Study Identifies Factors for Severe COVID-19 Illness Among Patients With Acute Leukemia or MDS

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In separate analyses of 257 patients with acute leukemia or myelodysplastic syndrome (MDS) who developed COVID-19 and are part of the American Society of Hematology (ASH) RC COVID-19 Registry for Hematology, both neutropenia and having active MDS or leukemia (vs being in remission) were found to strongly and independently predict severe COVID-19 illness. Once a patient was hospitalized, active disease by itself—whether a patient was newly diagnosed or had relapsed—was not tied to a greater risk of dying from COVID-19, nor was receiving ongoing cancer treatment. These findings were presented by Desai et al during the 2021 ASH Annual Meeting & Exposition (Abstract 280).

Analysis Details

For this retrospective analysis, which included data from 135 patients with acute myeloid leukemia, 82 with acute lymphocytic leukemia, and 40 with MDS who were diagnosed with COVID-19 from 2019 to present, researchers sought to identify characteristics that put patients at higher risk of severe illness or death from COVID-19. At the time of COVID-19 diagnosis, 46% of patients were in remission and 44% had active disease. COVID-19 severity was defined as mild (no hospitalization required), moderate (hospitalization required), or severe (intensive care unit [ICU] admission required). After adjusting for several risk factors, active disease and neutropenia at the time of COVID-19 diagnosis were also associated with severe COVID-19 illness that necessitated ICU-level care.

Overall, one out of five (21%) patients died from COVID-19, which was higher than the mortality rate reported for the registry as a whole (17%) or what was seen in the general public during the same period of time, researchers reported. Mortality among hospitalized patients with COVID-related illness was 34%, and mortality among patients once admitted in the ICU was 68%. The two factors most strongly associated with a higher likelihood of dying among these patients were:

  • How long a patient was perceived to live from the underlying MDS or leukemia before getting COVID-19, as defined as a physician’s estimated prognosis of less than 6-month survival
  • Whether or not they decided to go to the ICU if it was recommended.

Older age, male sex, and neutropenia at diagnosis were also associated with COVID-19 mortality, though less strongly.

“This is a particularly vulnerable population and we suspected they may do worse because they are immunocompromised and, as it is, the average survival for acute blood cancers if untreated is 3 to 6 months, so if COVID-19 comes together with that diagnosis, it’s very concerning,” said presenting author Pinkal Desai, MD, MPH, of Weill Cornell Medical College, New York. “Our data suggest these patients can survive COVID-19 and their underlying disease itself was not associated with worse mortality, which means that if these patients are given appropriate and aggressive treatment, we can help them recover. But if there are decisions that are made after they get to the hospital (for example, whether to go to the ICU) that clearly plays a role.”

In fact, patients for whom ICU-level care was recommended and declined had five times higher odds of dying compared with patients who opted to go to the ICU.

“Patients who went to the ICU did better regardless of disease status,” said Dr. Desai. “Just having acute leukemia or MDS puts these patients at high risk of severe COVID-19, and they need to be hospitalized and receive treatments, but decisions about the ICU should be individualized, a patient’s prognosis should be discussed, and if a patient wants aggressive care for COVID-19, that should be offered.”

Patients were more likely to forgo ICU care if they were older, male, smokers, or if they had active disease or an estimated pre–COVID-19 infection survival of less than 6 months. Forgoing ICU care was associated with a higher COVID-19 mortality in all patients.

“Our data show that these patients do survive COVID-19 after receiving care in the ICU and underscore that cancer treatments should not be withheld, as inferior treatment would quickly put many of these patients into the category of a prognosis of less than 6 months,” said Dr. Desai. “COVID-19 vaccination is also critically important.”

The data are limited in that they were collected before COVID-19 vaccines were widely available; future data should inform about mortality rates among vaccinated patients.

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