A Multicenter Analysis of the Outcome of Cancer Patients with Neutropenia and COVID-19 Optionally Treated with Granulocyte-Colony Stimulating Factor (G-CSF): A Comparative Analysis

Sereno, María; Jimenez-Gordo, Ana María; Baena-Espinar, Javier; Aguado, Carlos; Mielgo, Xabier; Pertejo, Ana; Álvarez-Álvarez, Rosa; Sánchez, Ana; López, Jose Luis; Molina, Raquel; López-Alfonso, Ana; Hernández, Berta; Chiara, Luis Enrique; Martín, Ana Manuela; López-Martín, Ana; Dorta, Miriam; Collazo-Lorduy, Ana; Casado, Enrique; de Molina, Ana Ramirez; Colmenarejo, Gonzalo

SIMPLE SUMMARY: Infections with COVID-19 in neutropenic cancer patients are related to poor outcomes. A G-CSF treatment used in neutropenic cancer with SARS-CoV-2 infections is related to a higher rate of respiratory failure according to progressive and growing evidence. In this small retrospective non-randomized study, we found an association between G-CSF treatment and the parameters predisposing for worse infections with COVID-19 and neutropenia compared with patients not treated with G-CSF. We also found that the number of days on G-CSF treatment was related to a higher risk of mortality in a multivariable analysis among patients treated with G-CSF. ABSTRACT: Background: Approximately 15% of patients infected by SARS-CoV-2 develop a distress syndrome secondary to a host hyperinflammatory response induced by a cytokine storm. Myelosuppression is associated with a higher risk of infections and mortality. There are data to support methods of management for neutropenia and COVID-19. We present a multicenter experience during the first COVID-19 outbreak in neutropenic cancer patients infected by SARS-CoV-2. Methods: Clinical retrospective data were collected from neutropenic cancer patients with COVID-19. Comorbidities, tumor type, stage, treatment, neutropenia severity, G-CSF, COVID-19 parameters, and mortality were analyzed. A bivariate analysis of the impact on mortality was carried out. Additionally, we performed a multivariable logistic regression to predict respiratory failure and death. Results: Among the 943 cancer patients screened, 83 patients (11.3%) simultaneously had neutropenia and an infection with COVID-19. The lungs (26%) and breasts (22%) were the primary locations affected, and most patients had advanced disease (67%). In the logistic model, as adjusted covariates, sex, age, treatment (palliative vs. curative), tumor type, and the lowest level of neutrophils were used. A significant effect was obtained for the number of days of G-CSF treatment (OR = 1.4, 95% CI [1,1,03,92], p-value = 0.01). Conclusions: Our findings suggest that a prolonged G-CSF treatment could be disadvantageous for these cancer patients with infections by COVID-19, with a higher probability of worse outcome.