Age, successive waves, immunization, and mortality in elderly COVID-19 hematological patients: EPICOVIDEHA findings
Giuseppe Rossi1, Jon Salmanton-García2, Chiara Cattaneo1
1Hematology Unit, ASST-Spedali Civili, Brescia, Italy.
Insights
Elderly patients with hematologic cancers faced varied COVID-19 impacts by age and pandemic wave. Vaccination and prompt treatment significantly improved survival rates in this vulnerable group.
Area of Science:
- Hematology
- Infectious Diseases
- Geriatrics
- Epidemiology
Background:
- Elderly individuals with hematologic malignancies are at high risk for severe COVID-19.
- Detailed analysis of COVID-19 impact across different age groups within this population is lacking.
Purpose of the Study:
- To investigate the impact of COVID-19 on elderly patients with hematologic malignancies.
- To identify factors influencing mortality in this cohort across different age strata and pandemic waves.
Main Methods:
- Analysis of 3,603 elderly patients (≥65 years) with hematologic malignancies from the EPICOVIDEHA registry (Jan 2020–Jul 2022).
- Stratification into four age groups (65-70, 71-75, 76-80, >80 years).
- Univariable and multivariable Cox regression models to determine mortality predictors.
Main Results:
- Overall 90-day survival was 71.2%, with significant variations across age groups and pandemic waves.
- The first wave most severely affected those >80, the second impacted 65-70 year olds, and the third wave was least severe.
- Mortality predictors included advanced age, comorbidities, lymphopenia, active malignancy, acute leukemia, <3 vaccine doses, severe COVID-19, and corticosteroid monotherapy.
Conclusions:
- Elderly patients with hematologic malignancies exhibit heterogeneous responses to COVID-19.
- COVID-19 waves and vaccination status significantly influenced outcomes.
- Findings aid in stratifying risk and planning targeted healthcare interventions for this population.
Objectives:
Elderly patients with hematologic malignancies face the highest risk of severe COVID-19 outcomes. The infection's impact on different age groups remains unstudied in detail.
Methods:
We analyzed elderly patients (age groups: 65-70, 71-75, 76-80, and >80 years old) with hematologic malignancies included in the EPICOVIDEHA registry between January 2020 and July 2022. Univariable and multivariable Cox regression models were conducted to identify factors influencing death in COVID-19 patients with hematological malignancy.
Results:
The study included data from 3,603 elderly patients (aged 65 or older) with hematological malignancy, with a majority being male (58.1%) and a significant proportion having comorbidities. The patients were divided into four age groups, and the analysis assessed COVID-19 outcomes, vaccination status, and other variables in relation to age and pandemic waves. The 90-day survival rate for patients with COVID-19 was 71.2%, with significant differences between groups. The pandemic waves had varying impacts, with the first wave affecting patients over 80 years old, the second being more severe in 65-70, and the third being the least severe in all age groups. Factors contributing to 90-day mortality included age, comorbidities, lymphopenia, active malignancy, acute leukemia, less than three vaccine doses, severe COVID-19, and using only corticosteroids as treatment.
Conclusion:
These data underscore the heterogeneity of elderly hematological patients, highlight the different impacts of COVID-19 waves and the pivotal importance of vaccination, and may help in planning future healthcare efforts.
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