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Link established between active disease carryover / ICU and COVID-19 mortality in AML, ALL and MDS

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According to data from the American Society of Hematology Research Collaborative, patients with acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), and myelodysplastic syndrome (MDS) who contract COVID-19 have a death rate higher than patients without cancer. (ASH RC) Data center for hematology.

The overall death rate from COVID-19 in the cohort of 257 AML / ALL / MDS patients was 21%. Overall, 60% of patients were hospitalized for COVID-19 infection; 1% of patients who died did not require hospitalization for COVID-19, compared with 34% who did. In patients who went to the intensive care unit (ICU), the death rate was 68%.

Additionally, the results, which were presented at the 2021 ASH Annual Meeting, indicated that patients with both active disease and neutropenia at diagnosis were more likely to have severe infection with COVID-19. However, people with active disease have not shown increased mortality from the virus.

“The 2 factors that impacted COVID-19 mortality were a primary disease prognosis of less than 6 months and postponement of intensive care,” study lead author Pinkal Desai, MD, assistant professor of medicine at Weill Cornell Medical College and assistant attending physician at NewYork-Presbyterian Hospital, said during a press briefing at the meeting. “Among hospitalized patients only, those with a pre-COVID-19 prognosis of less than 6 months and postponed to intensive care had higher COVID-19 mortality.”

Data is currently lacking on predictors of severe infection and outcomes with COVID-19 in patients with AML, ALL and MDS. However, it is believed that people with active disease may have poorer outcomes due to cytopenias and their overall prognosis. Additionally, Pinkal noted that single-center studies have shown higher severity and mortality rates from COVID-19 infection in patients with acute leukemia.

With the ASH RC Data Center for Hematology, researchers sought to identify risk factors for severe COVID-19 infection and mortality in patients with AML, ALL and MDS using the ASH registry RC COVID-19 for hematology.

The registry includes characteristics and results of confirmed or suspected diagnoses of COVID-19 in adult patients with current or history of hematologic disorders. Data collection was opened internationally on April 1, 2020, through a platform hosted by Prometheus Research, with regularly updated data on the ASH website.

Researchers analyzed patient characteristics, outcomes and predictors, and stratification factors included disease status (initial diagnosis active vs. relapsed / refractory vs. remission) and type of hematologic cancer; the variables were age, comorbidities, type of hematologic cancer (AML, ALL or MDS), neutrophil and lymphocyte count, and active treatment at the time of diagnosis of COVID-19. The severity of COVID-19 was rated as mild (no hospitalization), moderate (hospitalization), or severe (intensive care admission).

The primary endpoint of the research was mortality from COVID-19; The severity of COVID-19 was used as a secondary endpoint.

Data included 257 patients overall with AML (n = 135; 53%), ALL (n = 82; 32%) and MDS (n = 40; 16%); 46% of patients were in remission and 44% had active disease; 10% of patients had an unknown status. Almost half (49%) of patients were under 60 years old, 55% were men, and most patients (74%) had major comorbidity. Seventy-five percent of patients had received systemic therapy in the previous year and 72% had an estimated prognosis greater than 6 months. In addition, most patients (78%) did not have delayed intensive care.

In multivariate analyzes, the results showed that patients with active disease were shown to be independently associated with severe COVID-19 (odds ratio [OR], 2.23; 95% CI: 1.18-4.29; P = .014). Additionally, having neutropenia at the time of diagnosis was also an independent association with severe COVID-19 (OR, 4.00; 95% CI, 2.24-10.60; P <.0001>

Additionally, in patients with severe COVID-19, 67% had active disease compared to 33% who were in remission. In non-severe COVID-19 cases, 43% of patients had active disease and 57% of patients were in remission.

Variables associated with mortality in hospitalized ALL / AML / MDS patients who had COVID-19 had an estimated pre-COVID-19 diagnosis of primary illness within 6 months (OR, 6.49; 95 CI %, 2.12-22.57; P <.001 and with delayed icu status ci>P = .005).

“If patients wish, aggressive support for hospital patients with COVID-19 is appropriate regardless of remission status,” Pinkal concluded.

Reference

Desai P, Goldberg AG, Anderson KC, et al. Clinical Predictors of Outcome in Adult Patients with Acute Leukemia, Myelodysplastic Syndrome, and COVID-19 Infection: Report from the American Society of Hematology Research Collaborative (ASH RC) Data Hub. Presented at the 2021 ASH Annual Meeting and Exhibition; December 10-14, 2021; Atlanta, Georgia. Abstract 280.