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Higher risk of severe COVID-19 seen in people with blood cancers

The Lancet Oncology
Reuters Health - 01/09/2020 - Cancer patients with hematological malignancies are at greater risk of having a more severe COVID-19 trajectory compared with patients with solid-organ tumors, according to new findings.

"If this virus re-emerges, certain cancer-patient cohorts may need additional support to reduce their risk of getting the virus," Dr. Lennard Y. W. Lee of the University of Birmingham, in the UK, told Reuters Health by email.

"Blood-cancer patients," he added, "should be prioritized globally to ensure that they are given appropriate resources to take steps like shielding whilst continuing their treatments."

Dr. Lee and colleagues note compared participants in a UK monitoring project of cancer patients with COVID-19 and a parallel UK cancer control population without the disease. The case fatality rate for each primary tumor subtype was compared with non-colorectal cancers of the digestive organs as a reference.

Patients were followed from COVID-19 diagnosis to either discharge from hospital or death. Of the 1,044 patients in the COVID-19 cohort, 319 (30.6%) died of the disease during a median of six days of follow-up. The median age of those in the cohort was 70 years.

The all-cause case-fatality rate in patients with cancer following SARS-CoV-2 infection was significantly associated with age, increasing from 0.10 in those aged between 40 and 49 years to 0.48 in those 80 years or older.

All-cause fatality was also significantly associated with sex, with 35.6% of male patients dying compared to 23.6% of females, the researchers report in The Lancet Oncology.

The type of malignancy involved was a major factor influencing mortality. Patients with leukemia, lymphoma, and myeloma had a significantly more severe COVID-19 trajectory compared with those with solid-organ tumors (odds ratio, 1.57; P=0.004).

In particular, compared to the rest of the COVID-19 cohort, patients with leukemia had a significantly heightened case-fatality rate of 2.25. In addition, after adjustment for sex and age, patients with hematological malignancies who had recently had chemotherapy had an increased risk of death during COVID-19-associated hospital admission (OR, 2.09).

Morbidity and case-fatality rates from COVID-19 in UK patients with cancer who attend hospital are relatively high, say the researchers, "but not all cancer patients are affected equally." This important finding, they add, "could allow clinicians some ability to risk stratify their patients and make informed decisions on appropriate levels of social isolation and shielding."

By David Douglas

SOURCE: https://bit.ly/31P6yc9 The Lancet Oncology, online August 24, 2020.

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