Acute leukemia and sars-cov-2 infection: Single centre experience
Authors: N. Pantic, M. Mitrovic, N. Sabljic, M. Vucic, Z. Bukumiric, M. Virijevic, Z. Pravdic, J. Rajic, M. T. Balint, A. Vidovic, D. Tomin, N. S. Vukovic
Journal: HemaSphere (2021)

Background: During the past one year different protocols addressing the treatment of acute leukemia (AL) during the coronavirus disease 2019 (COVID-19) outbreak have emerged. However, reliable data regarding this topic are still deficient, since only case series with heterogeneous patient population with different hematologic malignancies are available. Aims: To determine clinical characteristics of COVID-19 and to assess risk factors for mortality in patients with AL. Methods: This prospective study included 51 consecutive adult patients actively treated for AL, with verified SARS-CoV-2 infection treated at two Clinical Centres in Central Serbia. The study enrolled all symptomatic and asymptomatic patients regardless of severity of the infection. Baseline data including age, sex, body mass index, comorbidities, AL type, disease status (newly diagnosed, complete remission (CR), relapsed/ refractory (RR)), treatment (intensive, low-intensity chemotherapy, supportive care), time since AL diagnosis, outcome, laboratory parameters at the onset of infection were collected. Moreover, dana regarding COVID-19 symptoms, disease severity, COVID-19-specific therapies and time to PCR negativity were collected. Methods of descriptive and analytical statistics were used. Results: Most patients (80.4%) had acute myeloid leukemia (AML). At time of COVID-19 diagnosis 35.3% of patients were newly diagnosed with AL. Concurrent diagnosis of COVID-19 and AML was made in 5.89% patients, 23.5% were RR and 41.2% were in CR. Intensive chemotherapy was administered in 80.4% of our patients. At the time of COVID-19 diagnosis 29.4% patients had bone marrow aplasia. Intrahospital transmission was probable in 50.98% patients. Five patients who were initially asymptomatic andwith negative PCR test at the time of admission developed COVID19 symptoms within the first 48 hours. The most common symptoms of COVID-19 were fever (70.4%), fatigue (66.7%) and dyspnea (39.2%). Asymptomatic, mild to moderate, severe and critical COVID-19 was registered in 9.8%, 43.1%, 37.3% and 9.8% patients, respectively. Median time to PCR negativity was 18 days (range 10-50). Mortality for the entire cohort was 17/51 (29.4%). In all cases death was associated with COVID-19 pneumonia. Among COVID-19 symptoms dyspnea (OR 12.536 (95% CI: 3.106 - 50.597)), cephalgia (OR 5.36 (95% CI: 1.200 - 26.482) and fatigue (OR 5.921(95% CI: 1.168 - 30.019) were associated with higher mortality. Patients newly diagnosed with AL (OR 6.00 (95% CI 1.133 - 15.188) and patients with bone marrow aplasia (OR 4.148 (95% CI 1.133 - 15.188) had a significantly worse outcome in comparison with patients in CR. Additionally, pneumonia severity (OR 14.963 (95% CI 3.212 - 69.700) and need for oxygen therapy (OR 6.455 (95% CI 2.56 - 20.262) were associated with higher mortality risk. Among laboratory parameters lower platelet count (OR 0.985 (95% CI 0.973 - 0.996)), prolonged prothrombin time (OR 1.554 (95% CI 1.104 - 2.186)), higher ISTH DIC score (OR 2.122 (95% CI 1.258 - 3.576), C-reactive protein (OR 1.011 (95% CI 1.004 - 1018) and LDH (OR 1.001 (95% CI 1.000 - 1.003) were predictive for death. Summary/Conclusion: Baring in mind high mortality rate, and rate of intrahospital transmission, rigorous isolation of AL patients, permanent symptoms monitoring and prompt testing should be prioritized. Careful risk-benefit assessment regarding the continuing of anticancer therapy is required in patients receiving palliative therapy and intensive induction therapy. Conversely, there is no reason to withhold therapy for the patients in CR.