In a UK study reported in The Lancet Oncology, Lee et al in the UK Coronavirus Cancer Monitoring Project (UKCCMP) found an increased prevalence of COVID-19 infection among patients with hematologic malignancies and increased risk of death from COVID-19 in patients with leukemia and those with hematologic malignancies who had recently received chemotherapy.
The study involved a comparison of data from 1,044 adult patients with cancer and a positive SARS-CoV-2 test enrolled in the UKCCMP cohort between March 18 and May 8, 2020, with data from a parallel non–COVID-19 UK cancer control population (n = 282,878) from the UK Office for National Statistics (ONS; 2017 data) to determine potential increased risk of COVID-19 infection by cancer type. Patients in the UKCCMP cohort were aged ≥ 18 years, had active cancer, and had presented to a UKCCMP network center. All patients attended secondary care to be reviewed for potential admission to hospital. Characteristics potentially associated with increased risk of severe COVID-19 infection and mortality among patients in the UKCCMP cohort were assessed.
In the comparison of representation in the UKCMMP cohort vs the ONS cohort, patients with hematologic malignancies appeared to be at significantly increased risk of COVID-19 infection, including those with leukemia (odds ratio [OR] = 2.82, P < .0001), multiple myeloma (OR = 2.03, P = .0001), and lymphoma (OR = 1.63, P < .0001). Patients with lung cancer (OR = 0.75, P = .003) and those with prostate cancer (OR = 0.72, P = .0008) appeared to be at lower risk. Men were over-represented in the UKCMMP cohort (56.9% vs 51.3%, OR = 1.26, P = .0002). Age distribution did not differ between the two cohorts.
In the UKCMMP cohort, patients with hematologic malignancies (leukemia, lymphoma, and multiple myeloma) had an increased risk for severe or critical COVID-19 infection vs patients with solid organ tumors (OR = 1.57, P < .0043).
Death occurred in 319 patients (30.6%) in the UKCCMP cohort, with 295 (92.5%) having COVID-19 as recorded cause of death. The all-cause case fatality rate was significantly associated with age, increasing from 0.10 in the 40-to-49 year age group to 0.48 in ≥ 80-year age group. The rate was also significantly higher in men vs women (OR = 1.92, P < .0001).
On multivariate analysis, patients with leukemia had a significantly increased case fatality rate (OR = 2.25, P = .023). After correction for age and sex, patients with hematologic malignancies who had recent chemotherapy (within 4 weeks of COVID-19 presentation) had increased risk of death during hospital admission for COVID-19 vs those without recent chemotherapy (OR = 2.09, P = .028).
The investigators formulated a risk table showing case fatality rates after presentation with COVID-19 according to tumor type, age, and sex.
The investigators concluded: “Patients with cancer with different tumour types have differing susceptibility to SARS-CoV-2 infection and COVID-19 phenotypes. We generated individualised risk tables for patients with cancer, considering age, sex, and tumour subtype. Our results could be useful to assist physicians in informed risk-benefit discussions to explain COVID-19 risk and enable an [evidence-based] approach to national social isolation policies.”
Gary Middleton, FRCP, of the Institute of Immunology and Immunotherapy, University of Birmingham, is the corresponding author for The Lancet Oncology article.
Disclosure: The study was funded by the University of Birmingham and University of Oxford. For full disclosures of the study authors, visit www.thelancet.com.