ABSTRACT
Introdução: A pandemia pelo SARS-CoV-2 (COVID-19) vem desafiando a comunidade científica e os serviços de saúde, superando mais de 4 milhões de mortos no mundo. A idade avançada e a presença de comorbidades cardiovasculares são relacionadas a maior mortalidade em relação a população geral, podendo atingir 15% dos casos infectados. Pacientes onco-hematológicos, devido a doença de base e ao seu tratamento, possuem comprometimento do sistema imune por período de tempo prolongado, o que os torna mais suceptiveis a infecções. A infecção pelo COVID-19 nesse grupo de pacientes tem demonstrado piores desfechos. Nesta série de casos avaliamos os desfechos de pacientes portadores de doenças linfoproliferativas diagnosticados com COVID-19 de Fevereiro de 2020 a Agosto de 2021 em duas instituições de São Paulo. Objetivo: Descrever os desfechos de pacientes com COVID-19 em pacientes com doenças linfoproliferativas. Métodos: Estudo multicêntrico, observacional e retrospectivo. Os dados foram obtidos através do prontuário eletrônico. Os critérios de inclusão foram diagnóstico de doença linfoproliferativa e infecção por COVID-19 confirmada através de teste RT-PCR em pacientes sintomáticos realizados nos centros participantes. Resultados: Em um tempo mediano de seguimento de 399 dias foram incluídos 41 pacientes com mediana de idade de 59 anos (DP 16,8). A maior parte dos pacientes eram portadores de linfoma difuso de grandes células B (LDGCB), representando 24% da amostra, seguidos por linfoma folicular (17%) e linfoma de Hodgkin (17%). Em relação as comorbidades, 9 (22%) pacientes diabéticos, 17 (41%) hipertensos e 9 (22%) obesos. A taxa de admissão hospitalar foi de 75% e, mais da metade dos pacientes foram admitidos em unidade de terapia intensiva (UTI). Metade dos pacientes necessitaram de suporte ventilatório sendo, 15% dos pacientes com ventilação mecânica e outros 35% com cateter nasal de oxigênio. A prevalência de eventos trombóticos foi de 17%. Em relação ao tratamento quimioterápico 85% dos pacientes dessa amostra estava em vigência de tratamento quimioterápico no momento da infecção pelo Covid-19, no entando na análise univariada não houve diferença estataisticamente significativa de mortalidade entre o grupo de pacientes que estavam em tratamento quimioterápico e os que não estavam (HR 1,18;IC 0,26-5,33;p = 0,83). A taxa de sobrevida global em 100 dias foi de 66% (IC95 53-83%). Discussão: A mortalidade de pacientes hematológicos com infecção pelo COVID-19 é superior a população geral e foi estimada em 34% dos casos na metanalise publicada por Vijenthira et all. Em um estudo multicêntrico realizado na Alemanha a mortalidade em pacientes hospitalizados sem antecedente de neoplasias foi em torno de 22%. A ausência do aumento da mortalidade em pacientes com exposição recente a tratamento quimio-imunoterápico é condizente com dados apresentados em literatura, no entando não há estudos prospectivos publicados que exaltem esses achados. A idade superior a 60 anos foi o fator de maior impacto na mortalidade dos pacientes com doenças onco-hematológicos de acordo dados de literatura e em nosso estudo esse dado não foi estatisticamente significante possivelmente devido a uma mediana de idade menor que 60 anos da amostra. É importante ressaltar que esse é um estudo retrospectivo, porém que reafirma o pior desfecho clínico dos pacientes com doença onco-hematológicos com infecção pelo COVID-19.
ABSTRACT
Purpose: This study aims to estimate the overall SARS-CoV-2 seroprevalence and evaluate the accuracy of an antibody rapid test compared to a reference serological assay during a COVID-19 outbreak in a prison complex housing over 13,000 prisoners in Brasília. Design/methodology/approach: The authors obtained a randomized, stratified representative sample of each prison unit and conducted a repeated serosurvey among prisoners between June and July 2020, using a lateral-flow immunochromatographic assay (LFIA). Samples were also retested using a chemiluminescence enzyme immunoassay (CLIA) to compare SARS-CoV-2 seroprevalence and 21-days incidence, as well as to estimate the overall infection fatality rate (IFR) and determine the diagnostic accuracy of the LFIA test. Findings: This study identified 485 eligible individuals and enrolled 460 participants. Baseline and 21-days follow-up seroprevalence were estimated at 52.0% (95% CI 44.9–59.0) and 56.7% (95% CI 48.2–65.3) with LFIA;and 80.7% (95% CI 74.1–87.3) and 81.1% (95% CI 74.4–87.8) with CLIA, with an overall IFR of 0.02%. There were 78.2% (95% CI 66.7–89.7) symptomatic individuals among the positive cases. Sensitivity and specificity of LFIA were estimated at 43.4% and 83.3% for IgM;46.5% and 91.5% for IgG;and 59.1% and 77.3% for combined tests. Originality/value: The authors found high seroprevalence of anti-SARS-CoV-2 antibodies within the prison complex. The occurrence of asymptomatic infection highlights the importance of periodic mass testing in addition to case-finding of symptomatic individuals;however, the field performance of LFIA tests should be validated. This study recommends that vaccination strategies consider the inclusion of prisoners and prison staff in priority groups. © 2022, Emerald Publishing Limited.
