COVID-19 Severity and Survival over Time in Patients with Hematologic Malignancies: A Population-Based Registry Study
Abstract
:Simple Summary
Abstract
1. Introduction
2. Material and Methods
2.1. Study Design and Participants
2.2. Data Collection and End Points
2.3. Statistical Analyses
3. Results
3.1. Patients
3.2. COVID-19 Diagnosis and Treatment
3.3. Comparison between the Early and Later Cohorts
3.4. Factors Associated with COVID-19 Severity
3.5. Factors Associated with Mortality
3.6. Comparison between HM and Non-Cancer Inpatients with COVID-19
3.7. Post COVID-19 Condition
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Patients with Hematologic Malignancies, N = 1166 | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
Total | Lymphoid Malignancies | Myeloid Malignancies | ||||||||
NHL | MM | CLL | HL | ALL | MDS | AML | CML | Ph-MPN | ||
Patients, n (%) | 1166 (100) | 325 (27.9) | 263 (22.6) | 175 (15.0) | 50 (4.3) | 26 (2.2) | 115 (9.9) | 92 (7.9) | 33 (2.8) | 87 (7.5) |
Age, y | N = 1147 | n = 322 | n = 253 | n = 174 | n = 49 | n = 26 | n = 113 | n = 91 | n = 32 | n = 87 |
Median (IQR) | 71 (59–79) | 69 (57–76) | 72 (63–79) | 74 (63–82) | 57 (42–71) | 47 (33–59) | 79 (71–84) | 65 (50–75) | 64 (54–84) | 72 (65–82) |
Sex, n (%) | N = 1152 | n = 321 | n = 261 | n = 175 | n = 49 | n = 26 | n = 113 | n = 91 | n = 33 | n = 83 |
Female | 464 (40.3) | 136 (42.4) | 108 (41.4) | 61 (34.9) | 18 (36.7) | 8 (30.8) | 41 (36.3) | 46 (50.5) | 8 (24.2) | 28 (34) |
Male | 688 (59.7) | 185 (57.6) | 153 (58.6) | 114 (65.1) | 31 (63.3) | 18 (69.2) | 72 (63.7) | 45 (49.5) | 25 (75.8) | 55 (66) |
Comorbidity count | N = 1166 | n = 325 | n = 263 | n = 175 | n = 50 | n = 26 | n = 115 | n = 92 | n = 33 | n = 87 |
0 | 314 (26.9) | 96 (29.4) | 62 (23.6) | 44 (25.1) | 13 (26.0) | 15 (57.7) | 22 (19.1) | 33 (35.9) | 11 (33.3) | 18 (20.7) |
1 | 484 (41.5) | 140 (43.1) | 102 (38.8) | 77 (44.0) | 18 (36.0) | 8 (30.8) | 50 (43.5) | 40 (43.5) | 9 (27.3) | 40 (46.0) |
≥2 | 368 (31.6) | 89 (27.4) | 99 (37.6) | 54 (30.9) | 19 (38) | 3 (11.6) | 43 (37.4) | 19 (20.7) | 13 (39.4) | 29 (33.3) |
Stem cell transplantation, * n (%) | N = 1127 | n = 312 | n = 259 | n = 168 | n = 47 | n = 24 | n = 112 | n = 92 | n = 32 | n = 81 |
Autologous | 100 (8.9) | 23 (7.4) | 66 (25.5) | 0 | 7 (14.9) | 1 (4.2) | 1 (0.9) | 2 (2.2) | 0 | 0 |
Allogeneic | 56 (5.0) | 5 (1.6) | 3 (1.2) | 1 (0.6) | 4 (8.5) | 9 (37.5) | 9 (8.0) | 25 (27.2) | 0 | 0 |
No | 971 (86.2) | 284 (91.0) | 190 (73.4) | 167 (99.4) | 36 (76.6) | 14 (58.3) | 102 (91.1) | 65 (70.7) | 32 (100) | 81 (100) |
