Outcome of sars-cov2 infection in hematological disorders: A tertiary-care cancer center experience

ABSTRACT

Aims & Objectives: We conducted a clinical audit of patients with hematological disorders and SARS-CoV2 infection. Patients/Materials & Methods: A prospective registry was established in April 2020 for patients from the department of clinical hematology and HCT who were diagnosed to be positive for SARSCoV2 by PCR test. Out patients creening was symptom/contact-exposure driven, and in patients creening was symptomaticorpreemptive. This study is a part of ASHCOVID19 International collaborative and an interim analysis of the institute registry data from April 15, 2020 to October 7, 2020. Results: 1201 new patients were registered and 9539 patient-visits were recorded in the out patient service of the department during this period. 91 (0.08%) patients tested positive for SARS-CoV2. Baseline characteristics of the patients are listed in Table 1. 56 (61.5%) patients needed hospitalization. The median absolute neutrophil count was 3700/cu.mm, while the median absolute lymphocyte count 900/cu.mm. Inflammatory markers (n = 21)median D-dimer was 2845 ng/ml (243-140643) and median CRP level was 14 mg/dl (3.3- 34). Therapy directed against SARS-CoV2 included, Azithromycin (n = 52,60.4%), Dexamethasone (27 patients,29.7%), Remdesivir (n = 10,11.1%) and doxycycline (n = 9,9.9%). 2(2.2%) patients received tocilizumab and 1 patient (1.1%) received convalescent plasma. On univariate analysis, none of the therapies seemed to affect outcomes. The SARS-CoV2 infection mortality was 15% (14/91). 2 patients died due to non-COVID related causes [tumor lysis syndrome (n = 1), leukocytostasis with CVA (n = 1)]. 7/45(15.5%) receiving anti-B-lymphocyte directed therapy died as compared to 7/46(15.21%) not receiving Anti-B-cell therapies. Patients with low grade B-NHL (5/16,31.25%) had the highest mortality rate followed by high grade B-NHL (7/23,30.4%).There was a trend to higher mortality in patients>50 years (12/45,26.6% in those[=50 years age as compared to 4/30,13.33% in those<50 years age). With data available until the date of censoring, most patients were diagnosed in August (n = 32,35.2%) with numbers tailing off in September (n = 20, 22%). Discussion & Conclusion: In our subset of patients with hematological disorders, SARS-COV2 infectivity was found to be low, hospitalization rate was moderate, and mortality was high and commoner in patients>50 yr and a B-cell lymphoma diagnosis. A more aggressive screening approach will potentially improveoutcomes.