Hematologic Cancers Tied to More Severe COVID-19 Illness

Roxanne Nelson, RN, BSN

August 31, 2020

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Patients with cancer are purported to have poor outcomes from COVID-19 infection, but the type of cancer makes a difference in the severity of illness, according to new findings from the UK.

Patients with hematologic cancers (leukemia, lymphoma, and myeloma) had a more severe COVID-19 trajectory compared to patients with solid organ tumors in the UK Coronavirus Cancer Monitoring Project (UKCCMP) cohort, report Lennerd Lee, BMBCh, PhD, of the Institute of Cancer and Genomic Sciences, University of Birmingham, UK, and colleagues.

For example, patients with hematologic cancers were more likely to require treatment in an intensive care unit.

Furthermore, patients with leukemia had a more than twofold risk of COVID-19–related death compared with the rest of the cohort.

Similar to results seen in the general population, increasing age and sex were predominant risk factors for COVID-19 infection and disease severity for most patients with cancer, the study authors also report.

The study was published online August 24 in The Lancet Oncology.

The new data add to the literature on COVID-19 and cancer. Previous studies have reported that patients with COVID-19 and progressing cancer have a higher risk of death. Data from the COVID-19 and Cancer Consortium (CCC19) registry have shown that certain subgroups of patients with cancer are at a higher risk of COVID-19–related death, including older patients, men, former smokers, those with poor performance status, and those with multiple comorbidities. In addition, their findings have also shown a higher mortality risk among patients with hematologic malignancies.

High Mortality in Subgroups

In the current study, UK researchers investigated the COVID-19 risks according to tumor subtype and patient demographics among patients with cancer in the UK.

They compared adults with cancer enrolled in the UKCCMP cohort between March 18 and May 8, 2020, with a non-COVID-19 UK cancer control population from the UK Office for National Statistics. The primary endpoint was the effect of the primary tumor subtype, age, and sex on COVID-19 prevalence and the case-fatality rate while hospitalized.

The cohort included 1044 patients from the UKCCMP and 282,878 controls. The most common solid tumor types in the COVID-19 cohort were breast (13.7%), colorectal (11.9%), prostate (10.9%), and lung (10.6%). Leukemia and lymphoma (7.6% each) were the most common hematologic malignancies, followed by myeloma (3.5%), and other types (2.8%).

A total of 319 (30.6%) patients in the UKCCMP cohort died, with 295 (92.5%) deaths related to COVID-19 infection.

Overall, patients with hematologic malignancies experienced a more severe COVID-19 trajectory compared to those with solid organ tumors (OR, 1.57; P < .0043). After correcting for age and sex, recent chemotherapy was also associated with an increased risk of death during COVID-19–associated hospital admission (OR, 2.09; P = .028).

The authors found that patients with hematologic malignancies appeared to be at significantly increased risk of COVID-19 infection, including those with leukemia (OR, 2.82; P < .0001), myeloma (OR, 2.03; P = .0001), and lymphoma (OR, 1.63; P < 0.0001).

Conversely, patients with lung cancer (OR, 0.75; P = .0033) and prostate cancer (OR, 0.72; P = .0008) were relatively under-represented compared with the control group.

Age and gender also played a role, as the all-cause case-fatality rate after COVID-19 infection was significantly associated with increasing age, rising from 0.10 in patients aged 40-49 years to 0.48 in those aged 80 years and older. It was also higher in men vs women (OR, 1.92; P < .0001).

On univariate analysis, prostate cancer (OR, 2.14) and leukemia (OR, 2.03) were associated with a significantly higher risk of death from COVID-19, and patients with breast (OR, 0.53) and gynecologic cancer (OR, 0.36) had a significantly lower risk.

However, upon multivariate analysis, which adjusted for age and sex, only leukemia (OR, 2.25; P = .023) was associated with a higher risk of COVID-19–related death (OR, 2.25), and breast and gynecologic cancers were no longer linked to a significantly lower risk.

This "highlights the effect of patient age and sex on case-fatality rate," the authors emphasize.

These findings show that not all patients with cancer are equally affected by COVID-19, write the authors. "This important finding could allow clinicians some ability to risk-stratify their patients and make informed decisions on appropriate levels of social isolation and shielding," they conclude. "Future work by the UKCCMP, in collaboration with international consortia, will define risk in much greater granularity, including different subtypes of a given tumor."

The study was funded by the University of Birmingham and University of Oxford. Several of the coauthors have reported relationships with industry, as listed in the article.

Lancet Oncol. Published online August 24, 2020. Full text

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