Leukemia and COVID-19: group ‘medically weak’

Patients with hematologic heart disease and COVID-19 appear to have a higher risk of severe infection and death, according to data from the International ASH Research Cooperative COVID-19 Registry for Hematology.

At the time of diagnosis, COVID-19 severity was strongly associated with cardiovascular disease, with 69% of those receiving primary treatment for hematologic heart disease having moderate or severe disease. A. Wood, MD, University of North Carolina at Chapel Hill.

Overall, 62% of patients with known severity have moderate or severe COVID-19 infection. <47% of 19-year-olds accounted for 43% of 19-39 year olds, 62% of 40-69 year olds and 70% ≥70.

The overall mortality rate in the first 250 patients in the registry is about 28%, but to date it has dropped to 20% in 656 patients, Wood told a news conference at a virtual meeting of the American Society of Hematology (ASH).

The risk of death is higher in adults, those with more severe infections, those who have decided to give up more intensive treatment, and / or those who have had a poor cancer diagnosis prior to COVID-19 infection.

One-third of patients in need of hospital or ICU-level care died, Wood reported, but pointed out Medpage today “An important finding is that we have reported that many patients with intensive care and hematological conditions have survived their COVID-19 infection.”

“If this is appropriate for the patient / provider’s preferences, we believe that maximum intensive care care is appropriate as long as it is in line with the patient’s preferences,” he said.

Wood, co-author, reported that lack of ICU care was strongly associated with age, with 73% of those who refused ICU level care having a mortality rate and 13% of those who did not.

The registry, launched in April, includes voluntary contributions of clinical data from more than 100 international study sites. Wood commented that the registry offers live data to hematologists and other clinics during a pandemic, and that Wood provides insight into patients who are most at risk for illness and death.

“We have found that individuals with hematologic heart disease and COVID-19 infection have a higher risk of developing the disease and death than the general population,” Wood said. “The risk of serious infection or death in these patients is concentrated in certain groups, and data from our global registry have helped to understand this more clearly.”

For the study, the authors collected data from the registry on 656 patients (over 40 years of age; 60% of men; 43% of whites) using various hematologic heart diseases and laboratory-confirmed or hypothetical COVID-19 diagnoses. 57% of participants had comorbidities, including hypertension (50%) and diabetes (30%).

In the case of cancer, 57% have leukemia, 25% have lymphoma, and 18% have plasma cell neoplasms. Prior to COVID-19 infection, 80% of people expected> survival of> 12 months.

The authors report that mortality varies with diagnosis, with 51% of patients before Kovid-19 expecting <12 months of survival, and 13% of patients expecting 12 months of survival. Mortality also varies according to the fatal condition: 11% of those starting treatment, 13% of those recovering, and 36% of those with relapse / refractory disease.

The most common COVID-19 associated symptoms are fever (65%) and cough (56%); 11% were asymptomatic.

Most patients received azithromycin (n = 143) and then hydroxychloroquine (n = 137) for COVID-19 treatment. The authors report that 44 patients were given remdecivir (Vecluri).

When it comes to COVID-19 infection, this analysis shows that people with hematologic diseases are a medically vulnerable population, ”Wood said. “This underscores the need to continue to encourage our patients to take appropriate precautions to limit COVID-19 exposure; to continue to take precautions in our healthcare environment to protect these patients; to prioritize these patients for COVID-19 testing.

Robert Glatter, MD, Northwell, Lennox Hill Hospital / Hofstra University, New York City Medpage today “Although the diagnosis and outcome of patients with COVID-19 and hematologic heart disease may be worse or similar compared to other high-risk medical conditions, it is essential to have a discussion about the goals of care with the patient and family.”

“In this case, it is important to identify and treat reversible conditions such as anemia, thrombocytopenia, coagulopathy, electrolyte and other nutritional deficiencies,” said Glatter, who did not participate in the study. “Informed decision making is essential when developing a care plan, especially in light of the high morbidity and mortality associated with COVID-19, as well as all the underlying and high-risk medical conditions.”

“Greetings expressed in a MOLST [medical orders for life-sustaining treatment] Form is crucial in this regard, “he commented.” I agree with the researchers’ conclusions [there is no reason] If aggressive supportive care matches patient preferences, prevent intensive care from patients with underlying hematologic heart disease and favorable diagnoses. “

Wood highlighted the registry’s “cooperative, global effort.” “We were able to quickly launch this resource with a spirit of volunteerism and cooperation around the world. Hematologists recognize the value of this data and continue to contribute to cases,” he said.

Although the current analysis is limited to patients with hematologic heart disease, the registry also collects data from patients with non-fatal blood disorders, Wood added.