Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 8 de 8
Filter
2.
Haematologica ; 2022 May 12.
Article in English | MEDLINE | ID: covidwho-1841291

ABSTRACT

Patients with acute myeloid leukemia (AML) are at high risk of mortality from coronavirus disease 2019 (COVID-19). The optimal management of AML patients with COVID-19 has not been established. Our multicenter study included 388 adult AML patients with COVID-19 diagnosis between February 2020 and October 2021. The vast majority were receiving or had received AML treatment in the prior 3 months. COVID-19 was severe in 41.2% and critical in 21.1% of cases. The chemotherapeutic schedule was modified in 174 patients (44.8%), delayed in 68 and permanently discontinued in 106. After a median follow-up of 325 days, 180 patients (46.4%) had died; death was attributed to COVID-19 (43.3%), AML (26.1%) or to a combination of both (26.7%), whereas in 3.9% of cases the reason was unknown. Active disease, older age, and treatment discontinuation were associated with death, whereas AML treatment delay was protective. Seventy-nine patients had a simultaneous AML and COVID-19 diagnosis, with an improved survival when AML treatment could be delayed (80%; p.

3.
Marchesi, Francesco, Salmanton-Garcia, Jon, Emarah, Ziad, Piukovics, Klára, Nucci, Marcio, Lopez-Garcia, Alberto, Racil, Zdenek, Farina, Francesca, Popova, Marina, Zompi, Sofia, Audisio, Ernesta, Ledoux, Marie-Pierre, Verga, Luisa, Weinbergerova, Barbora, Szotkowski, Tomas, Silva, Maria, Fracchiolla, Nicola Stefano, De Jonge, Nick, Collins, Graham, Marchetti, Monia, Magliano, Gabriele, GarcÍA-Vidal, Carolina, Biernat, Monika, Doesum, Jaap van, Machado, Marina, Demirkan, Fatih, Khabori, Murtadha Al, Zak, Pavel, Visek, Benjamin, Stoma, Igor, MÉNdez, Gustavo-Adolfo, Maertens, Johan, Khanna, Nina, Espigado, Ildefonso, Dragonetti, Giulia, Fianchi, Luana, Principe, Maria Ilaria Del, Cabirta, Alba, Ormazabal-VÉLez, Irati, Jaksic, Ozren, Buquicchio, Caterina, Bonuomo, Valentina, Batinić, Josip, Omrani, Ali, Lamure, Sylvain, Finizio, Olimpia, FernÁNdez, Noemí, Falces-Romero, Iker, Blennow, Ola, Bergantim, Rui, Ali, Natasha, Win, Sein, Praet, Jens V. A. N.; Tisi, Maria Chiara, Shirinova, Ayten, SchÖNlein, Martin, Prattes, Juergen, Piedimonte, Monica, Petzer, Verena, NavrÁTil, Milan, Kulasekararaj, Austin, Jindra, Pavel, Jiří, Glenthøj, Andreas, Fazzi, Rita, de Ramón, Cristina, Cattaneo, Chiara, Calbacho, Maria, Bahr, Nathan, El-Ashwl, Shaimaa Saber, Córdoba, Raúl, Hanakova, Michaela, Zambrotta, Giovanni, Sciumè, Mariarita, Booth, Stephen, Nunes-Rodrigues, Raquel, Sacchi, Maria Vittoria, GarcÍA-PoutÓN, Nicole, MartÍN-GonzÁLez, Juan-Alberto, Khostelidi, Sofya, GrÄFe, Stefanie, Rahimli, Laman, busca, alessandro, Corradini, Paolo, Hoenigl, Martin, Klimko, Nikolai, Koehler, Philipp, Pagliuca, Antonio, Passamonti, Francesco, Cornely, Oliver, pagano, Livio.
EuropePMC;
Preprint in English | EuropePMC | ID: ppcovidwho-328805

