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.
ABSTRACT
Background: Patients with acute respiratory infection due to COVID 19 have an increased risk of thromboembolic disease. Coagulation activation, endothelial dysfunction, platelet activation and impaired fibrinolysis have all been proposed as directly involved in its pathogenesis. In Latin America, data regarding the incidence of acute thrombotic complications (venous and arterial) is scarce. Aims: The aim of this analysis is to describe characteristics and outcomes of patients with confirmed COVID-19 infection with acute arterial and venous thrombotic events attended during a 10-month period, at a referral hospital in Mexico City. Methods: We included consecutive critical and non-critical adult patients, hospitalized at Hospital Central Norte Pemex in Mexico City, between April 1, 2020 and January 31, 2021. All patients tested positive for SARS- CoV-2 using RT- PCR from nasopharyngeal and oropharyngeal swabs. Thrombotic events were diagnosed during clinical care. Thrombotic events included both venous (deep vein thrombosis [DVT];pulmonary embolism [PE]) and arterial (myocardial infarction [MI], ischemic stroke, and other arterial thrombosis). All patients received thromboprophylaxis prior;and treatment (anticoagulation;platelet antiaggregation;a combination of both or other therapeutic interventions) at the time of diagnosis according to international and local recommendations. Continuous variables (age, leucocyte count with differentials, hemoglobin, D-dimer, ferritin, LDH, etc.) are presented as mean ± standard deviation, (or median and range as appropriate) and were compared using the student-t or Mann-Whitney U test. All data were analyzed using SPSS version 21 statistics software. A p value <0.05 was considered statistically significant. Results: We analyzed 1379 hospitalized patients with confirmed COVID- 19 infection. Twenty-five patients received a diagnosis of acute thrombotic events (1.81%): 13 cases (52%) of venous thrombosis (DVT: 1 case (4%);PE: 12 cases (48%)), and 12 cases (48%) of arterial thrombosis (acute Stroke: 6 cases (24%);MI/ACS: 5 cases (20%);and one case of Mesenteric thrombosis (4%)). Baseline characteristics are summarized in table 1. The mean age of all patients with thrombotic events was 62.96 14.4 years;and were predominantly male (64%). Patients with venous thromboembolic events presented with higher Ddimer levels at the time of admission compared to those who had arterial thrombosis (mean 1965.38 vs 663.92, P= 0.014). We also observed a trend to higher hemoglobin levels at the time of diagnosis in patients with arterial events compared to cases of venous thromboembolism (mean 15.83 vs 14.01, P= 0.063). Comparison of patient's characteristics between venous and arterial thrombosis is found in table 2. The overall mortality of the group with thrombotic events was 28%. The main cause for death was respiratory failure due to acute respiratory distress syndrome (5 patients, 71%). Summary/Conclusion: Our analysis shows a low venous thromboembolic rate compared with other groups, and similar to another series reported in our country. Interestingly, we observed a significant proportion of arterial thrombotic complications. However, this study has limitations. Venous thromboembolism may have been underdiagnosed because of limited imaging studies. Also, neurological or ischemic cardiac symptoms may have been underestimated in patients with severe COVID-19 infection. Changes in prophylactic anticoagulation strategies, as well as in clinical practice, could affect the incidence of thrombotic events.