ABSTRACT
Background: Data on SARS-CoV-2 infections in oncological patients in the outpatient settings are scarce. Methods: During the spread of the delta variant between April 2021 and September 2021, a total of 10.677 patients were tested for SARS-CoV-2 infection by RT-qPCR in seven outpatient clinics in Bavaria, Germany. Results: Within the tested patient cohort, 4.960 patients (46.5%) suffered from a malignant disease (74% solid tumors and 26% malignant hematological diseases). This group was compared with 5.717 patients (53.5%) without a malignant disease (33.1% with other hematological diseases and 66.9% patients without a hematological or oncological disease). During the observation period, 119 (2.4%) patients with malignancies were tested positive (88 patients with solid tumors;31 patients with malignant hematological diseases) compared to 115 positive patients (2.0%) in the control group. 32 of 119 positively tested patients (26.9%) suffering from malignant disease required hospitalization and 9/32 patients (28.1%) died during the clinical course. Conclusions: These observations are in clear contrast to data from patients we evaluated during the pre-delta variants period between 15 and 26 April 2020 in the same seven outpatient clinics. In this period, a total of 1.227 patients were tested for SARS-CoV-2 by RT-qPCR. 78/1227 patients (6.3%) were tested positive in RT-qPCR and most showed mild symptoms of infection. None of the SARS-CoV-2 infected patients died. These data were analyzed when no vaccination was available. These data were evaluated during a period where no vaccine was available. Vaccination of patients with malignancies with BiontechPfizer's mRNA vaccines was started in April 2021. The response to the vaccine was tested by an antibody assay (Elecsys Anti-SARS-CoV-2 S-immunoassay, Roche) at the earliest four weeks after the second vaccination. To assess the response, we compared five patient cohorts: Patients who received (i) B cell depleting antibodies, (ii) checkpoint inhibitors (ICI), (iii) chemotherapy, or (iv) tyrosin kinase inhibitors (TKIs), and (v) healthy controls. The patients treated with ICI or TKI showed a comparable vaccination response to the healthy patients, while patients receiving Rituximab/Obinutuzumab showed no significant humoral vaccination response at all. The more severe disease course of patients infected by the SARS-CoV-2 delta variant compared to the initial waves of infections strongly underline the importance of vaccination in cancer patients.
ABSTRACT
Background: It is still unclear whether oncological patients harbor a higher risk for an infection with the SARS-CoV-2 and for developing severe forms of COVID-19. Furthermore, it is unclear whether an infection affects essential therapy treatment and if a therapy increases the risk for an infection. Method(s): We tested every patient (n=1286) in 7 different oncology outpatient clinics from 04/15/2020 and 04/26/2020 for COVID-19 infection regardless of whether symptoms were present or not. Virus RNA was extracted using the MGIEasy extraction kit in combination with SP-960 robots and a RT qPCR was performed. Result(s): From 1286 tested patients 40 (3.1%) patients were identified positive. Only two of those (5.0%) had mild symptoms whereas one positive patient (2,5%) was treated stationary with pneumonia. The majority (37/40) was asymptomatic virus-carriers (92,5 %). Noteworthy is the fact that 22 (55%) of the positively tested patients were undergoing systemic therapy of which 10 (45.5%) patients received chemotherapy and 4 (18.2%) patients received immunomodulating antibodies. Conclusion(s): A consequent testing for COVID-19 in cancer patients is obligate to identify asymptomatric positive carrier to separate this potential vector group from COVID negative patients since the majority (37/40) of positive patients was asymptomatic virus-carriers (92,5 %). The data we collected contrasts strongly the hypothesis that cancer patients are suspected to be highly vulnerable for SARS-CoV-2 infections. Only a minority (3/40) of positively tested tumor patients showed symptoms. An asymptomatic COVID-19 infection seems to have no impact on the further course of a chemotherapy. Legal entity responsible for the study: The authors. Funding(s): Has not received any funding. Disclosure: All authors have declared no conflicts of interest. Copyright © 2020
ABSTRACT
Introduction: Chest x-ray (CXR) severity score and obesity are predictive risk factors for COVID-19 hospital admission. However, the relationship between abdominal obesity and CXR severity score is not fully explored. Methods: This retrospective cohort study analyzed the association of different adiposity indexes, including waist circumference and body mass index (BMI), with CXR severity score in 215 hospitalized patients with COVID-19. Results: Patients with abdominal obesity had significantly higher CXR severity scores (Figure 1A) and higher rates of these scores than those without abdominal obesity (P<0.001;P=0.001, respectively) while there were no significant differences between BMI classes (P=0.104;P=0.271, respectively) (Figure 1B). Waist circumference and waist-to-height ratio correlated more closely with CXR severity score than BMI (r=0.43, P<0.001;r=0.41, P<0.001;r=0.17, P=0.012, respectively). The AUCs for waist circumference and WHtR were significantly higher than those for BMI for distinguishing a high CXR severity score (≥8) (0.68 [0.60-0.75] and 0.67 [0.60-0.74] vs 0.58 [0.51-0.66], P=0.001) (Figure 2). Multivariable analysis indicated abdominal obesity (risk ratio: 1.75, 95% CI: 1.25-2.45, P<0.001), bronchial asthma (risk ratio: 1.73, 95% CI: 1.07-2.81, P=0.026) and oxygen saturation at admission (risk ratio: 0.96, 95% CI: 0.94-0.97, P<0.001) as the only independent predictors of a high CXR severity score. Conclusion: Abdominal obesity might predict a high CXR severity score better than general obesity in hospitalized patients with COVID-19. Therefore, in hospital clinical practice waist circumference should be assessed and patients with abdominal obesity should be monitored closely.