Influence of COVID-19 on Acute Myeloid Leukemia Treatment Efficacy: Insights from a Propensity Score-Matched Cohort Study
Authors: Sood Aditya , Sangari Anish , Wright Jervon , Locke Margaret , Elengickal Joseph , Hou Lilly , Aung Wint Yan , Singhal Adit , George Riya , Nieto Maria J 
Published: December 2024

Background:
Severe COVID-19 has long been known to cause long-term immunological changes in a subgroup of infected patients. As such, the COVID-19 pandemic has and will continue to hold the potential to complicate treatment outcomes for patients diagnosed with acute myeloid leukemia (AML). This study assesses whether COVID-19 infection among AML patients influenced mortality rates, renal failure incidence, and adverse reactions to treatment.
Methods:
Utilizing the TriNetX database and the US Collaborative Network with records from 60 healthcare organizations, we conducted a retrospective cohort study including AML cases diagnosed after January 1, 2019. Propensity score matching adjusted for variables such as stage, age, race, gender, and comorbidities created groups of AML patients matched for the above key factors with and without COVID-19. Primary and secondary endpoints included mortality, renal failure, and adverse reactions to treatment.
Results:
Our study matched 3,474 AML patients per group. Surprisingly, AML patients who contracted COVID-19 showed a significantly lower mortality rate of 24.1% compared to their non-COVID counterparts at 40.5% (Risk Difference (RD) -16.4%, 95% CI: -14.2% to -18.6%; p&lt;0.0001). However, the AML + COVID group experienced higher incidences of renal failure (41.7% vs. 32.9%, RD 8.8%, 95% CI: 11.2% to 6.5%; p&lt;0.0001) and adverse reactions to antineoplastics/immunosuppressives (47.1% vs. 31.7%, RD 15.4%, 95% CI: 17.7% to 13.1%; p&lt;0.0001).
Discussion:
This analysis of 6,948 patients indicated that AML patients infected with COVID-19 experienced increased rates of renal failure and adverse reactions to antineoplastic and immunosuppressive treatments, highlighting key intervention areas. The higher renal failure rates may result from the direct nephrotoxic effects of COVID-19 and the renal load from AML chemotherapies like cytarabine and anthracyclines. COVID-related systemic inflammation and potential direct renal infection might lead to acute kidney injury, exacerbating the renal impairment when combined with AML therapy nephrotoxicity.
The observed increase in adverse reactions to antineoplastic and immunosuppressive treatments may stem from altered pharmacokinetics due to systemic inflammation and organ dysfunction in COVID-19, potentially increasing drug toxicity. Additionally, immune dysregulation from COVID-19 could enhance the myelosuppressive effects of chemotherapy, escalating risks of severe neutropenia and related complications.
While there was a lower mortality rate in the AML+COVID-19 group compared to the AML only group, this data needs to be interpreted carefully, as this could be due to data inconsistencies or treatment bias within the database. The study's retrospective design might have also introduced selection and information biases. Future research should aim to improve data collection uniformity and include detailed information on treatment specifics and COVID-19 severity.