ABSTRACT

Patients with acute myeloid leukemia (AML) are at high risk of mortality from coronavirus disease 2019 (COVID-19). The optimal management of AML patients with COVID-19 has not been established. Our multicenter study included 388 adult AML patients with COVID-19 diagnosis between February 2020 and October 2021. The vast majority were receiving or had received AML treatment in the prior 3 months. COVID-19 was severe in 41.2% and critical in 21.1% of cases. The chemotherapeutic schedule was modified in 174 patients (44.8%), delayed in 68 and permanently discontinued in 106. After a median follow-up of 325 days, 180 patients (46.4%) had died. Death was attributed to COVID-19 (43.3%), AML (26.1%) or to a combination of both (26.7%). Active disease, older age, and treatment discontinuation were associated with death, whereas AML treatment delay was protective. Seventy-nine patients had a simultaneous AML and COVID-19 diagnosis, with an improved survival when AML treatment could be delayed. Patients with COVID-19 diagnosis between January and August 2020 had a significantly lower survival. COVID-19 in AML patients was associated with a high mortality rate and modifications of therapeutic algorithms. The best approach to improve survival was to delay AML treatment.

4.
Blood Adv ; 6(3): 774-784, 2022 02 08.
Article in English | MEDLINE | ID: covidwho-1542101

ABSTRACT

Recent studies have shown a suboptimal humoral response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) messenger RNA (mRNA) vaccines in patients diagnosed with hematologic malignancies; however, data about cellular immunogenicity are scarce. The aim of this study was to evaluate both the humoral and cellular immunogenicity 1 month after the second dose of the mRNA-1273 vaccine. Antibody titers were measured by using the Elecsys and LIAISON anti-SARS-CoV-2 S assays, and T-cell response was assessed by using interferon-γ release immunoassay technology. Overall, 76.3% (184 of 241) of patients developed humoral immunity, and the cellular response rate was 79% (184 of 233). Hypogammaglobulinemia, lymphopenia, active hematologic treatment, and anti-CD20 therapy during the previous 6 months were associated with an inferior humoral response. Conversely, age >65 years, active disease, lymphopenia, and immunosuppressive treatment of graft-versus-host disease (GVHD) were associated with an impaired cellular response. A significant dissociation between the humoral and cellular responses was observed in patients treated with anti-CD20 therapy (the humoral response was 17.5%, whereas the cellular response was 71.1%). In these patients, B-cell aplasia was confirmed while T-cell counts were preserved. In contrast, humoral response was observed in 77.3% of patients undergoing immunosuppressive treatment of GVHD, whereas only 52.4% had a cellular response. The cellular and humoral responses to the SARS-CoV-2 mRNA-1273 vaccine in patients with hematologic malignancies are highly influenced by the presence of treatments such as anti-CD20 therapy and immunosuppressive agents. This observation has implications for the further management of these patients.


Subject(s)
COVID-19 , Hematologic Neoplasms , 2019-nCoV Vaccine mRNA-1273 , Aged , Antibodies, Neutralizing , Antibodies, Viral , BNT162 Vaccine , COVID-19 Vaccines , Hematologic Neoplasms/therapy , Humans , Immunogenicity, Vaccine , RNA, Messenger/genetics , SARS-CoV-2
6.
J Hematol Oncol ; 14(1): 168, 2021 10 14.
Article in English | MEDLINE | ID: covidwho-1468074

