Abstract 721: Early death in acute lymphoblastic leukemia during COVID-19 pandemic: A single institution cohort study
Authors: Enriquez-Vera Daniel J. , Al-kassab-Cordova Ali , Lachira-Yparraguirre Lizbeth , Sandival-Ampuero Gustavo , Valcarcel Bryan , Samanez Cesar , Haro-Varas Juan , Quintana-Truyenque Shirley , Malpica Luis , Gomez-Leonidas Henry , Vidaurre-Rojas Tatiana 
Published: July 2021

Abstract
Background: COVID-19 is a condition caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing a systemic inflammatory response and respiratory failure. Patients with acute leukemia are presumed to be at the highest risk among all cancer patients, given their state of severe immunosuppression from both the disease and aggressive therapy. Therefore, we aimed to determine if COVID-19 increases the early-mortality risk of ALL patients during the induction phase.
Methods: We conducted a retrospective cohort study by reviewing medical records of newly diagnosed ALL patients between March 2020 and September 2020 at a single Peruvian institution (INEN, Lima-Peru). We included patients older than 14 years, with the initial intent of intensive treatment. The proposed protocol was the CALGB10403 with asparaginase modification. COVID-19 was determined by a +ve nasopharyngeal SARS-CoV-2 RT-PCR or serology. The outcomes were 30-day and 60-day mortality and treatment response at the end of induction.
Results: Of 63 patients with ALL in induction therapy, 22 (35%) had COVID-19, and 41 (65%) did not. Overall, the median age was 30 (IQR 21 - 42), and 59% were males. Table 1 shows that age, sex, ALL subtype, and laboratory characteristics had a similar distribution between both groups. The mortality rate of ALL patients with COVID-19 was non-statistically different from non-COVID-19 patients at 30 (23% versus 12%, p=0.466) and 60 days (32% versus 20%, p=0.434). Multivariate logistic regression did not find a significant association between COVID-19 and complete treatment response (aOR: 0.44, 95% CI: 0.02-4.54). Similarly, patients with COVID-19 did not had an increased mortality risk at 30 days (aHR: 2.37, 95% CI: 0.64-8.75) and 60 days (aHR: 1.98, 95% CI: 0.7-5.64).
Conclusion: In our cohort, COVID-19 did not increase the risk of early death in newly diagnosed patients with ALL.
Table 1.Characteristics of patients with ALLOverallCOVID-19 NegativeCOVID-19 positivep-value*n=63n=41n=22Age (years)**33 ±1532 ±1635 ±130.377Sex Male37 (59%)25 (61%)12 (55%)0.821 Female23 (41%)16 (39%)10 (45%)Type B-ALL56 (86%)36 (88%)18 (72%)0.787 T-ALL9 (14%)5 (12%)4 (18%)B-ALL subtype NOS42 (78%)29 (81%)13 (72%)0.873 E2A/PBX12 (4%)1 (3%)1 (6%) MLL/AF42 (4%)1 (3%)1 (6%) TEL/AML1 (2%)1 (3%)0 (0%) BCR/ABL5 (8%)3 (7%)2 (10%) Unknown2 (4%)1 (3%)1 (6%)DHL (U/L)655 ±854719 ±988536 ±5230.422D-dimer (ng/mL)4539 ±59085319 ±70293164 ±27290.184Leucocytes (x103µL)38 ±10044 ±11927 ±490.528Hemoglobin (g/dL) †9 (7-14)9 (7-11)10 (7-54)0.475CNS Infiltration11 (17%)8 (20%)3 (14%)0.812ECOG&gt;32 (3%)1 (2%)1 (5%)Complete Response43 (68%)28 (68%)15 (68%)0.896Minimal Residual Disease29 (46%)20 (49%)9 (41%)0.8330-day mortality10 (16%)5 (12%)5 (23%)0.46660-day mortality15 (24%)8 (20%)7 (32%)0.434*Univariate Cox regression.**Mean (standard deviation)†Median (Interquartile range)
Citation Format: Daniel J. Enriquez-Vera, Ali Al-kassab-Cordova, Lizbeth Lachira-Yparraguirre, Gustavo Sandival-Ampuero, Bryan Valcarcel, Cesar Samanez, Juan Haro-Varas, Shirley Quintana-Truyenque, Luis Malpica, Henry Gomez-Leonidas, Tatiana Vidaurre-Rojas. Early death in acute lymphoblastic leukemia during COVID-19 pandemic: A single institution cohort study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 721.