More severe COVID-19 outcomes for patients with haematologic malignancies

Patients with haematologic malignancies are at an increased risk of adverse COVID-19 outcomes. Data from the ASH COVID-19 Registry demonstrated that risks were greatest in those who were older, had advanced disease or limited prognosis, and were not admitted to intensive care [1].

Many patients with haematologic malignancies have underlying immune dysfunction and many are treated with chemo- and immunotherapies that are themselves profoundly immunosuppressive. In addition, patients with haematologic malignancies are often older and may have comorbidities, including hypertension and diabetes. Thus, they may be especially susceptible to complications of COVID-19, including hypercoagulability and thrombosis [1].

Prof. William A. Wood (University of North Carolina, USA) presented findings from the ASH Research Collaborative COVID-19 Registry for Hematology (www.ashrc.org), which were simultaneously published in Blood Advances [1,2]. This collaborative research hub was developed to study features and outcomes of COVID-19 in patients with underlying haematologic disorders, including haematologic malignancies. Prof. Wood presented data from 656 patients with haematologic malignancy from 74 sites worldwide who had been entered into the Registry. The most common malignancies were acute leukaemia (33%), non-Hodgkin lymphoma (27%), and myeloma or amyloidosis (16%). Most frequently observed symptoms included fever (73%), cough (67%), dyspnoea (50%), and fatigue (40%). COVID-19-directed therapies, such as hydroxychloroquine or azithromycin, were commonly used.

Overall mortality was 28%. Patients with an estimated prognosis of <12 months from the underlying haematologic malignancy at the time of COVID-19 diagnosis and those with relapsed or refractory disease were at higher risk of moderate-to-severe COVID-19 disease and death. In some cases, patients died after the decision not to be admitted to ICU in favour of a palliative approach.

This data supports the emerging consensus that patients with haematologic malignancies experience significant morbidity and mortality from COVID-19. However, based on their own data, Prof. Wood and colleagues see no reason to withhold intensive therapies from patients with underlying haematologic malignancies and favourable prognoses if aggressive supportive care is consistent with patient preferences.

Data collection for the ASH Research Collaborative COVID-19 Registry is ongoing and has been expanded to include non-malignant haematologic diseases. The Registry now supports batch data submissions from sites with high incidence of COVID-19.

1. Wood WA, et al. Outcomes of Patients with Hematologic Malignancies and COVID-19 Infection: A Report from the ASH Research Collaborative Data Hub. 62^nd ASH Annual Meeting, 5-8 December 2020. Abstract 215.
2. Wood WA, et al. Blood Adv. 2020;4:5966-75.

Posted on 18 February 202112 July 2021