ABSTRACT
Updated analysis confirms sustained poor prognosis of COVID-19 in patients with lymphoma in Latin America: A cohort of 160 patients from GELL. Introduction: Ongoing SARS-COV-2 pandemic has impacted the management of cancer patients worldwide. Several reports have demonstrated inferior outcomes of patients with hematological malignancies, including higher rates of intensive care unit admission, need for mechanical ventilation and death. The impact of COVID-19 is profound in resource-restricted countries, including Latin America. Most cohorts reported have not included patients from Latin America, and there is paucity of data of the outcome of cancer patients with COVID-19 in low- and middle-income countries. Grupo de Estudio De Linfoproliferativos En Latino-America (GELL )is a collaborative network of hematological centers in 13 countries in Latin America. We report updated outcomes of lymphoma patients diagnosed with COVID-19 in Latin America. Methods: We conducted a retrospective study including patients with a diagnosis of lymphoma and COVID-19 infection. Patients with chronic lymphocytic leukemia/small lymphocytic lymphoma were excluded from the analysis We defined active disease as follow: (1) patients with detectable disease either prior to initiating therapy or upon relapse, and/or (2) patients undergoing active cancer treatment. The primary outcome was overall survival at 100 days. Survival curves were estimated using the Kaplan Meier method. Uni and multivariable analysis were carried out with Cox model. Results: A total of 160 patients were available for analysis. Median age was 60 years old. Hypertension was the most common comorbidity (33%). Most patients had aggressive lymphomas (62%), including 43% of patients with diffuse large B-Cell lymphoma (DLBCL). Follicular lymphomas were observed in 13% of patients and Hodgkin lymphoma in 12.5% of patients. With a median follow-up of 37 days, the 100-day OS was 64% (95CI 56-74%, fig. 1). In univariate analysis, age (HR 1.03, p=0.0025), hypertension (HR 2.01, p=0.017), >1 number of prior lines (HR 2.78, p=0.011), patients currently on treatment (HR 1.83, p=0.043), ferritin >2000 ng/mL (HR 4.74 p=0.00047) were associated with inferior OS. In multivariate analysis, age (HR 1.03, p=0.0026) and patients currently on treatment (HR 1.82, p=0.04) had inferior OS. There was a trend towards inferior outcomes in patients receiving monoclonal antibodies in univariate analysis (HR 1.82, p=0.081) but not in multivariable analysis (HR=1.29, p=0.48). Use of steroids was not statistically related to mortality (HR 1.79, p=0.074). Finally, contrary to other cohorts, no improvement in OS was observed in patients diagnosed later on the pandemic (fig. 2). Conclusion: In this large cohort of Latin American patients with lymphoma malignancies, our updated analysis showed a maintained dismal prognosis with COVID-19 infection. With a median follow up of 37 days, the 100-day OS was 64%. Older age and ongoing active cancer treatment were significantly associated with mortality. The use of monoclonal antibodies and systemic corticosteroids were not statistically associated to poor survival. Current efforts are focused on improving immunization in the Latin American population. There is an unmet need for improving survival in patients with hematologic malignancies and COVID-19 infection. [Formula presented] Disclosures: Perini: Janssen: Honoraria, Speakers Bureau;Takeda: Honoraria, Speakers Bureau;Astra Zeneca: Honoraria, Speakers Bureau;MSD: Honoraria, Speakers Bureau. Otero: ASTRA ZENECA: Current Employment. Abello: Dr Reddy's: Research Funding;Amgen: Honoraria;Janssen: Honoraria. Castillo: Abbvie: Consultancy, Research Funding;BeiGene: Consultancy, Research Funding;Pharmacyclics: Consultancy, Research Funding;Janssen: Consultancy;Roche: Consultancy;TG Therapeutics: Research Funding.