Cancer therapy, within 30 d, † n (%) | N = 1162 | n = 325 | n = 260 | n = 175 | n = 50 | n = 26 | n = 115 | n = 92 | n = 33 | n = 86 |
Active therapy | 679 (58.4) | 178 (54.8) | 190 (73.1) | 55 (31.4) | 24 (48.0) | 16 (61.5) | 50 (43.5) | 61 (66.3) | 29 (87.9) | 76 (88.4) |
Conventional chemotherapy | 260 (22.4) | 112 (34.5) | 82 (31.5) | 3 (1.7) | 17 (34.0) | 13 (50.0) | 2 (1.7) | 31 (33.7) | 0 | 0 |
Low-intensity chemotherapy | 71 (6.1) | 4 (1.2) | 8 (3.1) | 3 (1.7) | 0 | 1 (3.8) | 3 (2.6) | 0 | 4 (12.1) | 48 (55.8) |
Molecular-targeted therapy | 130 (11.2) | 13 (4.0) | 20 (7.7) | 43 (24.6) | 0 | 1 (3.8) | 1 (0.9) | 5 (5.4) | 24 (72.7) | 23 (26.7) |
Immunotherapy, mAb only ‡ | 56 (4.8) | 38 (11.7) | 10 (3.8) | 3 (1.7) | 4 (8.0) | 1 (3.8) | 0 | 0 | 0 | 0 |
Immunomodulator drugs | 71 (6.1) | 1 (0.3) | 69 (26.5) | 0 | 0 | 0 | 1 (0.9) | 0 | 0 | 0 |
Hypomethylating agents | 49 (4.2) | 1 (0.3) | 0 | 0 | 0 | 0 | 24 (20.9) | 24 (26.1) | 0 | 0 |
Supportive therapy | 31 (2.7) | 5 (1.5) | 0 | 2 (1.1) | 0 | 0 | 19 (16.5) | 0 | 0 | 5 (5.8) |
Active, not detailed | 11 (0.9) | 4 (1.2) | 1 (0.4) | 1 (0.6) | 3 (6.0) | 0 | 0 | 1 (1.1) | 1 (3.0) | 0 |
No active therapy | 483 (41.6) | 147 (45.2) | 70 (26.9) | 120 (68.6) | 26 (52.0) | 10 (38.5) | 65 (56.5) | 31 (33.7) | 4 (12.1) | 10 (11.6) |
Survival Estimate, % (95% CI) | Hazard Ratio (95% CI) | |||
---|---|---|---|---|
30-d | 60-d | Unadjusted | Adjusted * | |
All patients † | 68.4 (65.3–71.3) | 56.3 (52.6–59.9) | ||
Age | ||||
Age 18–49 y | 93.7 (86.6–97.1) | 90.1 (80.8–95.1) | reference | reference |
Age 50–79 y | 72.8 (68.9–76.2) | 58.8 (54.0–63.3) | 3.59 (2.01–6.42) | 3.01 (1.67–5.43) |
Age ≥ 80 y | 46.3 (39.8–52.5) | 35.1 (28.3–42.0) | 7.86 (4.36–14.2) | 6.24 (3.39–11.49) |
Sex | ||||
Female | 69.5 (64.5–74.0) | 60.0 (54.2–65.4) | reference | reference |
Male | 67.4 (63.3–71.2) | 53.6 (48.6–58.3) | 1.12 (0.91–1.38) | 1.15 (0.93–1.41) |
Comorbidities | ||||
0 | 79.3 (73.5–84.0) | 69.7 (62.3–76.0) | reference | reference |
1 | 70.9 (66.1–75.1) | 56.3 (50.4–61.7) | 1.49 (1.12–1.98) | 1.10 (0.83–1.48) |
2 | 61.4 (53.7–68.2) | 49.7 (41.0–57.9) | 1.89 (1.37–2.61) | 1.15 (0.82–1.61) |
≥3 | 50.4 (41.4–58.7) | 41.6 (32.0–51.0) | 2.57 (1.84–3.59) | 1.43 (1.01–2.03) |
Hematologic malignancy | ||||
NHL | 71.0 (64.9–76.2) | 57.2 (49.9–63.8) | reference | reference |
MM | 69.7 (62.9–75.5) | 57.3 (49.1–64.7) | 0.98 (0.73–1.32) | 0.83 (0.61–1.12) |
CLL | 59.1 (50.5–66.8) | 49.8 (39.8–59.0) | 1.37 (1.00–1.87) | 1.02 (0.74–1.41) |
