Patients with blood cancers, particularly those with more advanced disease, are at increased risk for serious COVID-19 outcomes, including an elevated chance of severe illness or death from infection, according to an analysis of more than 1,000 patients in the ASH Research Collaborative (RC) COVID-19 Registry for Hematology. The report revealed that 17% of patients with blood cancers who developed COVID-19 died from COVID-related illness—a higher mortality rate than what was seen in the general population, according to researchers. Older age, male sex, poor cancer prognosis, and electing to defer intensive care when it was recommended were all independently associated with a heightened chance of dying, according to results presented by Lisa K. Hicks, MD, MSc, and colleagues at the 2021 American Society of Hematology (ASH) Annual Meeting & Exposition (Abstract 3040).
“In our analysis, having a poor prognosis for underlying disease prior to COVID-19 [infection] and deciding to forgo intensive care unit (ICU)-level care for that disease were the most powerful predictors of mortality among patients with blood cancer and COVID-19—and the two may very well be related,” said Dr. Hicks, of St. Michael’s Hospital in Toronto, Canada. “If someone is sick enough to require ICU-level care and their preference is not to receive this type of care, we would expect that decision to have a major impact on their survival.”
Data were collected between April 1, 2020, and July 2, 2021, as part of the ASH RC COVID-19 Registry for Hematology, which is a public-facing, volunteer registry reporting outcomes of COVID-19 infection in patients with underlying blood disorders. A total of 1,029 patients from around the globe were included in this analysis. Of these, 41% were female; the median age was 50 to 59 years, but patients ranged from 5 to older than 90 years; and 27% had at least one coexisting condition such as heart disease, hypertension, respiratory disease, or diabetes. Researchers sought to identify factors associated with a higher likelihood of hospitalization and death from COVID-19.
Of people included in the analysis, 354 (34%) had acute leukemia or myelodysplastic syndromes (MDS), 255 (25%) had lymphoma, 206 (20%) had plasma cell dyscrasia (multiple myeloma/amyloidosis/POEMS [polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes] syndrome), 116 (11%) had chronic lymphocytic leukemia (CLL), and 98 (10%) had myeloproliferative neoplasms (MPN).
The data from the ASH RC COVID-19 Registry has limitations and findings should generally be regarded as hypothesis-generating. Nonetheless, the data do suggest that patients with blood cancers are at substantial risk from COVID-19…this finding has implications for our patients; how we manage our clinics amid COVID-19 and the changing variants; and how vaccines, boosters, and antibody treatments are distributed.— Lisa K. Hicks, MD, MSc
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More Findings From the Registry
According to the data, patients whose physician had estimated that they had less than 6 months to live due to their cancer before being infected with COVID-19 had sixfold higher odds of dying; these odds nearly doubled among people who decided to forgo more intensive care due to COVID-19. However, these groups represented a small proportion of the overall sample, with only 7% estimated to have a pre–COVID-19 prognosis of under 6 months and 9% deferring ICU care.
Of particular interest to the field was whether blood cancer treatment would affect COVID-19 mortality. Most patients included in the dataset (71%) received cancer treatment during the previous year; others were either in remission or had not yet needed treatment. In addition, receiving cancer treatment in the year prior to COVID-19 infection did not significantly increase the risk of death; however, it was linked to an increased risk of hospitalization. Older age, being male, having active cancer, and having other health conditions were also associated with an increased risk of hospitalization from COVID-19 among patients with blood cancers.
“In the early days of the pandemic, there was a lot of uncertainty about whether we should withhold or modify blood cancer treatments in regions with high levels of COVID-19,” said Dr. Hicks. “The data are somewhat reassuring in that, while recent cancer treatment was linked to a higher risk of hospitalization among those with blood cancer and COVID-19, it wasn’t independently associated with a statistically greater likelihood of dying. The type of blood cancer was also not associated with a higher risk of COVID-19 mortality. These findings suggest that patients who need treatment for their hematologic malignancy should likely proceed with that treatment.”
Patients with MPNs and plasma cell dyscrasia had less severe COVID-19 illness overall compared to patients with CLL, leukemia, MDS, or lymphoma, which Dr. Hicks said is not surprising as patients with MPN typically live with their disease for many years, are generally in better health, and may not require immunosuppressive treatment.
“The data from the ASH RC COVID-19 Registry have limitations, and findings should generally be regarded as hypothesis-generating,” Dr. Hicks said. “Nonetheless, the data do suggest that patients with blood cancers are at substantial risk from COVID-19…this finding has implications for our patients; how we manage our clinics amid COVID-19 and the changing variants; and how vaccines, boosters, and antibody treatments are distributed.”
In this analysis, 17% of those with blood cancers died of COVID-19; the mortality rate among those infected with SARS–CoV-2 in the general U.S. population has been reported to be between 1.6% and 6.2% at various times during the pandemic, Dr. Hicks added.
The ASH RC Registry is a public voluntary registry that continues to accrue cases and provide the information on a public dashboard to help keep the hematology community apprised on changing trends. Dr. Hicks said the team will also be looking at how the risks of hospitalization and death changed as vaccines and COVID-19 treatments became more widely available.
Disclosure: For full disclosures of the study authors, visit ash.confex.com.
