COVID-19 pneumonia in patients with hematologic malignancies-a report from the us epicenter

ABSTRACT

Background: Limited data are available for risk assessment and outcome of COVID-19 in patients with hematologic malignancies (HM). We present a single center study of COVID-19 pneumonia in a cohort of 31 patients with HM. Methods: Data were abstracted from electronic medical records for patients admitted to NYPH between 3/5/20 and 4/17/20 and entered into a REDCap database. Results: Twenty (64.5%) were male;median age was 71 years. There were 8 patients with Multiple Myeloma (MM), 8 with Chronic Lymphocytic Leukemia (CLL), 6 (19.4%) had AML, 5 (16.1%) NHL, 2 (3.2%) ALL;CML, MDS and Polycythemia Vera occurred in 1 patient each. Twenty-four (77.4%) had active HM;6 (19.4%) were in remission;and 1 relapsed. Nineteen patients (61.3%) received recent chemotherapy and 11 (35.5%) immunosuppressive therapies. There were 7 (22.6%) hematopoietic stem cell transplant (HSCT) recipients (4 allogeneic and 3 autologous). Comorbidities were evenly distributed among all malignancies 18 (58.1%) had hypertension, 9 (38.7%) obesity, 7 (22.6%) diabetes mellitus, and 11 (35.5%) were former smokers. The most common symptoms included cough (90.3%), fever (83.9%) and dyspnea (61.3%);7 (22.6%) had nausea and vomiting;7 (22.6%) had diarrhea. On presentation, hypoxia (O2 sat ≤94% on room air) occurred in 64.5%;median ALC was 330/ml;23 (74.2%) had ALC< 1000/ml;median CRP was 15.9 mg/dl (2.5-40.4), ferritin 1162 ng/ml (264 - > 16500), and D-dimers 456 ng/ml (< 150-2418). Thirteen patients (41.9%) required ICU admission and were intubated;among those 9 (69.2%) had either MM or CLL. Co-infections were uncommon;two patients developed HSV1 pneumonitis and one of these also had CMV pneumonitis. Twenty-eight (90.3%) were treated with hydroxychloroquine, 5 (16.1%) remdesivir, 2 (6.5%) tocilizumab, 1 (3.2%) sarilumab, and 4 (12.9%) with methylprednisolone 0.5mg/kg Q12h. Seventeen patients (54.8%) recovered and were discharged, 12 (38.7%) died;2 (6.5%) were still hospitalized but left the ICU. Conclusion: In our cohort, there were predominantly more patients with MM and CLL and 56% of these were intubated;larger cohort studies will further define the risk and outcome for COVID-19 in patients with HM.