Center for Artificial Intelligence in Drug Discovery, School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
Center for Science, Health, and Society, School of Medicine, Case Western Reserve University, Cleveland, OH, USA; Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
Blood Rev. 2021 May;47:100775. doi: 10.1016/j.blre.2020.100775. Epub 2020 Nov 9.
Scientific data is limited on the risks, adverse outcomes and racial disparities for COVID-19 illness in individuals with hematologic malignancies in the United States. To fill this void, we screened and analyzed a nation-wide database of patient electronic health records (EHRs) of 73 million patients in the US (up to September 1st) for COVID-19 and eight major types of hematologic malignancies. Patients with hematologic malignancies had increased odds of COVID-19 infection compared with patients without hematologic malignancies for both all-time diagnosis (malignancy diagnosed in the past year or prior) (adjusted Odds ratio or AOR: 2.27 [2.17-2.36], p < 0.001) and recent diagnosis (malignancy diagnosed in the past year) (AOR:11.91 [11.31-12.53], p < 0.001), with strongest effect for recently diagnosed acute lymphoid leukemia (AOR: 31.03 [25.87-37.27], p < 0.001), essential thrombocythemia (AOR: 20.65 [19.10-22.32], p < 0.001), acute myeloid leukemia (AOR: 18.94 [15.79-22.73], p < 0.001), multiple myeloma (AOR: 14.21 [12.72-15.89], p < 0.001). Among patients with hematologic malignancies, African Americans had higher odds of COVID-19 infection than Caucasians with largest racial disparity for multiple myeloma (AOR: 4.23 [3.21-5.56], p < 0.001). Patients with recently diagnosed hematologic malignancies had worse outcomes (hospitalization: 51.9%, death: 14.8%) than COVID-19 patients without hematologic malignancies (hospitalization: 23.5%, death: 5.1%) (p < 0.001) and hematologic malignancy patients without COVID-19 (hospitalization: 15.0%, death: 4.1%) (p < 0.001).
关于美国血液系统恶性肿瘤患者 COVID-19 疾病的风险、不良结局和种族差异，科学数据有限。为了填补这一空白，我们对美国全国范围内的 7300 万患者的电子健康记录（EHR）数据库进行了筛查和分析，这些患者的 COVID-19 和八种主要类型的血液系统恶性肿瘤数据截至 9 月 1 日。与无血液系统恶性肿瘤的患者相比，所有时间诊断（过去一年或之前诊断出的恶性肿瘤）（调整后的优势比或 AOR：2.27 [2.17-2.36]，p < 0.001）和近期诊断（过去一年诊断出的恶性肿瘤）（AOR：11.91 [11.31-12.53]，p < 0.001）的血液系统恶性肿瘤患者更有可能感染 COVID-19，近期诊断的急性淋巴细胞白血病（AOR：31.03 [25.87-37.27]，p < 0.001）、特发性血小板增多症（AOR：20.65 [19.10-22.32]，p < 0.001）、急性髓系白血病（AOR：18.94 [15.79-22.73]，p < 0.001）和多发性骨髓瘤（AOR：14.21 [12.72-15.89]，p < 0.001）的患者影响最强。在患有血液系统恶性肿瘤的患者中，非裔美国人感染 COVID-19 的几率高于白人，而多发性骨髓瘤的种族差异最大（AOR：4.23 [3.21-5.56]，p < 0.001）。与无血液系统恶性肿瘤的 COVID-19 患者（住院：23.5%，死亡：5.1%）（p < 0.001）和无 COVID-19 的血液系统恶性肿瘤患者（住院：15.0%，死亡：4.1%）（p < 0.001）相比，最近诊断出患有血液系统恶性肿瘤的患者的预后更差（住院：51.9%，死亡：14.8%）。
