Impact of hematologic malignancy and type of cancer therapy on COVID-19 severity and mortality: lessons from a large population-based registry study

García-Suárez, Julio; de la Cruz, Javier; Cedillo, Ángel; Llamas, Pilar; Duarte, Rafael; Jiménez-Yuste, Víctor; Hernández-Rivas, José Ángel; Gil-Manso, Rodrigo; Kwon, Mi; Sánchez-Godoy, Pedro; Martínez-Barranco, Pilar; Colás-Lahuerta, Blanca; Herrera, Pilar; Benito-Parra, Laurentino; Alegre, Adrián; Velasco, Alberto; Matilla, Arturo; Aláez-Usón, María Concepción; Martos-Martínez, Rafael; Martínez-Chamorro, Carmen; Susana-Quiroz, Keina; Del Campo, Juan Francisco; de la Fuente, Adolfo; Herráez, Regina; Pascual, Adriana; Gómez, Elvira; Pérez-Oteyza, Jaime; Ruiz, Elena; Alonso, Arancha; González-Medina, José; Martín-Buitrago, Lucía Núñez; Canales, Miguel; González-Gascón, Isabel; Vicente-Ayuso, María Carmen; Valenciano, Susana; Roa, María García; Monteliu, Pablo Estival; López-Jiménez, Javier; Escobar, Cristián Escolano; Ortiz-Martín, Javier; Diez-Martin, José Luis; Martinez-Lopez, Joaquín

BACKGROUND: Patients with cancer have been shown to have a higher risk of clinical severity and mortality compared to non-cancer patients with COVID-19. Patients with hematologic malignancies typically are known to have higher levels of immunosuppression and may develop more severe respiratory viral infections than patients with solid tumors. Data on COVID-19 in patients with hematologic malignancies are limited. Here we characterize disease severity and mortality and evaluate potential prognostic factors for mortality. METHODS: In this population-based registry study, we collected de-identified data on clinical characteristics, treatment and outcomes in adult patients with hematologic malignancies and confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection within the Madrid region of Spain. Our case series included all patients admitted to 22 regional health service hospitals and 5 private healthcare centers between February 28 and May 25, 2020. The primary study outcome was all-cause mortality. We assessed the association between mortality and potential prognostic factors using Cox regression analyses adjusted for age, sex, comorbidities, hematologic malignancy and recent active cancer therapy. RESULTS: Of 833 patients reported, 697 were included in the analyses. Median age was 72 years (IQR 60–79), 413 (60%) patients were male and 479 (69%) and 218 (31%) had lymphoid and myeloid malignancies, respectively. Clinical severity of COVID-19 was severe/critical in 429 (62%) patients. At data cutoff, 230 (33%) patients had died. Age ≥ 60 years (hazard ratios 3.17–10.1 vs < 50 years), > 2 comorbidities (1.41 vs ≤ 2), acute myeloid leukemia (2.22 vs non-Hodgkin lymphoma) and active antineoplastic treatment with monoclonal antibodies (2·02) were associated with increased mortality; conventional chemotherapy showed borderline significance (1.50 vs no active therapy). Conversely, Ph-negative myeloproliferative neoplasms (0.33) and active treatment with hypomethylating agents (0.47) were associated with lower mortality. Overall, 574 (82%) patients received antiviral therapy. Mortality with severe/critical COVID-19 was higher with no therapy vs any antiviral combination therapy (2.20). CONCLUSIONS: In this series of patients with hematologic malignancies and COVID-19, mortality was associated with higher age, more comorbidities, type of hematological malignancy and type of antineoplastic therapy. Further studies and long-term follow-up are required to validate these criteria for risk stratification.