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Clinical manifestations and risk factors for COVID-19 and its severity in patients with hematological malignancies
Tzong-Yow Wu1, Wan-Ting Tsai2, Kai-Hsiang Chen3
1Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Insights
Patients with hematological malignancies face severe COVID-19 outcomes. Allogeneic stem cell transplant, diabetes, and lymphopenia increase mortality risk, while vaccination offers protection.
Area of Science:
- Hematology
- Infectious Diseases
- Oncology
Background:
- Patients with hematological malignancies (HM) are at high risk for severe coronavirus disease 2019 (COVID-19).
- Assessing clinical outcomes in hospitalized HM patients with COVID-19 is crucial.
Purpose of the Study:
- To evaluate the clinical outcomes of COVID-19 in hospitalized patients with hematological malignancies.
- To identify factors associated with severe disease progression and de-isolation in this patient group.
Main Methods:
- Retrospective analysis of adult HM patients hospitalized with laboratory-confirmed COVID-19 (May 2021 - November 2022).
- Primary outcome: respiratory failure requiring mechanical ventilation or 60-day mortality.
- Secondary analysis: factors associated with de-isolation within 28 days.
Main Results:
- Of 152 patients, 14.5% experienced respiratory failure or mortality within 60 days.
- Risk factors for severe outcomes included allogeneic hematopoietic stem-cell transplantation (allo-HSCT), type 2 diabetes, lymphopenia, and <2 SARS-CoV-2 vaccine doses.
- 65.1% achieved de-isolation within 28 days; B-cell depletion therapy and lymphopenia were associated with delayed de-isolation.
Conclusions:
- Hematological malignancy patients have a high rate of respiratory failure and mortality from SARS-CoV-2 infection.
- Allo-HSCT, type 2 diabetes, and admission lymphopenia are key risk factors for poor outcomes.
- Receiving at least two vaccine doses significantly protected against severe COVID-19 progression.
Background:
Patients with hematological malignancies (HM) were at a high risk of developing severe disease from coronavirus disease 2019 (COVID-19). We aimed to assess the clinical outcome of COVID-19 in hospitalized patients with HM.
Methods:
Adult patients with HM who were hospitalized with a laboratory-confirmed COVID-19 between May, 2021 and November, 2022 were retrospectively identified. Primary outcome was respiratory failure requiring mechanical ventilation or mortality within 60 days after hospitalization. We also analyzed associated factors for de-isolation (defined as defervescence with a consecutive serial cycle threshold value > 30) within 28 days.
Results:
Of 152 eligible patients, 22 (14.5%) developed respiratory failure or mortality in 60 days. Factors associated with developing respiratory failure that required mechanical ventilation or mortality included receipt of allogeneic hematopoietic stem-cell transplantation (allo-HSCT) (adjusted hazards ratio [aHR], 5.10; 95% confidence interval [CI], 1.64-15.85), type 2 diabetes mellitus (aHR, 2.47; 95% CI, 1.04-5.90), lymphopenia at admission (aHR, 6.85; 95% CI, 2.45-19.15), and receiving <2 doses of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines (aHR, 3.00; 95% CI, 1.19-7.60). Ninety-nine (65.1%) patients were de-isolated in 28 days, against which two hazardous factors were identified: receipt of B-cell depletion therapies within one year prior to COVID-19 (aHR, 0.55, 95% CI, 0.35-0.87) and lymphopenia upon admission (aHR, 0.65; 95% CI, 0.43-1.00).
Conclusion:
We found a high rate of respiratory failure and mortality among patients with HM who contracted the SARS-CoV-2. Factors associated with developing respiratory failure or mortality in 60 days included receipt of allo-HSCT, type 2 diabetes mellitus and lymphopenia upon admission. Having received ≥2 doses of vaccination conferred protection against clinical progression.
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