Seasonal community acquired respiratory viruses (CARV) are associated with a high burden of disease in patients with malignancies - preliminary data of the OncoReVir registry

Background: Community acquired respiratory viruses (CARVs) may cause severe respiratory infections in patients (pts) with cancer. To collect epidemiological and clinical data of CARV-infections the multicentric registry OncoReVir was established. Here, we present a preliminary analysis of pts with cancer infected with CARVs. Method(s): A total of 1,142 pts with cancer and CARV-infection were enrolled between Nov2018 and Jan2022. Most cases were documented for season 17/18 and 18/19. Data on demographics, comorbidities, cancer, CARVs and infection course were collected. Pre-defined endpoints were pneumonia, admission to ICU and mortality. The relationship between cancer-specific factors and outcome was evaluated by bivariate logistic regression. Result(s): The median age was 60 (IQR 50-67) years, 42% of pts were female. Solid tumors were present in < 10%, leukemia, lymphoma and multiple myeloma in 36.5%, 27% and 23%, respectively. 50% had active cancer, 40% had received chemotherapy within the last 3 months. Targeted therapy was reported in 11.5%, high-dose steroids in 16% of pts, 56% were SCTrecipients. Commonly detected CARVs were influenza (39.5%), parainfluenza (18%), respiratory syncytial virus (15%), rhinovirus (14.5%), human metapneumovirus (hMPV, 5.5%), endemic coronavirus (5.5%) and SARSCoV- 2 (2%). Among all CARVs, frequent symptoms were cough, fever, dyspnea and rhinitis. Rates of pneumonia were highest in hMPV (33%) and SARS-CoV-2 (32%), lowest in endemic coronavirus (16%, p=0.334). 8.5% required intensive care, most of them due to COVID-19 (p=0.084). Infection-associated mortality but not rate of pneumonia showed significant differences comparing CARVs. In regression analysis, active cancer was associated with all endpoints: infection-related mortality (4.02 [1.63- 9.88], p=0.002), ICU admission (1.75 [1.07-2.88], p= 0.027) and pneumonia (1.47 [1.1-1.96], 0.009). Conclusion(s): In our cohort, all CARVs could potentially lead to severe disease. Active cancer was an independent risk factor for adverse outcome in pts with cancer and CARV-infection.

COVID-19 in cancer patients - higher inflammatory response in patients with active cancer

Background: Active cancer has been identified as an independent risk factor for severity and mortality in COVID-19. However, direct comparisons of SARS-CoV-2 infected patients (pts) with active and non-active cancers remain scarce. Method(s): We retrospectively analyzed a cohort of pts with cancer with confirmed SARS-CoV-2 infection, enrolled 03/16/2020 - 07/31/2021. Data on demographics, cancer and laboratory findings were collected. Descriptive and subsequent regression analysis was performed. Endpoints were progression to severe COVID-19 and infection-associated mortality. Result(s): In total, 987 pts with cancer (510 active vs 477 non-active) were included in our analysis. Majority was male and > 55 years, with a higher number of elderly pts with non-active cancer. CCI was 4.75 vs 3.85 in pts with active and non-active cancer (p<0.001). Localized solid tumors were reported in 38 vs 79% (p<0.001), metastasized in 37.5 vs 5.5% (p<0.001) and hematological diseases in 37.5 vs 19.5% (p<0.001) pts with active and non-active cancer, respectively. At virus detection, majority of pts showed mild to moderate symptoms, while deterioration to severe COVID-19 was slightly more common in pts with active cancer (19% vs 16%;p=0.284). COVID-19 related mortality was significantly higher in pts with active cancer (24% vs 17.5%, p<0.001). In line, severe cytopenia and an increase of inflammatory markers were common findings in pts with active cancer at baseline, particularly in those who developed severe infection or died. Multivariate analysis revealed that ferritin (14.24 [2.1-96], p=0.006) and CRP (2.85 [1.02-8.02], p=0.046) were associated with severe COVID-19 and infection-related mortality. In pts with non-active cancer, association was seen for ferritin only (4.1 [1.51-11.17], p=0.006). Conclusion(s): Comparing pts with active and non-active cancer, mortality rate was significantly higher in pts with active cancer. Also inflammatory markers were significantly increased assuming higher levels of inflammation may play a role in adverse outcome of COVID-19 in pts with active cancer.

Managing hematological cancer patients during the COVID-19 pandemic: an ESMO-EHA Interdisciplinary Expert Consensus.

BACKGROUND: The COVID-19 pandemic has created enormous challenges for the clinical management of patients with hematological malignancies (HMs), raising questions about the optimal care of this patient group. METHODS: This consensus manuscript aims at discussing clinical evidence and providing expert advice on statements related to the management of HMs in the COVID-19 pandemic. For this purpose, an international consortium was established including a steering committee, which prepared six working packages addressing significant clinical questions from the COVID-19 diagnosis, treatment, and mitigation strategies to specific HMs management in the pandemic. During a virtual consensus meeting, including global experts and lead by the European Society for Medical Oncology and the European Hematology Association, statements were discussed and voted upon. When a consensus could not be reached, the panel revised statements to develop consensual clinical guidance. RESULTS AND CONCLUSION: The expert panel agreed on 33 statements, reflecting a consensus, which will guide clinical decision making for patients with hematological neoplasms during the COVID-19 pandemic.

COVID-19 in cancer patients: clinical characteristics and outcome-an analysis of the LEOSS registry.

INTRODUCTION: Since the early SARS-CoV-2 pandemic, cancer patients have been assumed to be at higher risk for severe COVID-19. Here, we present an analysis of cancer patients from the LEOSS (Lean European Open Survey on SARS-CoV-2 Infected Patients) registry to determine whether cancer patients are at higher risk. PATIENTS AND METHODS: We retrospectively analyzed a cohort of 435 cancer patients and 2636 non-cancer patients with confirmed SARS-CoV-2 infection, enrolled between March 16 and August 31, 2020. Data on socio-demographics, comorbidities, cancer-related features and infection course were collected. Age-, sex- and comorbidity-adjusted analysis was performed. Primary endpoint was COVID-19-related mortality. RESULTS: In total, 435 cancer patients were included in our analysis. Commonest age category was 76-85 years (36.5%), and 40.5% were female. Solid tumors were seen in 59% and lymphoma and leukemia in 17.5% and 11% of patients. Of these, 54% had an active malignancy, and 22% had recently received anti-cancer treatments. At detection of SARS-CoV-2, the majority (62.5%) presented with mild symptoms. Progression to severe COVID-19 was seen in 55% and ICU admission in 27.5%. COVID-19-related mortality rate was 22.5%. Male sex, advanced age, and active malignancy were associated with higher death rates. Comparing cancer and non-cancer patients, age distribution and comorbidity differed significantly, as did mortality (14% vs 22.5%, p value < 0.001). After adjustments for other risk factors, mortality was comparable. CONCLUSION: Comparing cancer and non-cancer patients, outcome of COVID-19 was comparable after adjusting for age, sex, and comorbidity. However, our results emphasize that cancer patients as a group are at higher risk due to advanced age and pre-existing conditions.