Clinical outcomes and risk factors for severe COVID-19 in patients with haematological disorders receiving chemo- or immunotherapy

被引:51
作者
Fox, Thomas A. [1 ,2 ]
Troy-Barnes, Ethan [1 ]
Kirkwood, Amy A. [3 ]
Chan, Wei Yee [1 ,4 ]
Day, James W. [1 ,2 ]
Chavda, Selina J. [1 ,4 ]
Kumar, Emil A. [1 ,5 ]
David, Kate [6 ]
Tomkins, Oliver [1 ]
Sanchez, Emilie [6 ]
Scully, Marie [1 ,7 ]
Khwaja, Asim [1 ,4 ]
Lambert, Jonathan [1 ,7 ]
Singer, Mervyn [7 ,8 ]
Roddie, Claire [1 ,4 ,7 ]
Morris, Emma C. [1 ,2 ,7 ,9 ]
Yong, Kwee L. [1 ,4 ,7 ]
Thomson, Kirsty J. [1 ,7 ]
Ardeshna, Kirit M. [1 ,7 ]
机构
[1] Univ Coll London NHS Fdn Trust, Dept Haematol, London, England
[2] UCL Inst Immun & Transplantat, London, England
[3] UCL, UCL Canc Inst, CR UK & UCL Canc Trials Ctr, London, England
[4] UCL Canc Inst, Dept Haematol, London, England
[5] Queen Mary Univ London, Ctr Canc Genom & Computat Biol, Barts Canc Inst, London, England
[6] Univ Coll London NHS Fdn Trust, Dept Clin Virol, London, England
[7] UCLH NIHR Biomed Res Ctr, London, England
[8] UCL, Bloomsbury Inst Intens Care Med, London, England
[9] Royal Free London Hosp NHS Fdn Trust, Dept Immunol, London, England
关键词
Covid-19; chemotherapy; risk factors; CHEMOTHERAPY; CANCER;
D O I
10.1111/bjh.17027
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Haematology patients receiving chemo- or immunotherapy are considered to be at greater risk of COVID-19-related morbidity and mortality. We aimed to identify risk factors for COVID-19 severity and assess outcomes in patients where COVID-19 complicated the treatment of their haematological disorder. A retrospective cohort study was conducted in 55 patients with haematological disorders and COVID-19, including 52 with malignancy, two with bone marrow failure and one immune-mediated thrombotic thrombocytopenic purpura (TTP). COVID-19 diagnosis coincided with a new diagnosis of a haematological malignancy in four patients. Among patients, 82% were on systemic anti-cancer therapy (SACT) at the time of COVID-19 diagnosis. Of hospitalised patients, 37% (19/51) died while all four outpatients recovered. Risk factors for severe disease or mortality were similar to those in other published cohorts. Raised C-reactive protein at diagnosis predicted an aggressive clinical course. The majority of patients recovered from COVID-19, despite receiving recent SACT. This suggests that SACT, where urgent, should be administered despite intercurrent COVID-19 infection, which should be managed according to standard pathways. Delay or modification of therapy should be considered on an individual basis. Long-term follow-up studies in larger patient cohorts are required to assess the efficacy of treatment strategies employed during the pandemic.
引用
收藏
页码:194 / 206
页数:13
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