Patients with haematological malignancies and KOVID-19 appeared to be at higher risk of severe infection and death, according to data analyzed from the ASH Research Collaborative COVID-19 International Hematology Register.
The severity of KOVID-19 was strongly associated with malignancy status at the time of diagnosis, with 69% of those receiving initial treatment for haematological malignancy having moderate to severe disease versus 50% in remission, and 79% with recurrent or refractory disease. announced William A. Wood, Ph.D., from the University of North Carolina at Chapel Hill.
Overall, 62% of patients with known severity status had moderate or severe KOVID-19 infection. Among those ages <19, 47% had moderate or severe disease versus 43% of those aged 19-39, 62% of those aged 40-69, and 70% of 70-year-olds.
The overall mortality rate among the top 250 patients on the register is about 28%, but that number has dropped to 20% of 656 patients so far, Wood told a news conference at the American Hematology Association (ASH) virtual conference.
The risk of death was highest in those who were older, had a more severe infection, decided to give up more intensive treatment and / or had a poorer prognosis of cancer before infection with KOVID-19, according to the analysis.
A third of patients in need of hospital or ICU care died, Wood said, but indicated that MedPage today “One important finding is that we have reported that many patients with underlying haematological conditions who have received intensive care have survived COVID-19 infection.”
“If it is appropriate to the patient / provider preferences, we believe that maximum intensive supportive care may be appropriate as long as it aligns with the patient’s preferences,” he said.
Wood and co-authors reported that lack of care for the ICU was strongly age-related, with a mortality rate of 73% for those who refused ICU-level care, compared with 13% for those who did not.
The registry began in April and includes voluntary contributions of clinical data from more than 100 international study sites. Wood noted that the registry provides real-time data to hematologists and other clinicians during a pandemic and provides insights into which patients are most vulnerable to serious illness and death.
“We have seen and continue to see that people with haematological malignancies and KOVID-19 infection appear to have more serious illnesses and a greater likelihood of death than the general population,” Wood said. “This increased risk of severe infection or death in these patients is concentrated in certain groups of people, and data from our global registry have helped to understand this more clearly.”
For the study, the authors combined data from the registry of 656 patients (most 40 years old; 60% men; 43% white) with various haematological malignancies and laboratory-confirmed or presumptive diagnosis of COVID-19. Among participants, 57% had concomitant diseases. including hypertension (50%) and diabetes (30%).
Of their cancers, 57% had leukemia, 25% had lymphoma, and 18% had plasma cell neoplasms. Prior to KOVID-19 infection, 80% had an expected survival of> 12 months.
The authors report that mortality rates vary according to prognosis, with 51% of patients with pre-KOVID-19 expecting survival from <12 месеци умирање наспроти 13% од пациентите со очекувано преживување>> 12 months. Mortality rates also varied by malignancy status: 11% mortality in those starting treatment, 13% in those in remission, and 36% in those with relapsing / refractory disease.
Also, the most common symptoms associated with KOVID-19 were fever (65%) followed by cough (56%); 11% were asymptomatic.
Most patients received azithromycin (n = 143) followed by hydroxychloroquine (n = 137) as treatment with COVID-19. Remedisivir (Vecluri) was given to 44 patients, according to the authors.
“This analysis emphasizes that patients with haematological disorders are a medically vulnerable population when it comes to COVID-19 infection,” Wood said. “It underscores the need to continue to encourage our patients to take appropriate precautions to limit their exposure to COVID-19; to continue to take precautions in our healthcare delivery environment to protect these patients; “and prioritize these patients for COVID-19 testing as well as vaccine distribution, once effective and safe vaccines are available.”
This was stated by Robert Glater, PhD, from Lennox Hill Hospital / Hofstra Northwell University in New York MedPage today that “Although the prognosis and outcome of patients with KOVID-19 and haematological malignancies may be worse or similar compared to other high-risk medical conditions, it is always essential to discuss patient and family care goals.”
“In this context, it is particularly important to identify and treat reversible conditions such as anemia, thrombocytopenia, coagulopathy, electrolyte and other nutritional deficiencies,” said Glatter, who was not included in the study. “Informed decision-making is essential when developing a care plan, especially in light of the higher morbidity and mortality associated with KOVID-19, as well as all the basic and risky medical conditions.
“Respect for the wishes expressed in MOLST [medical orders for life-sustaining treatment] “The form is critical in this regard,” he said. “I agree with the researchers’ conclusions that [there is no reason] “To maintain intensive care in patients with underlying haematological malignancies and favorable prognosis, provided that aggressive support is in line with patient preferences.”
Wood highlighted the registry’s “collaborative, global effort.” “We were able to launch this resource quickly and in a spirit of volunteerism and collaboration from around the world. Hematologists recognize the value of this data and continue to contribute cases,” he said.
While the current analysis is limited to patients with haematological malignancies, data from patients with non-malignant blood disorders are also being collected from the registry, Wood added.
Wood disclosed relevant relationships with Pfizer, Teladok / Top Doctors and the Academy of Research in collaboration. The co-authors revealed more relevant relationships with the industry.
Glatter did not disclose any relevant industry links.