Patients with blood cancers are especially vulnerable to serious COVID-19 outcomes, including an elevated chance of severe illness and death from COVID-19, according to an analysis of more than 1000 patients in the American Society of Hematology (ASH) RC COVID-19 Registry for Hematology, presented at the ASH Annual Meeting and Exposition 2021. The investigators said this increase in risk is particularly pronounced in those with more advanced disease.
According to the report, 17% of patients with blood cancers who developed COVID-19 died from COVID-related illness, which the investigators said was significantly higher than the mortality rate seen in the general population, which ranges between 1.6% and 6.2%. This increased rate of mortality was further associated with older age, male sex, poor cancer prognosis, and electing to defer intensive care when it was recommended.
“In our analysis, having a poor prognosis for underlying disease prior to COVID-19 and deciding to forgo ICU-level care for that disease were the most powerful predictors of mortality among patients with blood cancer and COVID-19–and the two may very well be related,” said Lisa K. Hicks, MD, MSc, of St. Michael’s Hospital in Toronto, Canada, in a press release. “If someone is sick enough to require ICU-level care and their preference is not to receive this type of care, we would expect that decision to have a major impact on their survival.”
The investigators also found that although patients who received cancer care in the year prior to COVID-19 infection did not have a significantly higher risk of mortality, they did have an increased risk of hospitalization if infected. Hospitalization risk also increased if the patient was older, male, had active cancer, or had other health conditions.
“In the early days of the pandemic, there was a lot of uncertainty about whether we should withhold or modify blood cancer treatments in regions with high levels of COVID-19,” Hicks said in the release. “The data are somewhat reassuring in that, while recent cancer treatment was linked to a higher risk of hospitalization among those with blood cancer and COVID-19, it wasn’t independently associated with a statistically greater likelihood of dying. The type of blood cancer was also not associated with a higher risk of COVID-19 mortality. These findings suggest that patients who need treatment for their hematologic malignancy should likely proceed with that treatment.”
The data used in the study were collected between April 1, 2020, and July 2, 2021, as part of the ASH RC’s COVID-19 Registry for Hematology, with 1029 patients participating in the analysis. Of the individuals included, 34% had acute leukemia or myelodysplastic syndromes (MDS), 25% had lymphoma, 20% had plasma cell dyscrasia (myeloma/amyloid/POEMS), 11% had chronic lymphocytic leukemia (CLL), and 10% had myeloproliferative neoplasm (MPN). According to the investigators, Patients with MPN and plasma cell dyscrasia had less severe COVID-19 illness overall compared to patients with CLL, leukemia, MDS, or lymphoma.
“The data from the ASH RC COVID-19 Registry has limitations and findings should generally be regarded as hypothesis generating,” Hicks said in the release. “Nonetheless, the data do suggest that patients with blood cancers are at substantial risk from COVID-19; this finding has implications for our patients, how we manage our clinics amid COVID-19 and the changing variants, and how vaccines, boosters, and antibody treatments are distributed.”
ASH RC COVID-19 registry reveals potential risk factors for COVID-related deaths and hospitalizations among people with blood cancers [news release]. ASH; December 11, 2021. Accessed December 13, 2021.