Myelodysplastic syndromes (MDS) and neutropenia were both found to be strong, independent predictors of severe COVID-19 illness in patients with acute leukemia or MDS who developed COVID-19, according to data from the American Society of Hematology (ASH) RC COVID-19 Registry for Hematology presented at the ASH Annual Meeting and Exposition 2021. However, active disease alone for hospitalized patients was not associated with greater odds of dying from COVID-19, nor was receiving ongoing cancer treatment, according to the study.
The analysis included data from 135 patients with acute myeloid leukemia (AML), 82 with acute lymphocytic leukemia (ALL), and 40 with MDS who were diagnosed with COVID-19. The investigators sought to identify characteristics that put patients at higher risk of severe illness or death from COVID-19. At the time of COVID-19 diagnosis, 46% of study participants were in remission while 44% had active disease.
According to the study results, 21% of patients died from COVID-19, higher than the overall percentage of the registry (17%) and considerably higher than the mortality rate in the general public. Mortality among hospitalized patients with COVID-related illness was 34%, and mortality among patients admitted to the ICU was 68%.
The investigators said the 2 factors most strongly associated with a higher likelihood of mortality among these patients were how long someone was perceived to live from the underlying MDS or leukemia before getting COVID-19, as defined by a physician’s estimated prognosis of less than 6 months survival, and whether they decided to go to the ICU if it was recommended.
“This is a particularly vulnerable population and we suspected they may do worse because they are immunocompromised and, as it is, the average survival for acute blood cancers if untreated is 3 to 6 months, so if COVID-19 comes together with that diagnosis, it’s very concerning,” said Pinkal Desai, MD, MPH, of Weill Cornell Medical College, New York, in a press release. “Our data suggest these patients can survive COVID-19 and their underlying disease itself was not associated with worse mortality, which means that if these patients are given appropriate and aggressive treatment, we can help them recover. But if there are decisions that are made after they get to the hospital (for example, whether to go to the ICU) that clearly plays a role.”
Patients for whom ICU-level care was recommended and declined had a 5-fold increase in mortality odds compared to patients who opted to go to the ICU, according to the investigators. Study participants were more likely to forgo ICU care if they were older, male, smokers, or if they had active disease or an estimated pre-COVID-19 survival of less than 6 months.
“Patients who went to the ICU did better regardless of disease status,” Desai said in the release. “Just having acute leukemia or MDS puts these patients at high risk of severe COVID-19, and they need to be hospitalized and receive treatments, but decisions about the ICU should be individualized, a patient’s prognosis should be discussed, and if a patient wants aggressive care for COVID-19 that should be offered.”
Patients with acute leukemias or myelodysplastic syndromes at high risk for severe COVID-19; Pre-COVID prognosis and deferring ICU care play a defining role in outcomes [news release]. ASH; December 11, 2021. Accessed December 13, 2021.