International multicenter study comparing COVID-19 in patients with cancer to patients without cancer: Impact of risk factors and treatment modalities on survivorship
Authors: Raad Issam I , Hachem Ray , Masayuki Nigo , Datoguia Tarcila , Dagher Hiba , Jiang Ying , Subbiah Vivek , Siddiqui Bilal , Bayle Arnaud , Somer Robert , Fernández Cruz Ana , Gorak Edward , Bhinder Arvinder , Mori Nobuyoshi , Hamerschlak Nelson , Shelanski Samuel , Dragovich Tomislav , Vong Kiat Yee Elise , Fakhreddine Suha , Pierre Abi Hanna , Chemaly Roy F , Mulanovich Victor , Adachi Javier , Borjan Jovan , Khawaja Fareed , Granwehr Bruno , John Teny , Yepez Eduardo Yepez , Torres Harrys A , Ammakkanavar Natraj Reddy , Yibirin Marcel , Reyes-Gibby Cielito C , Pande Mala , Ali Noman , Rojo Raniv Dawey , Ali Shahnoor M , Deeba Rita E , Chaftari Patrick , Matsuo Takahiro , Ishikawa Kazuhiro , Hasegawa Ryo , Aguado-Noya Ramón , García Alvaro Garcia , Puchol Cristina Traseira , Lee Dong Gun , Slavin Monica , Teh Benjamin , Arias Cesar A ,   Data-Driven Determinants for COVID-19 Oncology Discovery Effort (D3CODE) Team, Kontoyiannis Dimitrios P , Malek Alexandre E , Chaftari Anne-Marie 
Published: January 2023

Background:In this international multicenter study, we aimed to determine the independent risk factors associated with increased 30 day mortality and the impact of cancer and novel treatment modalities in a large group of patients with and without cancer with COVID-19 from multiple countries.Methods:We retrospectively collected de-identified data on a cohort of patients with and without cancer diagnosed with COVID-19 between January and November 2020 from 16 international centers.Results:We analyzed 3966 COVID-19 confirmed patients, 1115 with cancer and 2851 without cancer patients. Patients with cancer were more likely to be pancytopenic and have a smoking history, pulmonary disorders, hypertension, diabetes mellitus, and corticosteroid use in the preceding 2 wk (p≤0.01). In addition, they were more likely to present with higher inflammatory biomarkers (D-dimer, ferritin, and procalcitonin) but were less likely to present with clinical symptoms (p≤0.01). By country-adjusted multivariable logistic regression analyses, cancer was not found to be an independent risk factor for 30 day mortality (p=0.18), whereas lymphopenia was independently associated with increased mortality in all patients and in patients with cancer. Older age (≥65y) was the strongest predictor of 30 day mortality in all patients (OR = 4.47, p<0.0001). Remdesivir was the only therapeutic agent independently associated with decreased 30 day mortality (OR = 0.64, p=0.036). Among patients on low-flow oxygen at admission, patients who received remdesivir had a lower 30 day mortality rate than those who did not (5.9 vs 17.6%; p=0.03).Conclusions:Increased 30 day all-cause mortality from COVID-19 was not independently associated with cancer but was independently associated with lymphopenia often observed in hematolgic malignancy. Remdesivir, particularly in patients with cancer receiving low-flow oxygen, can reduce 30 day all-cause mortality.Funding:National Cancer Institute and National Institutes of Health.