Clinical outcomes and risk factors for severe COVID-19 in patients with haematological disorders receiving chemo- or immunotherapy

Br J Haematol. 2020 Oct;191(2):194-206. doi: 10.1111/bjh.17027. Epub 2020 Aug 12.

Abstract

Haematology patients receiving chemo- or immunotherapy are considered to be at greater risk of COVID-19-related morbidity and mortality. We aimed to identify risk factors for COVID-19 severity and assess outcomes in patients where COVID-19 complicated the treatment of their haematological disorder. A retrospective cohort study was conducted in 55 patients with haematological disorders and COVID-19, including 52 with malignancy, two with bone marrow failure and one immune-mediated thrombotic thrombocytopenic purpura (TTP). COVID-19 diagnosis coincided with a new diagnosis of a haematological malignancy in four patients. Among patients, 82% were on systemic anti-cancer therapy (SACT) at the time of COVID-19 diagnosis. Of hospitalised patients, 37% (19/51) died while all four outpatients recovered. Risk factors for severe disease or mortality were similar to those in other published cohorts. Raised C-reactive protein at diagnosis predicted an aggressive clinical course. The majority of patients recovered from COVID-19, despite receiving recent SACT. This suggests that SACT, where urgent, should be administered despite intercurrent COVID-19 infection, which should be managed according to standard pathways. Delay or modification of therapy should be considered on an individual basis. Long-term follow-up studies in larger patient cohorts are required to assess the efficacy of treatment strategies employed during the pandemic.

Keywords: Covid-19; chemotherapy; risk factors.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / administration & dosage
  • Antineoplastic Agents / therapeutic use*
  • Black People
  • COVID-19 / complications*
  • COVID-19 / mortality
  • COVID-19 / therapy
  • Comorbidity
  • Cross Infection / complications
  • Female
  • Hematologic Diseases / complications*
  • Hematologic Diseases / drug therapy
  • Hematologic Diseases / mortality
  • Hematologic Diseases / therapy
  • Hematopoietic Stem Cell Transplantation
  • Humans
  • Immunotherapy*
  • Leukemia / complications
  • Leukemia / drug therapy
  • Leukemia / mortality
  • London / epidemiology
  • Lymphoma / complications
  • Lymphoma / drug therapy
  • Lymphoma / mortality
  • Male
  • Middle Aged
  • Respiration, Artificial
  • Retrospective Studies
  • Risk Factors
  • SARS-CoV-2
  • Thrombophilia / drug therapy
  • Thrombophilia / etiology
  • Treatment Outcome
  • Young Adult

Substances

  • Antineoplastic Agents