Risks for Hospitalization and Death Among Patients with Blood Disorders from the ASH RC COVID-19 Registry for Hematology

ABSTRACT

INTRODUCTION: Patients (pts) with blood disorders are at particular risk for severe infection and death from COVID-19. Factors that contribute to this risk, including cancer treatment, have not been clearly delineated. The ASH RC COVID-19 Registry for Hematology is a public-facing, volunteer registry reporting outcomes of COVID-19 infection in pts with underlying blood disorders. We report a multivariable analysis of the impact of cancer treatment and other key variables on COVID-19 mortality and hospitalization among pts with blood cancer. METHODS: Data were collected between April 1, 2020, and July 2, 2021. All analyses were performed using R version 4.0.2. Multivariable logistic regression explored associations between mortality and seven patient/disease factors previously reported as important to COVID-19 outcome. Independent variables included age (>60);sex;presence of a major comorbidity (defined as any of heart disease, hypertension, pulmonary disease and/or diabetes);type of hematologic malignancy;estimated prognosis of < 6 months prior to COVID-19;deferral of ICU care;and administration of cancer treatment in the previous year (excluding single agent hydroxyurea). A secondary multivariable logistic regression explored associations between the same variables and hospitalization with COVID-19. RESULTS: We included all pts in the registry with a malignant diagnosis except for 3 patients excluded based on a data sharing agreement (N=1029). Median age category was 50-59y (range <5y to > 90y). The sample was 42% female and 28% had major comorbidities. Types of hematologic malignancies were 354 (34%) acute leukemia/MDS, 255 (25%) lymphoma, 206 (20%) plasma cell dyscrasia (myeloma/amyloid/POEMS), 116 (11%) CLL, 98 (10%) myeloproliferative neoplasm (MPN). Most pts (73%) received cancer treatment during the previous year, 9% had a pre-COVID-19 prognosis of <6months, and 10% deferred ICU care. COVID-19 mortality in the entire cohort was 17%. In multivariable analyses, age > 60 (OR 2.03, 1.31-3.18), male sex (OR 1.69, 1.11 - 2.61), estimated pre-COVID-19 prognosis of less than 6 months (OR 6.16, 3.26 - 11.70) and ICU deferral (OR 10.87, 6.36 - 18.96) were all independently associated with an increased risk of death. Receiving cancer treatment in the year prior to COVID-19 diagnosis and type of hematologic malignancy were not significantly associated with death. In multivariable analyses, age > 60 (OR 2.46, 1.83 - 3.31), male sex (OR 1.34, 1.02 - 1.76), estimated pre-COVID-19 prognosis of < 6 months (OR 4.81, 2.45 - 10.50), presence of a major comorbidity (OR 1.57, 1.15 - 2.16), and cancer treatment in the previous year (OR 1.50, 1.10 - 2.06) were all independently associated with an increased risk of a severe COVID-19 requiring hospitalization. Pts with a MPN or plasma cell dyscrasia and COVID-19 were less likely to require hospitalization for COVID-19 compared to patients with CLL, leukemia/MDS, or lymphoma. CONCLUSIONS: These analyses confirm the negative impact of age > 60, male sex, pre-COVID-19 prognosis of < 6 months, and deferral of ICU care on mortality among patients with hematologic malignancy and COVID-19. We did not observe an increased risk of COVID-19 mortality among pts with COVID-19 who received blood cancer treatment in the previous year, although rate of hospitalization was higher. Pts with some hematologic malignancies (MPN, plasma cell dyscrasias), may experience less severe COVID-19 infections than others. Disclosures Anderson Celgene Membership on an entity's Board of Directors or advisory committees;Millenium-Takeda Membership on an entity's Board of Directors or advisory committees;Gilead Membership on an entity's Board of Directors or advisory committees;Janssen Membership on an entity's Board of Directors or advisory committees;Sanofi-Aventis Membership on an entity's Board of Directors or advisory committees;Bristol Myers Squibb Membership on an entity's Board of Directors or advisory committees;Pfizer Membership on an entity's Board of Directors or advisory committees;Scientific Founder of Oncopep and C4 Therapeutics Current equity holder in publicly-traded company, Current holder of individual stocks in a privately-held company;AstraZeneca Membership on an entity's Board of Directors or advisory committees;Mana Therapeutics Membership on an entity's Board of Directors or advisory committees. Desai Janssen R&D Research Funding;Astex Research Funding;Kura Oncology Consultancy;Agios Consultancy;Bristol Myers Squibb Consultancy;Takeda Consultancy. Goldberg Celularity Research Funding;Genentech Consultancy, Membership on an entity's Board of Directors or advisory committees;Astellas Consultancy, Membership on an entity's Board of Directors or advisory committees;Aptose Consultancy, Research Funding;Prelude Therapeutics Research Funding;DAVA Oncology Honoraria;Pfizer Research Funding;Arog Research Funding;Aprea Research Funding;AbbVie Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding. Neuberg Madrigal Pharmaceuticals Other Stock ownership;Pharmacyclics Research Funding. Radhakrishnan Janssen India Honoraria;Dr Reddy's Laboratories Honoraria, Membership on an entity's Board of Directors or advisory committees;Aurigene Speakers Bureau;Novartis Honoraria;Johnson and Johnson Honoraria;Pfizer Consultancy, Honoraria;Astrazeneca Consultancy, Honoraria;Emcure Pharmaceuticals Other payment to institute;Cipla Pharmaceuticals Honoraria, Other payment to institute;Bristol Myers Squibb Other payment to institute;Roche Honoraria, Other payment to institute;Intas Pharmaceutical Other payment to institute;NATCO Pharmaceuticals Research Funding. Sehn Genmab Consultancy;Debiopharm Consultancy;Novartis Consultancy. Sekeres Novartis Membership on an entity's Board of Directors or advisory committees;Takeda/Millenium Membership on an entity's Board of Directors or advisory committees;BMS Membership on an entity's Board of Directors or advisory committees. Tallman Kura Membership on an entity's Board of Directors or advisory committees;Syros Membership on an entity's Board of Directors or advisory committees;Innate Pharma Membership on an entity's Board of Directors or advisory committees;Novartis Membership on an entity's Board of Directors or advisory committees;Biosight Membership on an entity's Board of Directors or advisory committees;Roche Membership on an entity's Board of Directors or advisory committees;Jazz Pharma Membership on an entity's Board of Directors or advisory committees;Oncolyze Membership on an entity's Board of Directors or advisory committees;KAHR Membership on an entity's Board of Directors or advisory committees;Orsenix Membership on an entity's Board of Directors or advisory committees;Daiichi-Sankyo Membership on an entity's Board of Directors or advisory committees;Abbvie Membership on an entity's Board of Directors or advisory committees;Amgen Research Funding;Rafael Pharmaceuticals Research Funding;Glycomimetics Research Funding;Biosight Research Funding;Orsenix Research Funding;Abbvie Research Funding;NYU Grand Rounds Honoraria;Mayo Clinic Honoraria;UC DAVIS Honoraria;Northwell Grand Rounds Honoraria;NYU Grand Rounds Honoraria;Danbury Hospital Tumor Board Honoraria;Acute Leukemia Forum Honoraria;Miami Leukemia Symposium Honoraria;New Orleans Cancer Symposium Honoraria;ASH Honoraria;NCCN Honoraria.