ABSTRACT

BACKGROUND: Patients with hematological malignancies (HM) are at high risk of mortality from SARS-CoV-2 disease 2019 (COVID-19). A better understanding of risk factors for adverse outcomes may improve clinical management in these patients. We therefore studied baseline characteristics of HM patients developing COVID-19 and analyzed predictors of mortality. METHODS: The survey was supported by the Scientific Working Group Infection in Hematology of the European Hematology Association (EHA). Eligible for the analysis were adult patients with HM and laboratory-confirmed COVID-19 observed between March and December 2020. RESULTS: The study sample includes 3801 cases, represented by lymphoproliferative (mainly non-Hodgkin lymphoma n = 1084, myeloma n = 684 and chronic lymphoid leukemia n = 474) and myeloproliferative malignancies (mainly acute myeloid leukemia n = 497 and myelodysplastic syndromes n = 279). Severe/critical COVID-19 was observed in 63.8% of patients (n = 2425). Overall, 2778 (73.1%) of the patients were hospitalized, 689 (18.1%) of whom were admitted to intensive care units (ICUs). Overall, 1185 patients (31.2%) died. The primary cause of death was COVID-19 in 688 patients (58.1%), HM in 173 patients (14.6%), and a combination of both COVID-19 and progressing HM in 155 patients (13.1%). Highest mortality was observed in acute myeloid leukemia (199/497, 40%) and myelodysplastic syndromes (118/279, 42.3%). The mortality rate significantly decreased between the first COVID-19 wave (March-May 2020) and the second wave (October-December 2020) (581/1427, 40.7% vs. 439/1773, 24.8%, p value < 0.0001). In the multivariable analysis, age, active malignancy, chronic cardiac disease, liver disease, renal impairment, smoking history, and ICU stay correlated with mortality. Acute myeloid leukemia was a higher mortality risk than lymphoproliferative diseases. CONCLUSIONS: This survey confirms that COVID-19 patients with HM are at high risk of lethal complications. However, improved COVID-19 prevention has reduced mortality despite an increase in the number of reported cases.


Subject(s)
COVID-19/complications , Hematologic Neoplasms/complications , Adult , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/therapy , Europe/epidemiology , Female , Hematologic Neoplasms/epidemiology , Hematologic Neoplasms/therapy , Hospitalization , Humans , Intensive Care Units , Male , Middle Aged , Registries , Risk Factors , SARS-CoV-2/isolation & purification , Young Adult
7.
Ther Adv Med Oncol ; 13: 17588359211042224, 2021.
Article in English | MEDLINE | ID: covidwho-1394385

ABSTRACT

BACKGROUND: Specialist palliative care team (SPCT) involvement has been shown to improve symptom control and end-of-life care for patients with cancer, but little is known as to how these have been impacted by the COVID-19 pandemic. Here, we report SPCT involvement during the first wave of the pandemic and compare outcomes for patients with cancer who received and did not receive SPCT input from multiple European cancer centres. METHODS: From the OnCovid repository (N = 1318), we analysed cancer patients aged ⩾18 diagnosed with COVID-19 between 26 February and 22 June 2020 who had complete specialist palliative care team data (SPCT+ referred; SPCT- not referred). RESULTS: Of 555 eligible patients, 317 were male (57.1%), with a median age of 70 years (IQR 20). At COVID-19 diagnosis, 44.7% were on anti-cancer therapy and 53.3% had ⩾1 co-morbidity. Two hundred and six patients received SPCT input for symptom control (80.1%), psychological support (54.4%) and/or advance care planning (51%). SPCT+ patients had more 'Do not attempt cardio-pulmonary resuscitation' orders completed prior to (12.6% versus 3.7%) and during admission (50% versus 22.1%, p < 0.001), with more SPCT+ patients deemed suitable for treatment escalation (50% versus 22.1%, p < 0.001). SPCT involvement was associated with higher discharge rates from hospital for end-of-life care (9.7% versus 0%, p < 0.001). End-of-life anticipatory prescribing was higher in SPCT+ patients, with opioids (96.3% versus 47.1%) and benzodiazepines (82.9% versus 41.2%) being used frequently for symptom control. CONCLUSION: SPCT referral facilitated symptom control, emergency care and discharge planning, as well as high rates of referral for psychological support than previously reported. Our study highlighted the critical need of SPCTs for patients with cancer during the pandemic and should inform service planning for this population.

