smoking or functional status. 

“The short median follow-up interval of 20 days highlights that the associations identified are with early mortality and might not reflect an entire COVID-19 course”, they add, emphasizing the need for long-term follow-up of pandemic patients. 

References  

Passamonti F, Cattaneo C, Arcaini L, et al. Clinical characteristics and risk factors associated with COVID-19 severity in patients with haematological malignancies in Italy: a retrospective, multicentre, cohort study. Lancet Haematol; Advance online publication 13 August 2020. https://doi.org/10.1016/S2352-3026(20)30251-9 

Rubinstein SM, Warner JL. COVID-19 and haematological malignancy: navigating a narrow strait. Lancet Haematol; Advance online publication 13 August 2020. https://doi.org/10.1016/S2352-3026(20)30252-0