COVID-19 Outcomes of patients with hematologic malignancies: A single center experience
Authors: S. Spyridis, D. Mallouri, T. Chatzikonstantinou, C. Demosthenous, N. Stavroyianni, A. Lalayanni, I. Batsis, I. Sakellari, A. Anagnostopoulos, D. Sotiropoulos
Journal: HemaSphere (2021)

Background: SARS-CoV-2 is a novel coronavirus causing an infection, named Coronavirus Disease 2019 (COVID-19). As of February 22, 2021, the virus had affected more than112 millions individuals and resulted in over 2,4 millions deaths worldwide. Mortality can be as high as15% in elderly patients, and/or in patients with comorbidities. Data from studies suggest that patients with cancer have a higher incidence of severe events after contacting the virus. Very few data are available on COVID-19 outcomes in patients with hematologic diseases who are highly immunocompromised due to their underlying disease and the treatments they receive, with high risk of morbidity and mortality from COVID-19. Aims: The purpose of this study was to perform a review to quantify the outcomes (hospitalizations and deaths) of patients with hematologic malignancy and COVID-19. Methods: Our department consists of Hematology Clinic and BMT Unit. We included patients with a hematologic disease, with laboratory- confirmed COVID-19 infection between October 2020 and February 2021. A confirmed case of COVID-19 was defined by a positive result on RT-PCR assay. We reviewed hematological medical records to collect demographic, clinical, and treatment data and outcomes of COVID-19. We evaluated 73 patients (43 male, 30 female, median age 61). Information extracted included total number of patients, coronavirus symptoms, hospital admission rate, death rate. Hematologic malignancy subtypes were: acquired bone marrow failure syndromes;acute leukemias;lymphomas;chronic lymphocytic leukemia;plasma cell dyscrasias;MPNs;other hematologic conditions;stem cell transplantation. Results: According to our analysis, regarding COVID-19 symptoms at diagnosis, 47 of 73 pts (64%) presented fever, as single symptom or combined with at least one more symptom, 20 of 73 pts (27%) presented two or more symptoms, including anosmia, cough, shortness of breath, myalgias, fatigue, while 9 of 73 pts (12%) were asymptomatic and diagnosis confirmed only with positive PCR test. Patients presented with moderate or severe COVID-19 were 28 of 73 (38%), while 9 of 28 hospitalized pts (32%) required Intensive Care Unit (ICU) admission. Data collected regarding hematologic malignancy subtype showed: lymphomas, non including CLL, 24 of 73 pts (33%), CLL,17 of 73 pts (23%), acute leukemias, 7 of 73 pts (10%), MPNs, 8 of 73 pts (11%), acquired bone marrow failure syndromes, 5 of 73 pts (7%), multiple myeloma, 3 of 73 pts (4%), other hematologic conditions 5 of 73 (7%), while patients who underwent transplantation were 4 of 73 (5%). Regarding treatment, patients divided in two subgroups, 52 of 73 (71%) received anticancer therapy at some time in their lives, while 21 of 73 pts (29%) have never been on treatment. Total death rate was 23% (17 of 73 pts), while among hospitalized pts was nearly 54% (15 of 28), with all patients requiring ICU not surviving (9 of 9, rate100%). 2 of17 pts (11%) died without hospitalization. Death rate in CLL pts was 41% (7 of17 pts) with 2 of17 (11%) not on treatment, in lymphomas16% (4 of 24 pts), while in other hematologic subgroups were reported from1 to 2 deaths per group. Summary/Conclusion: Hematological patients appear to be a population very vulnerable to COVID-19 infection, with significant morbidity and mortality. More data are necessary in further surveys from more centers and larger number of patients. Hematology departments should remain COVID-19 free zones dedicated only to hematologic treatment and patients should strictly comply with social distancing.