Cancer patients have always had a higher risk of developing severe coronavirus disease 2019 (COVID-19) due to underlying malignancies that undermine the immune system and the common use of immunosuppressive treatments in these patients. Many patients and health care workers have had to make difficult decisions to delay or stop chemotherapy to better treat COVID-19 in these patients.
In a recent study in Health Sciences Reports, researchers investigated risk factors present in individuals suffering from hematologic and COVID-19 diseases.
Study: Hematologic malignancies and COVID-19 infection: a monocentric retrospective study. Image credit: Chaikom / Shutterstock.com
About the study
The current study was conducted at Taleghani Hospital and included the analysis of the medical history, comorbidities, chemotherapeutic regimens and the phase of the hematological treatment of the patients. Patients with a history of allogeneic or autologous hematopoietic stem cell transplants, as well as patients with other explanations for pneumonia, were excluded from the current study.
All patients should have had a computed tomography (CT) scan to confirm COVID-19 pneumonia. Laboratory tests were also performed to collect complete blood count (CBC) data, liver and kidney function, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), as well as other inflammatory markers such as lactate dehydrogenase. LDH).
Enrolled patients had a variety of illnesses and were therefore divided according to their treatment phases. These phases included preinduction, induction, consolidation, maintenance, and refractory.
Some of the diseases that these patients had included acute myeloid leukemia (AML), acute lymphocytic leukemia (ALL), Hodgkin’s and non-Hodgkin’s lymphoma, multiple myeloma, myelodysplastic syndromes, hairy cell leukemia, and hemophagocytic lymphohistiocytosis.
Any patient in the preinduction phase was eligible to start chemotherapy, but had not yet done so due to COVID-19. In comparison, those in the induction phase were receiving chemotherapy when they tested positive for COVID-19.
The consolidation phase included patients with AML or ALL who were in remission, as well as patients who had recently received chemotherapy and were diagnosed with cytopenia. The maintenance phase included patients in remission receiving long-term chemotherapy. Finally, the refractory phase included patients who were not responding to any type of chemotherapy and were still experiencing the active disease.
The objectives of the current study included the frequency of COVID-19, admission to the intensive care unit (ICU), therapies received, patient outcome, length of hospital stay, and any changes in pre-existing comorbidities. Quantitative and qualitative data were presented as mean, median, and frequency.
Study results
The current retrospective study included a total of 194 patients hospitalized with haematological diseases and COVID-19. Logistic regression models were created, which showed that the strongest predictor of death was ICU admission, with patients admitted to the ICU 23.35 times more likely to die than others.
Although some studies have shown that men are more likely to have severe COVID-19 compared to women, this does not appear to be the case for patients with haematological malignancies. In fact, women were 3.48 times more likely to die than men. Age was also associated with an increased risk of death, while length of hospital stay was associated with a reduced risk of death.
Several different inflammatory markers were associated with mortality in different diseases. For example, VES has been associated with an increased risk of death in patients with ALL, myelodysplastic syndromes, hair cell leukemia, and patients with hemophagocytic lymphohistiocytosis.
In comparison, higher LDH levels were associated with an increased risk of death in patients with lymphoma and multiple myeloma. Increased ferritin levels were also a significant indicator of death in patients with multiple myeloma.
Higher fibrinogen levels were associated with higher overall mortality rates. In addition, elevated levels of ESR, LDH, and fibrinogen were associated with lower oxygen saturation.
Conclusions
Several different risk factors were identified among patients with hematologic tumors that subsequently become infected with SARS-CoV-2. Identifying these risk factors could help improve hospital triage and better inform health care workers about which subset of patients with certain hematologic diseases are at increased risk for severe and fatal COVID-19.
Magazine reference:
- Tehrani, HA, Ramezaninejad, S., Mardani, M., et al. (2022). Hematologic malignancies and COVID-19 infection: a monocentric retrospective study. Health Science Reports 5 (3). doi: 10.1002 / hsr2.638