COVID-19 infection in adult patients with hematological malignancies: a European Hematology Association Survey (EPICOVIDEHA)
Authors: Pagano Livio , Salmanton-García Jon , Marchesi Francesco , Busca Alessandro , Corradini Paolo , Hoenigl Martin , Klimko Nikolai , Koehler Philipp , Pagliuca Antonio , Passamonti Francesco , Verga Luisa , Víšek Benjamin , Ilhan Osman , Nadali Gianpaolo , Weinbergerová Barbora , Córdoba-Mascuñano Raúl , Marchetti Monia , Collins Graham P. , Farina Francesca , Cattaneo Chiara , Cabirta Alba , Gomes-Silva Maria , Itri Federico , van Doesum Jaap , Ledoux Marie-Pierre , Čerňan Martin , Jakšić Ozren , Duarte Rafael F. , Magliano Gabriele , Omrani Ali S. , Fracchiolla Nicola S. , Kulasekararaj Austin , Valković Toni , Poulsen Christian Bjørn , Machado Marina , Glenthøj Andreas , Stoma Igor , Ráčil Zdeněk , Piukovics Klára , Navrátil Milan , Emarah Ziad , Sili Uluhan , Maertens Johan , Blennow Ola , Bergantim Rui , García-Vidal Carolina , Prezioso Lucia , Guidetti Anna , del Principe Maria Ilaria , Popova Marina , de Jonge Nick , Ormazabal-Vélez Irati , Fernández Noemí , Falces-Romero Iker , Cuccaro Annarosa , Meers Stef , Buquicchio Caterina , Antić Darko , Al-Khabori Murtadha , García-Sanz Ramón , Biernat Monika M. , Tisi Maria Chiara , Sal Ertan , Rahimli Laman , Čolović Natasa , Schönlein Martin , Calbacho Maria , Tascini Carlo , Miranda-Castillo Carolina , Khanna Nina , Méndez Gustavo-Adolfo , Petzer Verena , Novák Jan , Besson Caroline , Duléry Rémy , Lamure Sylvain , Nucci Marcio , Zambrotta Giovanni , Žák Pavel , Seval Guldane Cengiz , Bonuomo Valentina , Mayer Jiří , López-García Alberto , Sacchi Maria Vittoria , Booth Stephen , Ciceri Fabio , Oberti Margherita , Salvini Marco , Izuzquiza Macarena , Nunes-Rodrigues Raquel , Ammatuna Emanuele , Obr Aleš , Herbrecht Raoul , Núñez-Martín-Buitrago Lucía , Mancini Valentina , Shwaylia Hawraa , Sciumè Mariarita , Essame Jenna , Nygaard Marietta , Batinić Josip , Gonzaga Yung , Regalado-Artamendi Isabel , Karlsson Linda Katharina , Shapetska Maryia , Hanakova Michaela , El-Ashwah Shaimaa , Borbényi Zita , Çolak Gökçe Melis , Nordlander Anna , Dragonetti Giulia , Maraglino Alessio Maria Edoardo , Rinaldi Amelia , De Ramón-Sánchez Cristina , Cornely Oliver A. ,   EPICOVIDEHA working group, Finizio Olimpia , Fazzi Rita , Sapienza Giuseppe , Chauchet Adrien , Van Praet Jens , Prattes Juergen , Dargenio Michelina , Rossi Cédric , Shirinova Ayten , Malak Sandra , Tafuri Agostino , Ommen Hans-Beier , Bologna Serge , Khedr Reham Abdelaziz , Choquet Sylvain , Joly Bertrand , Ceesay M. Mansour , Philippe Laure , Kho Chi Shan , Desole Maximilian , Tsirigotis Panagiotis , Otašević Vladimir , Borducchi Davimar M. M. , Antoniadou Anastasia , Gaziev Javid , Almaslamani Muna A. , García-Poutón Nicole , Paterno Giovangiacinto , Torres-López Andrea , Tarantini Giuseppe , Mellinghoff Sibylle , Gräfe Stefanie , Börschel Niklas , Passweg Jakob , Merelli Maria , Barać Aleksandra , Wolf Dominik , Shaikh Mohammad Usman , Thiéblemont Catherine , Bernard Sophie , Funke Vaneuza Araújo Moreira , Daguindau Etienne , Khostelidi Sofya , Nucci Fabio Moore , Martín-González Juan-Alberto , Landau Marianne , Soussain Carole , Laureana Cécile , Lacombe Karine , Kohn Milena , Aliyeva Gunay , Piedimonte Monica , Fouquet Guillemette , Rêgo Mayara , Hoell-Neugebauer Baerbel , Cartron Guillaume , Pinto Fernando , Alburquerque Ana Munhoz , Passos Juliana , Yilmaz Asu Fergun , Redondo-Izal Ana-Margarita , Altuntaş Fevzi , Heath Christopher , Kolditz Martin , Schalk Enrico , Guolo Fabio , Karthaus Meinolf , Della Pepa Roberta , Vinh Donald , Noël Nicolas , Deau Fischer Bénédicte , Drenou Bernard , Mitra Maria Enza , Meletiadis Joseph , Bilgin Yavuz M. , Jindra Pavel , Espigado Ildefonso , Drgoňa Ľuboš , Serris Alexandra , Di Blasi Roberta , Ali Natasha 
Published: October 2021

Abstract
Background
Patients with hematological malignancies (HM) are at high risk of mortality from SARS-CoV-2 disease 2019 (COVID-19). A better understanding of risk factors for adverse outcomes may improve clinical management in these patients. We therefore studied baseline characteristics of HM patients developing COVID-19 and analyzed predictors of mortality.

Methods
The survey was supported by the Scientific Working Group Infection in Hematology of the European Hematology Association (EHA). Eligible for the analysis were adult patients with HM and laboratory-confirmed COVID-19 observed between March and December 2020.

Results
The study sample includes 3801 cases, represented by lymphoproliferative (mainly non-Hodgkin lymphoma n = 1084, myeloma n = 684 and chronic lymphoid leukemia n = 474) and myeloproliferative malignancies (mainly acute myeloid leukemia n = 497 and myelodysplastic syndromes n = 279). Severe/critical COVID-19 was observed in 63.8% of patients (n = 2425). Overall, 2778 (73.1%) of the patients were hospitalized, 689 (18.1%) of whom were admitted to intensive care units (ICUs). Overall, 1185 patients (31.2%) died. The primary cause of death was COVID-19 in 688 patients (58.1%), HM in 173 patients (14.6%), and a combination of both COVID-19 and progressing HM in 155 patients (13.1%). Highest mortality was observed in acute myeloid leukemia (199/497, 40%) and myelodysplastic syndromes (118/279, 42.3%). The mortality rate significantly decreased between the first COVID-19 wave (March–May 2020) and the second wave (October–December 2020) (581/1427, 40.7% vs. 439/1773, 24.8%, p value < 0.0001). In the multivariable analysis, age, active malignancy, chronic cardiac disease, liver disease, renal impairment, smoking history, and ICU stay correlated with mortality. Acute myeloid leukemia was a higher mortality risk than lymphoproliferative diseases.

Conclusions
This survey confirms that COVID-19 patients with HM are at high risk of lethal complications. However, improved COVID-19 prevention has reduced mortality despite an increase in the number of reported cases.