8.
Blood ; 136(Supplement 1):30-31, 2020.
Article in English | PMC | ID: covidwho-1339058

ABSTRACT

INTRODUCTION: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic raises many questions about the management of patients with significant comorbidities. Hematologic patients are usually fragile due to an important immunosuppression, so the impact of coronavirus disease (COVID-19) is yet to be determined.MATERIALS AND METHODS: We conducted a single-center retrospective observational study of patients with hematologic malignancies diagnosed with SARS-CoV-2 at Vall d´Hebron University Hospital (HUVH) between March 1st and May 31st 2020 to analyze their clinical characteristics and evolution. Patient's demographic data, underlying pathology, signs and symptoms of COVID-19, treatment received and clinical course were collected. A statistical analysis was performed to identify the possible variables associated with COVID-19 mortality. For this purpose, we used univariate and multivariable logistic regression models.RESULTS: We identified 70 patients with PCR confirmed SARS-CoV-2 infection and hematologic malignancy. The median age was 75 years (range 22-91), and 44% were female. The majority (74%) had evidence of active malignancy and 53% were receiving active therapy. Lymphoid pathology (73%) predominated over myeloid. The median number of previous lines of treatment was 0 (range 0-6), 23% had received at least 2 lines, whereas 10% underwent hematopoietic stem cell transplantation (HSCT) (5 patients allo-HSCT, 2 auto-HSCT). Half of the patients had more than one pre-existing comorbidity (17% obstructive pulmonary disease).At diagnosis the most common symptoms were fever (76%), cough (60%) and dyspnea (31%). We observed that 58% of patients presented a chest X-ray compatible with COVID-19. Regarding laboratory parameters, stood out lymphopenia (65% of patients presented <1200 lymphocytes/mm3) and elevation of inflammation parameters, such as D-dimer (median 365 ng/mL, range 50-5860), ferritin (median 1063 ng/mL, range 73-14191), IL-6 (median 59,6 pg/mL, range 3-4079) and PCR (median 11,2 mg/dL, range 0,3-79,9). Empirical therapy for COVID-19 included antibiotics (78%), anti-virals (50%, 3% remdesivir), and hydroxychloroquine (88%). Only 24% received tocilizumab, 50% heparin (33% prophylactic dose), 12% G-CSF, 9% norepinephrine, 4% corticosteroids and 1% ß-IFN. Most of patients (73%) required oxygen therapy: 36% high-flow, 29% low flow and 8% endotracheal intubation. There were 6 patients who did not receive any treatment.COVID-19 was acquired via nosocomial infection in 23% of patients, 91% of them requiring hospitalization, 14% in the Intensive Care Unit (ICU). The median days of hospitalization since diagnosis was 17 (range 3-55). The case fatality rate (CFR) from COVID-19 was higher in hematologic patients than the one observed in non-hematologic patients at the HUVH (figure 1), being of 41% at 11 days from diagnosis. CFR was higher in patients older than 75 years old (61%), while the mortality among patients receiving active therapy was 42%. The main cause of death was acute respiratory failure (93%). In the univariate logistic regression model, age >75 years (OR 1.07;p=0.008), active malignancy (OR 5;p=0,02), >1 comorbidity (OR 5.3;p=0,049) and high levels of IL-6 (OR 8.2;p= 0.005) were statistically significant. In the multivariable logistic regression model, age ≥75 years (OR 4.4;p=0.01) and IL-6 levels at baseline >59.6 pg/mL (OR 7.2;p=0.01) were associated with a higher mortality (table 1). The presence of an active malignancy was not a significant variable in the multivariable logistic regression model.CONCLUSIONS: Patients with hematologic malignancies and COVID-19 presented similar symptoms, signs and radiological characteristics to those described in the general population at diagnosis. In our cohort, advanced age and high IL-6 values were associated with higher mortality. Furthermore, it was observed that active hematologic disease is a factor of poor prognosis of COVID-19.

SELECTION OF CITATIONS
SEARCH DETAIL