ABSTRACT
It was established early in the COVID-19 (SARS-CoV- 2) pandemic that patients with cancer, in particular haematological malignancy, have worse outcomes than non-cancer patients. Monoclonal gammopathy of undetermined significance (MGUS) is a premalignant condition, which may be linked with immune dysregulation, raising the possibility that patients with MGUS could also have worse outcomes from COVID-19 infection. Our aim was to identify all local patients with MGUS who had contracted COVID-19 since the start of the pandemic. 120 cases of COVID-19 infection in 114 MGUS patients were identified. Pillar 1 (patients with clinical needs and healthcare workers, n = 35) and pillar 2 (wider population, n = 85) test results were compared to our patient database to identify cases. Patients were subdivided based on the time period when they acquired COVID-19: wave 1 (February 2020-June 2020, n = 2), wave 2 (July 2020-May 2021, n = 31) and wave 3 (June 2021-current [data to end April 2022], n = 87). No subgroup analysis was carried out for the wave 1 data due to small numbers. Our outcomes were hospital admission and 4-week mortality. We compared our patient outcomes to regional, age-matched, population data for the same time periods. For rates of hospital admission, we looked at patients aged 65+ years. When looking at all MGUS patients from waves 2 and 3, the rate of hospital admission was not significantly different to the regional population (30.1% vs. 24.1%, p = 0.11). In wave 3, the hospital admission rate fell in both groups but was significantly higher in the MGUS patients compared to the regional population (26.9% vs. 16.4%, p = 0.02). For patient mortality, we looked at patients aged 50+ years. The overall 4 -week mortality rate for MGUS patients was higher than the age-matched regional population (5.4% vs. 2.4%, p = 0.02). A higher mortality rate was seen in waves 2 and 3 of the pandemic, with wave 3 also showing a statistically significant difference (3.7% vs. 1.2%, p = 0.02). Comparing MGUS patient outcomes from wave 2 to wave 3, there was a modest reduction in hospital admission over this time period (38.1% to 26.9%), with a more notable reduction in COVID-related mortality (9.7% to 3.7%). In conclusion, patients with MGUS and COVID-19 seem to have higher rates of mortality, and possibly also hospital admission, compared to the age-matched regional population.
ABSTRACT
Background: It was established early in the COVID-19 pandemic that patients with cancer, in particular haematological malignancy, had worse outcomes than non-cancer patients. There is a lack of recent data to describe how mortality in patients with haematology malignancy has changed with widespread accination and seeral effectie treatments now being aailable. Aims: Based in a large NHS Trust in the North-East of England, our aim was to identify all local patients with haematological malignancy who had contracted COVID-19 since the start of the pandemic. We then examined these patients in more detail to ascertain risk factors for mortality, and how this has changed oer the course of the pandemic. Methods: We included patients with an actie diagnosis of haematological malignancy, or those who had receied potentially curatie treatment within the past 3 years. We excluded patients with pre-malignant conditions. Data up to the end of Noember 2021 found 213 eligible patients. Nearly all patients identified in the 1st wae of the pandemic were identified from Hospital testing, reflecting the lack of aailability of widespread testing in the community. More recently, patients identified in the community hae predominated. Results: Oerall mortality following COVID-19 infection was 21.6% at 4 weeks and 27.7% at 8 weeks after COVID-19 diagnosis. Mortality was highest in wae 1 (March - June 2020), decreasing in wae 2 (Sept 20 - March 2021) and again in wae 3 (May 2021 - current), with 4-week mortality figures of 44%, 26% and 8% respectiely. It should be noted that widespread community testing was not aailable early in the pandemic so the recorded cases in wae 1 were sicker patients needing Hospital care. Remoing pillar 2 data still shows a reduction in 4-week mortality oer the course of the pandemic, from 46% (wae 1) to 39% (wae 2) and 8% (wae 3). Although official COVID-19 mortality figures only include deaths within 4 weeks of a confirmed infection, we note that the Kaplan-Myer mortality cure did not leel out until 6-8 weeks after initial infection (figure 1). Oerall mortality at 8 weeks was therefore higher at 61% (wae 1), 31% (wae 2) and 11% (wae 3). The main risk factor for mortality was patient age, with 8-week mortality in age groups <60yr, 60-69yr, 70-79yr, 80-89yr and 90+yr being 2%, 26%, 30%, 51% and 86% respectiely. Although men comprised the majority of detected cases (62%), mortality at four and eight weeks was near identical between sexes. Although disease subgroups were relatiely small, we found the highest COVID-related mortality in patients with CLL (43%) and MDS (42%). It is perhaps not surprising as these two disease groups also had the highest mean patient ages. Patients receiing chemotherapy had no significant increase in 8-week mortality compared to those not receiing chemotherapy, 30% s. 27% (p=ns). The presence of neutropenia was howeer a risk factor for mortality. Patients who were neutropenic at the time of infection had an 8-week mortality of 43%, compared to 25% in those who were not neutropenic (P=0.04). Summary/Conclusion: Oerall, COVID-19 related mortality in patients with haematological malignancy has significantly declined oer the course of the pandemic. The main risk factor for death is increased patient age, with neutropenia also being a risk factor. (Figure Presented).