HL | 73.0 (55.6–84.4) | 68.1 (49.0–81.3) | 0.77 (0.43–1.41) | 0.89 (0.49–1.64) |
ALL | 78.4 (52.2–91.3) | 47.0 (17.6–72.1) | 0.99 (0.46–2.13) | 2.31 (1.04–5.12) |
MDS | 59.4 (48.9–68.4) | 48.7 (37.2–59.3) | 1.46 (1.04–2.05) | 0.96 (0.68–1.37) |
AML | 63.8 (52.2–73.2) | 53.6 (41.3–64.3) | 1.41 (0.99–2.01) | 1.68 (1.17–2.40) |
CML | 81.8 (58.5–92.8) | 81.8 (58.5–92.8) | 0.58 (0.24–1.43) | 0.44 (0.18–1.08) |
Ph-MPN | 82.4 (71.0–89.6) | 66.4 (50.9–78.0) | 0.70 (0.43–1.13) | 0.51 (0.31–0.82) |
Stem cell transplantation ‡ | ||||
No | 65.7 (62.2–68.9) | 53.9 (49.8–57.8) | reference | reference |
Autologous | 85.3 (75.1–91.6) | 80.8 (68.7–88.6) | 0.58 (0.34–0.99) | 0.54 (0.31–0.95) |
Allogeneic | 86.2 (71.8–93.6) | 69.6 (51.2–82.2) | 0.35 (0.20–0.59) | 1.15 (0.64–2.07) |
Cancer therapy, within 30 d ¶ | ||||
No active therapy | 67.4 (62.3–71.9) | 58.7 (51.8–63.3) | reference | reference |
Active therapy | 69.0 (65.0–72.7) | 55.4 (50.6–60.1) | 1.08 (0.88–1.33) | 1.10 (0.89–1.36) |
Conventional chemotherapy | 66.4 (59.6–72.3) | 51.8 (44.0–59.2) | 1.16 (0.90–1.50) | 1.49 (1.14–1.93) |
Low-intensity chemotherapy | 76.8 (63.4–85.8) | 63.1 (46.1–76.1) | 0.80 (0.48–1.32) | 0.65 (0.39–1. 08) |
Molecular targeted therapy | 69.2 (59.4–77.1) | 60.4 (48.9–70.0) | 1.05 (0.75–1.47) | 1.02 (0.73–1.44) |
Immunotherapy, mAb only | 68.9 (53.2–80.2) | 47.7 (30.2–63.2) | 1.14 (0.72–1.80) | 1.40 (0.88–2.24) |
Immunomodulator drugs | 70.4 (56.8–80.5) | 58.2 (42.3–71.1) | 0.88 (0.56–1.39) | 0.84 (0.53–1.33) |
Hypomethylating agents | 64.6 (47.6–77.3) | 60.5 (42.8–74.3) | 1.46 (0.94–2.27) | 1.07 (0.68–1.67) |
Supportive therapy | 64.7 (43.1–79.8) | 41.2 (19.9–61.4) | 1.39 (0.79–2.46) | 0.90 (0.51–1.61) |
Time period of COVID-19 diagnosis | ||||
Early cohort (1st wave, February–June 2020) | 67.4 (63.7–70.8) | 56.3 (52.0–60.4) | reference | reference |
Later cohort (2nd/3rd wave, July 2020–February 2021) | 70.9 (64.9–76.1) | 55.8 (48.0–62.9) | 0.93 (0.73–1.17) | 0.99 (0.79–1.26) |
Care setting of COVID-19 treatment | ||||
Outpatient | 99.4 (95.5–99.9) | 93.8 (85.3–97.4) | reference | reference |
Inpatient | 62.1 (58.6–65.4) | 49.3 (45.2–53.2) | 10.8 (5.37–21.8) | 8.81 (4.37–17.8) |
Intensive care unit | 45.2 (38.9–51.2) | 28.0 (22.1–34.1) | 2.21 (1.80–2.71) | 2.42 (1.97–2.99) |
Pharmacologic therapies for COVID-19 ¶¶ | ||||
(Hydroxy)chloroquine | 67.7 (63.6–71.4) | 56.9 (52.2–61.2) | 1.00 (0.81–1.23) | 0.96 (0.77–1.19) |
Azithromycin | 67.7 (62.5–72.5) | 56.6 (50.3–62.3) | 1.06 (0.86–1.30) | 1.03 (0.83–1.27) |
Lopinavir/darunavir | 66.1 (60.9–70.7) | 56.1 (50.3–61.5) | 1.03 (0.84–1.26) | 1.09 (0.88–1.35) |
