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BACKGROUND

Patients with hematological malignancies (HM) are at high risk of mortality from SARS-CoV-2 disease 2019 (COVID-19). A better understanding of risk factors for adverse outcomes may improve clinical management in these patients. We therefore studied baseline characteristics of HM patients developing COVID-19 and analyzed predictors of mortality.

METHODS

The survey was supported by the Scientific Working Group Infection in Hematology of the European Hematology Association (EHA). Eligible for the analysis were adult patients with HM and laboratory-confirmed COVID-19 observed between March and December 2020.

RESULTS

The study sample includes 3801 cases, represented by lymphoproliferative (mainly non-Hodgkin lymphoma n = 1084, myeloma n = 684 and chronic lymphoid leukemia n = 474) and myeloproliferative malignancies (mainly acute myeloid leukemia n = 497 and myelodysplastic syndromes n = 279). Severe/critical COVID-19 was observed in 63.8% of patients (n = 2425). Overall, 2778 (73.1%) of the patients were hospitalized, 689 (18.1%) of whom were admitted to intensive care units (ICUs). Overall, 1185 patients (31.2%) died. The primary cause of death was COVID-19 in 688 patients (58.1%), HM in 173 patients (14.6%), and a combination of both COVID-19 and progressing HM in 155 patients (13.1%). Highest mortality was observed in acute myeloid leukemia (199/497, 40%) and myelodysplastic syndromes (118/279, 42.3%). The mortality rate significantly decreased between the first COVID-19 wave (March-May 2020) and the second wave (October-December 2020) (581/1427, 40.7% vs. 439/1773, 24.8%, p value < 0.0001). In the multivariable analysis, age, active malignancy, chronic cardiac disease, liver disease, renal impairment, smoking history, and ICU stay correlated with mortality. Acute myeloid leukemia was a higher mortality risk than lymphoproliferative diseases.

CONCLUSIONS

This survey confirms that COVID-19 patients with HM are at high risk of lethal complications. However, improved COVID-19 prevention has reduced mortality despite an increase in the number of reported cases.

背景

患有血液系统恶性肿瘤（HM）的患者因 2019 年严重急性呼吸综合征冠状病毒 2 型（SARS-CoV-2）疾病（COVID-19）而死亡的风险很高。更好地了解不良结局的危险因素可能会改善这些患者的临床管理。因此，我们研究了发生 COVID-19 的 HM 患者的基线特征，并分析了死亡的预测因素。

方法

该研究由欧洲血液学协会（EHA）感染血液学科学工作组支持。符合分析条件的是 2020 年 3 月至 12 月期间患有 HM 且实验室确诊 COVID-19 的成年患者。

结果

研究样本包括 3801 例病例，代表淋巴增生性疾病（主要为非霍奇金淋巴瘤 n=1084、骨髓瘤 n=684 和慢性淋巴细胞白血病 n=474）和髓系增生性恶性肿瘤（主要为急性髓系白血病 n=497 和骨髓增生异常综合征 n=279）。63.8%（n=2425）的患者发生严重/危重症 COVID-19。总体而言，2778 例（73.1%）患者住院，其中 689 例（18.1%）患者入住重症监护病房（ICU）。总体而言，有 1185 例患者（31.2%）死亡。主要死亡原因为 COVID-19（688 例，58.1%）、HM（173 例，14.6%）以及 COVID-19 和进展性 HM 共同作用（155 例，13.1%）。急性髓系白血病（199/497，40%）和骨髓增生异常综合征（118/279，42.3%）的死亡率最高。COVID-19 第一波（2020 年 3 月至 5 月）和第二波（2020 年 10 月至 12 月）之间的死亡率差异有统计学意义（581/1427，40.7% vs. 439/1773，24.8%，p 值<0.0001）。多变量分析显示，年龄、活动性恶性肿瘤、慢性心脏疾病、肝脏疾病、肾功能不全、吸烟史和 ICU 住院与死亡率相关。与淋巴增生性疾病相比，急性髓系白血病的死亡率更高。