Determinants of outcome in Covid-19 hospitalized patients with lymphoma: A retrospective multicentric cohort study
Sylvain Lamure1, Rémy Duléry2, Roberta Di Blasi3
1Département d'Hématologie Clinique, CHU de Montpellier, UMR-CNRS 5535, Université de Montpellier, Montpellier, France.
Insights
Older age and relapsed/refractory lymphoma increase mortality risk for hospitalized lymphoma patients with Coronavirus Disease 2019 (Covid-19). Younger patients without relapsed/refractory disease show comparable survival to the general population.
Area of Science:
- Oncology
- Infectious Diseases
- Epidemiology
Background:
- Lymphoma patients are immunocompromised due to disease and treatment.
- Coronavirus Disease 2019 (Covid-19) poses a significant risk to immunocompromised individuals.
Purpose of the Study:
- To describe characteristics of lymphoma patients hospitalized with Covid-19.
- To identify pre-Covid-19 factors associated with mortality in these patients.
Main Methods:
- Retrospective multicentric cohort study using French healthcare administrative data.
- Inclusion of adult lymphoma patients hospitalized for Covid-19 during March-April 2020.
- Data collection on lymphoma and Covid-19 characteristics from medical charts.
Main Results:
- Eighty-nine patients were analyzed; median age 67, 72% had comorbidities.
- Thirty-day overall survival was 71%.
- Mortality associated with age ≥70 years (HR 2.87) and relapsed/refractory lymphoma (HR 2.54). Recent bendamustine treatment also showed increased mortality (HR 3.20).
Conclusions:
- Thirty-day mortality in lymphoma patients with Covid-19 is linked to older age and relapsed/refractory disease status.
- Survival for younger patients (<70 years) without relapsed/refractory lymphoma mirrors that of the general population.
Background:
Patients with lymphoma are immunocompromised because of the disease per se and its treatments. We aimed to describe the characteristics of patients with lymphoma hospitalized for Coronavirus Disease 2019 (Covid-19) and to analyze pre-Covid-19 determinants of mortality.
Methods:
This retrospective multicentric cohort study used the Programme de Médicalisation des Systèmes d'Information database to identify all adult patients with lymphoma, hospitalized for Covid-19 in March and April 2020, in 12 hospitals of three French regions with pandemic outbreaks. The characteristics of lymphoma and Covid-19 were collected from medical charts.
Findings:
Eighty-nine patients were included. The median age was 67 years (range, 19-92), 66% were male and 72% had a comorbidity. Most patients had B-cell non-Hodgkin lymphoma (86%) and had received a lymphoma treatment within one year (70%). With a median follow-up of 33 days from admission, 30-day overall survival was 71%, (95% confidence interval, 62-81%). In multivariable analysis, having an age ≥ 70 years (hazard ratio 2·87, 1·20-6·85, p = 0·02) and relapsed/refractory lymphoma (hazard ratio 2·54, 1·14-5·66, p = 0·02) were associated with mortality. Recent bendamustine treatment (n = 9) was also pejorative (hazard ratio 3·20, 1·33-7·72, p = 0·01), but was strongly associated with relapsed/refractory lymphoma. Remarkably, 30-day overall survival for patients < 70 years of age without relapsed/refractory lymphoma was 88% (78% - 99%).
Interpretation:
Thirty-day mortality was associated with being older and relapsed/refractory lymphoma. Survival of patients younger than 70 years without relapsed/refractory lymphoma was comparable to that of the general population.
Funding:
There have been no specific funds to run this study.
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