Remdesivir | 80.5 (68.2–88.4) | 61.5 (46.3–73.6) | 0.71 (0.46–1.08) | 0.84 (0.55–1.28) |
Tocilizumab | 66.3 (58.3–73.2) | 52.0 (43.1–60.1) | 1.07 (0.83–1.37) | 1.25 (0.96–1.62) |
Corticosteroids | 59.8 (55.4–63.8) | 45.2 (40.4–49.9) | 2.15 (1.71–2.69) | 2.06 (1.64–2.59) |
Oxygen support during COVID-19 treatment | ||||
No | 98 (94–99) | 91 (85–95) | reference | reference |
Low-flow oxygen support | 67.5 (63.0–71.6) | 57.7 (52.4–62.6) | 4.9 (3.09–7.62) | 3.68 (2.33–5.81) |
High-flow oxygen support or mechanical ventilation | 44.3 (37.9–50.4) | 26.8 (20.9–33.0) | 10.1 (6.4–15.9) | 8.52 (5.38–13.5) |
Clinical severity of COVID-19 | ||||
Mild | 96.1 (91.6–98.2) | 90.5 (82.3–95.7) | reference | reference |
Moderate | 92.9 (88.2–95.7) | 85.8 (78.9–90.6) | 1.45 (0.77–2.74) | 1.17 (0.62–2.22) |
Severe | 57.8 (52.5–62.8) | 46.8 (40.8–52.5) | 7.34 (4.26–12.7) | 5.64 (3.26–9.79) |
Critical | 40.9 (34.0–47.7) | 21.7 (15.7–28.4) | 12.4 (7.17–21.5) | 11.0 (6.32–19.2) |
Patients with COVID-19 Severity Data, N = 1131 | Odds Ratio (95% CI) | ||||
---|---|---|---|---|---|
Total, N = 1131* | Mild/Moderate, n = 508 | Severe/Critical, n = 623 | Unadjusted | Adjusted † | |
Age, y | n = 1112 | n = 491 | n = 621 | ||
Median (IQR) | 71 (60–79) | 66 (54–76) | 73 (65–82) | n/a | n/a |
Age 18–49 y, n (%) | 129 (11.6) | 88 (17.9) | 41 (6.6) | reference | reference |
Age 50–79 y, n (%) | 718 (64.6) | 318 (64.8) | 400 (64.4) | 2.70 (1.81–4.02) | 2.19 (1.44–3.33) |
Age ≥80 y, n (%) | 265 (23.8) | 85 (17.3) | 180 (29.0) | 4.54 (2.89–7.14) | 3.37 (2.08–5.46) |
Sex, n (%) | N = 1117 | n = 501 | n = 616 | ||
Female | 448 (40.1) | 212 (42.3) | 236 (38.3) | reference | reference |
Male | 669 (59.9) | 289 (57.7) | 380 (61.7) | 1.18 (0.93–1.50) | 1.16 (0.90–1.50) |
Comorbidity count | N = 1131 | n = 508 | n = 623 | ||
0 | 305 (27.0) | 181 (35.6) | 124 (19.9) | reference | reference |
1 | 469 (41.5) | 199 (39.2) | 270 (43.3) | 1.98 (1.48–2.65) | 1.53 (1.12–2.10) |
≥2 | 357 (31.6) | 128 (25.2) | 229 (36.8) | 2.61 (1.91–3.58) | 1.62 (1.14–2.30) |
Hematologic malignancy, n (%) | N = 1131 | n = 508 | n = 623 | ||
Lymphoid malignancy | 816 (72.1) | 386 (76.0) | 430 (69.0) | reference | reference |
Myeloid malignancy | 315 (27.9) | 122 (24.0) | 193 (31.0) | 1.42 (1.09–1.85) | 1.30 (0.98–1.72) |
NHL | 315 (27.9) | 165 (32.5) | 150 (24.1) | reference | reference |
MM | 258 (22.8) | 130 (25.6) | 128 (20.5) | 1.08 (0.78–1.51) | 0.97 (0.69–1.38) |
CLL | 169 (14.9) | 55 (10.8) | 114 (18.3) | 2.28 (1.54–3.37) | 2.02 (1.34–3.05) |
