COVID-19 Mortality Rates Linked to Active Disease, ICU Deferral in AML, ALL, and MDS

Patients with acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), and myelodysplastic syndrome (MDS) had higher mortality rates after being diagnosed with COVID-19 than those with COVID-19 who did not have cancer, according to data from the American Society of Hematology Research Collaborative (ASH RC) Data Hub for Hematology.¹

The overall mortality rate from COVID-19 in the cohort of 257 patients with AML/ALL/MDS was 21%. Sixty percent of patients overall were hospitalized for COVID-19 infection; 1% of patients who died did not require hospitalization for COVID-19 compared with 34% who did. In patients who went to the intensive care unit (ICU), the mortality rate was 68%.

Additionally, the findings, which were presented during the 2021 ASH Annual Meeting, indicated that patients with both active disease and neutropenia at diagnosis were more likely to experience severe COVID-19 infection. However, those with active disease were not found to have increased mortality from the virus.

“The 2 factors that did impact COVID-19 mortality was having a primary disease prognosis of less than 6 months and deferral of ICU,” lead study author Pinkal Desai, MD, an assistant professor of medicine at Weill Cornell Medical College and assistant attending physician at NewYork-Presbyterian Hospital, said in a press briefing during the meeting. “Among hospitalized patients only, those with a pre–COVID-19 prognosis of less than 6 months and ICU deferral had higher COVID-19 mortality.”

Data are currently lacking on predictors of severe infection and outcomes with COVID-19 in patients with AML, ALL, and MDS. However, it is believed that those with active disease may experience poorer outcomes because of cytopenias and their overall prognosis. Additionally, Pinkal noted that single-center studies have demonstrated higher rates of COVID-19 infection severityand mortalityin patients with acute leukemia.

With the ASH RC Data Hub for Hematology, investigators sought to identify risk factors for severe COVID-19 infection and mortality in patients with AML, ALL, and MDS by utilizing the ASH RC COVID-19 Registry for Hematology.

The registry comprises the features and outcomes of confirmed or presumptive COVID-19 diagnoses in adult patients with ongoing or a history of hematologic disorders. Data collection was opened internationally on April 1, 2020, through a platform hosted by Prometheus Research, with data regularly updated on the ASH website.

Investigators analyzed patient characteristics, outcomes, and predictors, and stratification factors included disease status (active initial diagnosis vs relapsed/refractory vs remission) and type of hematologic cancer; variables were age, comorbidities, type of hematologic cancer (AML, ALL, or MDS), neutrophil and lymphocyte count, and active treatment at time of COVID-19 diagnosis. COVID-19 severity was considered mild (no hospitalization), moderate (hospitalization), or severe (ICU admission).

The primary end point of the research was mortality from COVID-19; COVID-19 severity served as a secondary end point.

Data comprised 257 patients overall with AML (n = 135; 53%), ALL (n = 82; 32%), and MDS (n = 40; 16%); 46% of patients were in remission and 44% had active disease; 10% of patients had unknown status. Nearly half (49%) of patients were younger than 60 years, 55% were male, and most patients (74%) had a major comorbidity. Seventy-five percent of patients had received systemic therapy in the previous year, and 72% had an estimated prognosis of more than 6 months. Also, most patients (78%) did not have deferred ICU.

In multivariable analyses, results showed that patients with active disease were found to be independently associated with severe COVID-19 (odds ratio [OR], 2.23; 95% CI, 1.18-4.29; P = .014). Furthermore, having neutropenia at diagnosis was also an independent association with severe COVID-19 (OR, 4.00; 95% CI, 2.24-10.60; P <.0001).

Additionally, in patients who had severe COVID-19, 67% had active disease compared with 33% who were in remission. In non-severe COVID-19 cases, 43% of patients had active disease and 57% of patients were in remission.

The variables associated with mortality among hospitalized patients with ALL/AML/MDS who had COVID-19 were having an estimated pre–COVID-19 diagnosis from the primary disease as less than 6 months (OR, 6.49; 95% CI, 2.12-22.57; P <.001) and having deferred ICU status (OR, 4.12; 95% CI, 1.53-11.63; P = .005).

“If desired by patients, aggressive support for hospitalized patients with COVID-19 is appropriate regardless of remission status,” Pinkal concluded.

_Reference

_{1. Desai P, Goldberg AG, Anderson KC, et al. Clinical predictors of outcome in adult patients with acute leukemias and myelodysplastic syndrome and COVID-19 infection: report from the American Society of Hematology Research Collaborative (ASH RC) Data Hub. Presented at: 2021 ASH Annual Meeting & Exposition; December 10-14, 2021; Atlanta, GA. Abstract 280.}