ASH Posters Evaluate COVID-19 Risk Among Patients With Blood Cancers

Patients with blood disorders have a greater risk for severe infection and death from COVID-19, and 2 studies presented at the 63rd American Society of Hematology (ASH) Annual Meeting and Exposition shed light on the burden COVID-19 has on people with blood disorders.

Both posters analyzed data of patients in the ASH Research Collaborative (RC) COVID-19 Registry for Hematology. This registry was started in the early days of the pandemic to provide real-time observational data summaries to clinicians on the front lines of the fight against COVID-19, as well as researchers and providers around the world.

One poster evaluated 1029 patients with hematologic malignancies.¹ The median age category was 50 to 59 years, 42% were female and 28% had major comorbidities, defined as any heart disease, hypertension, pulmonary disease, and/or diabetes. The most common malignancy was acute leukemia/myelodysplastic syndrome (MDS, 34%), followed by lymphoma (25%), plasma cell dyscrasia (20%, chronic lymphocytic leukemia (CLL, 11%), and myeloproliferative neoplasm (MPN, 10%).

In the overall cohort, 17% of patients who developed COVID-19 died from a pandemic–related illness. Older age (> 60 years), male sex, a pre–COVID-19 prognosis of less than 6 months, and deferral of intensive care unit (ICU) care were all associated with an increased risk of death.

“In our analysis, having a poor prognosis for underlying disease prior to COVID-19 and deciding to forgo 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,” lead author Lisa K. Hicks, MD, MSc, of St. Michael’s Hospital in Toronto, Canada, said in a statement. “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.”

While receiving cancer treatment in the year prior to getting COVID-19 was not associated with a significant increase in the risk of death, it was linked to an increased risk of hospitalization. Other factors associated with an increased risk of severe COVID-19 requiring hospitalization were older age (> 60 years), male sex, a pre–COVID-19 prognosis of less than 6 months, and presence of a major comorbidity.

Patients with CLL, leukemia/MDS, or lymphoma were more likely to require hospitalization for COVID-19 compared with patients with a MPN or plasma cell dyscrasia.

“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 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.”

In the second poster, 257 patients with acute myeloid leukemia (n = 135), acute lymphocytic leukemia (n = 82), or MDS (n = 40) who developed COVID-19 and were part of the ASH RC COVID-19 Registry for Hematology were evaluated to identify risk factors for severe infection and mortality.²

The overall mortality from COVID-19 in this cohort was 21%—higher than the 17% in the overall registry—and patients with active disease were significantly more likely to present with moderate and severe COVID-19 compared with patients in remission.

“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 three to six months, so if COVID-19 comes together with that diagnosis, it’s very concerning,” said lead 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.”

Characteristics that were significantly associated with increased mortality after COVID-19 diagnosis were advanced age, male sex, a pre–COVID-19 prognosis of less than 6 months, active disease status, neutropenia, lymphopenia, and forgoing ICU care.

“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 six months,” said Desai. “COVID-19 vaccination is also critically important.”

References

1. Hicks LK, Redd RA, Anderson KC, et al. Risks for Hospitalization and Death Among Patients with Blood Disorders from the ASH RC COVID-19 Registry for Hematology. Presented at: 63rd ASH Meeting and Exposition; December 11-14, 2021; Atlanta and virtual. Poster 3040.

2. Desai P, Goldberg AD, Anderson KC, et al. Clinical Predictors of Outcome in Adult Patients with Acute Leukemias and Myelodysplastic Syndrome and COVID-19 Infection: Report from the American Society of Hematology Research Collaborative (ASH RC) Data Hub. Presented at: 63rd ASH Meeting and Exposition; December 11-14, 2021; Atlanta and virtual. Poster 280.