HL | 48 (4.2) | 24 (4.7) | 24 (3.9) | 1.10 (0.60–2.02) | 1.61 (0.82–3.16) |
ALL | 26 (2.3) | 12 (2.4) | 14 (2.2) | 1.28 (0.58–2.86) | 2.88 (1.22–6.82) |
MDS | 111 (9.8) | 41 (8.1) | 70 (11.2) | 1.81 (1.18–2.76) | 1.31 (0.82–2.11) |
AML | 91 (8.0) | 29 (5.7) | 62 (10.0) | 2.35 (1.44–3.85) | 3.13 (1.83–5.34) |
CML | 31 (2.7) | 21 (4.1) | 10 (1.6) | 0.52 (0.24–1.15) | 0.57 (0.24–1.32) |
Ph-MPN | 82 (7.3) | 31 (6.1) | 51 (8.2) | 1.81 (1.10–2.98) | 1.43 (0.84–2.42) |
Stem cell transplantation, ‡ n (%) | N = 1098 | n = 494 | n = 604 | ||
Autologous | 100 (9.1) | 65 (13.2) | 35 (5.8) | 0.39 (0.26–0.61) | 0.56 (0.35–0.90) |
Allogeneic | 56 (5.1) | 31 (6.3) | 25 (4.1) | 0.59 (0.34–1.02) | 1.02 (0.56–1.84) |
No | 942 (85.8) | 398 (80.6) | 544 (90.1) | reference | reference |
Cancer therapy, within 30 d, ¶ n (%) | N = 1131 | n = 508 | n = 623 | ||
No active therapy | 461 (41.8) | 208 (40.9) | 253 (40.6) | reference | reference |
Active therapy | 670 (59.2) | 300 (59.1) | 370 (59) | 1.01 (0.80–1.29) | 1.02 (0.79–1.31) |
Conventional chemotherapy | 255 (23) | 125 (24.6) | 130 (20.9) | 0.86 (0.63–1.16) | 1.05 (0.76–1.46) |
Low-intensity chemotherapy | 67 (6) | 28 (5.5) | 39 (6.3) | 1.15 (0.68–1.92) | 0.88 (0.51–1.52) |
Molecular-targeted therapy | 129 (11.4) | 56 (11.0) | 73 (11.7) | 1.07 (0.72–1.59) | 1.06 (0.70–1.61) |
Immunotherapy, mAb only | 56 (5) | 24 (4.7) | 32 (8.7) | 1.10 (0.63–1.92) | 1.21 (0.67–2.21) |
Immunomodulator drugs | 70 (6) | 33 (6.6) | 37 (5.9) | 0.92 (0.56–1.53) | 0.83 (0.49–1.41) |
Hypomethylating agents | 49 (4) | 16 (3.2) | 33 (5.3) | 1.70 (0.91–3.17) | 1.23 (0.65–2.33) |
Supportive therapy | 30 (2.7) | 11 (2.2) | 19 (3.1) | 1.42 (0.66–3.05) | 0.98 (0.51–1.52) |
Active, not detailed | 14 (1.2) | 7 (1.4) | 7 (1.1) | 0.69 (0.21; 2.2) | 0.60 (0.16–2.24) |
Early Cohort | Later Cohort | |||||
---|---|---|---|---|---|---|
Patients with Hematologic Malignancies n = 681 | Non-Cancer Inpatients n = 5227 | Odds Ratio (95% CI) | Patients with Hematologic Malignancies n = 215 | Non-Cancer Inpatients n = 5312 | Odds Ratio (95% CI) | |
Age, y | n = 207 | |||||
Median (IQR) | 72 (62–80) | 66 (53–68) | – | 72 (64–80) | 70 (57–81) | – |
Age ≥ 65 y, n (%) | 483 (70.9) | 2829 (54.1) | 2.68 (1.74–2.46) | 151 (73.0) | 3248 (61.1) | 1.71 (1.25–2.34) |
Sex, n (%) | n = 669 | n = 5218 | ||||
Female | 259 (38.7) | 2213 (42.4) | reference | 89 (41.4) | 2272 (42.8) | reference |
Male | 410 (61.3) | 3005 (57.6) | 1.17 (0.99–1.37) | 126 (58.6) | 3040 (57.2) | 1.06 (0.80–1.40) |
Patients matched by characteristics | n = 669 | n = 669 | n = 207 | n = 207 | ||
Age, y | ||||||
Median (IQR) | 72 (62–80) | 72 (62–80) | – | 72 (64–80) | 72 (64–80) | – |
Sex, n (%) | ||||||
Female | 259 (38.7) | 259 (38.7) | – | 84 (40.6) | 84 (40.6) | – |
Male | 410 (61.3) | 410 (61.3) | – | 123 (59.4) | 123 (59.4) | – |
Comorbidities | ||||||
Cardiac disease | 148 (22.1) | 420 (62.8) | 0.17 (0.13- 0.21) | 46 (22.2) | 138 (66.7) | 0.14 (0.09–0.22) |
Respiratory disease | 102 (15.2) | 143 (21.4) | 0.66 (0.50–0.88) | 34 (16.4) | 49 (23.7) | 0.63 (0.39–1.03) |
Renal disease | 81 (12.1) | 41 (6.1) | 2.11 (1.43–3.12) | 28 (13.5) | 7 (3.4) | 4.47 (1.91–10.5) |
Diabetes | 126 (18.8) | 145 (21.7) | 0.80 (0.62–1.05) | 45 (21.7) | 57 (27.5) | 0.73 (0.47–1.15) |
Hypertension | 291 (43.5) | 391 (58.4) | 0.55 (0.44–0.68) | 84 (40.6) | 129 (62.3) | 0.41 (0.28–0.61) |
Pharmacologic therapies for COVID-19 | ||||||
(Hydroxy)chloroquine | 590 (88.2) | 567 (84.8) | 1.34 (0.98–1.84) | 0 | 0 | n/a |
Azithromycin | 318 (47.5) | 343 (51.3) | 0.86 (0.69–1.07) | 27 (13.0) | 43 (20.8) | 0.57 (0.34–0.97) |
Lopinavir/darunavir | 383 (57.2) | 424 (63.4) | 0.77 (0.62–0.96) | 0 | 0 | n/a |
Remdesivir | 22 (3.3) | 3 (0.4) | 7.55 (2.25–25.3) | 53 (25.6) | 54 (26.1) | 0.98 (0.63–1.51) |
Tocilizumab | 131 (19.6) | 44 (6.6) | 3.46 (2.41–4.96) | 41 (19.8) | 35 (16.9) | 1.21 (0.74–2.00) |
Corticosteroids | 283 (42.3) | 172 (25.7) | 2.12 (1.68–2.67) | 191 (92.3) | 182 (87.9) | 1.64 (0.85–3.17) |
Oxygen support during COVID-19 treatment | ||||||
No or Low-flow oxygen support | 511 (76.4) | 575 (86.0) | reference | 107 (51.7) | 126 (60.9) | reference |
High-flow oxygen support or mechanical ventilation | 158 (23.6) | 94 (14.0) | 1.89 (1.43–2.51) | 100 (48.3) | 81 (39.1) | 1.45 (0.98–2.15) |
Inpatient 30-d mortality * | 216/669 (32.3) | 198/669 (29.6) | 1.13 (0.90–1.43) | 72/207 (34.8) | 26/207 (12.6) | 3.71 (2.25–6.13) |
Patients with PCC Data, N = 278 * | Odds Ratio (95% CI) | ||||
---|---|---|---|---|---|
Total, N = 278 | PCC, n = 76 | No PCC, n = 202 | Unadjusted | Adjusted † | |
Age, y | N = 276 | n = 200 | |||
Median (IQR) | 67 (54.5–76) | 69 (54–76) | 67 (54.5–75) | n/a | n/a |
Age 18–49 y, n (%) | 47 (17.0) | 11 (14.5) | 36 (18) | reference | reference |
Age 50–79 y, n (%) | 191 (69.2) | 54 (71.1) | 142 (71.0) | ||
Age ≥ 80 y, n (%) | 33 (12.0) | 11 (14.5) | 22 (11) | 1.64 (0.61–4.40) | 1.24 (0.42–3.69) |
Sex, n (%) | N = 271 | n = 72 | n = 199 | ||
Female | 149 (55.0) | 42 (58.3) | 107 (53.8) | reference | reference |
Male | 122 (45.0) | 30 (41.7) | 92 (46.2) | 1.20 (0.70–2.08) | 1.20 (0.69–2.08) |
Comorbidities | |||||
Number of 6 specified comorbidities | |||||
0 | 78 (28.1) | 16 (21.1) | 62 (30.7) | reference | reference |
≥1 | 200 (71.9) | 60 (79.0) | 140 (69.3) | 1.66 (0.89–3.11) | 1.57 (0.78–3.16) |
Other comorbidities | 144 (51.8) | 44 (57.9) | 100 (49.5) | 1.40 (0.82–2.39) | 1.36 (0.77–2.42) |
Hematologic malignancy | |||||
NHL | 83 (29.9) | 16 (21.1) | 67 (33.2) | reference | reference |
MM | 66 (23.7) | 21 (27.6) | 45 (22.3) | 1.95 (0.92–4.15) | 1.86 (0.85–4.05) |
CLL | 29 (10.4) | 10 (13.2) | 19 (9.4) | 2.20 (0.86–5.64) | 2.10 (0.81–5.44) |
HL | 16 (5.8) | 4 (5.3) | 12 (5.9) | 1.40 (0.38–4.90) | 1.06 (0.25–4.41) |
ALL | 3 (1.1) | 1 (1.3) | 2 (1) | 2.09 (0.18–24.5) | 2.16 (0.17–27.1) |
MDS | 23 (8.3) | 6 (7.9) | 17 (8.4) | 1.48 (0.50–4.35) | 1.47 (0.48–4.47) |
AML | 28 (10.1) | 8 (10.5) | 20 (9.9) | 1.68 (0.63–4.84) | 1.58 (0.58–4.30) |
CML | 7 (2.5) | 1 (1.3) | 6 (3.0) | 0.70 (0.08–6.21) | 0.58 (0.06–5.31) |
Ph-MPN | 23 (8.3) | 9 (11.8) | 14 (6.9) | 2.69 (0.99–7.31) | 2.02 (0.68–6.02) |
Stem cell transplantation ‡ | N = 274 | n = 72 | |||
No | 219 (79.9) | 59 (81.9) | 160 (79.2) | reference | reference |
Autologous | 35 (12.8) | 7 (9.7) | 28 (13.9) | 0.68 (0.28–1.64) | 0.68 (0.25–1.84) |
Allogeneic | 20 (7.3) | 6 (8.3) | 14 (6.9) | 2.16 (0.43–3.17) | 1.36 (0.46–4.05) |
Cancer therapy, within 30 d § | N = 276 | ||||
No active therapy | 105 (38.0) | 28 (36.8) | 77 (38.1) | reference | reference |
Active therapy | 173 (62.0) | 48 (63.2) | 125 (61.9) | 1.06 (0.61–1.82) | 0.95 (0.54–1.67) |
Conventional chemotherapy | 62 (22.5) | 17 (22.7) | 45 (22.4) | 1.04 (0.51–2.11) | 0.99 (0.47–2.08) |
Low-intensity chemotherapy | 16 (5.8) | 5 (6.7) | 11 (5.5) | 1.25 (0.40–3.92) | 0.98 (0.28–3.50) |
Molecular targeted therapy | 34 (12.3) | 11 (14.7) | 23 (11.4) | 1.32 (0.57–3.04) | 1.03 (0.42–2.56) |
Immunotherapy, mAb only | 16 (5.8) | 2 (2.7) | 14 (7.0) | 0.39 (0.08–1.84) | 0.41 (0.09–1.99) |
Immunomodulator drugs | 19 (6.9) | 4 (5.3) | 15 (7.5) | 0.73 (0.22–2.40) | 0.63 (0.19–2.11) |
Hypomethylating agents | 16 (5.8) | 4 (5.3) | 12 (6.0) | 0.92 (0.27–3.08) | 0.76 (0.21–2.71) |
Supportive therapy | 5 (1.8) | 2 (2.7) | 3 (1.5) | 1.83 (0.29–11.6) | 1.35 (0.20–9.02) |
Time period of COVID-19 diagnosis | |||||
Early cohort (1st wave, March–June 2020) | 209 (75.2) | 63 (82.9) | 146 (72.3) | reference | reference |
Later cohort (2nd/3rd wave, July 2020–February 2021) | 69 (24.8) | 13 (17.1) | 56 (27.7) | 0.54 (0.28–1.05) | 0.60 (0.30–1.20) |
Care setting of COVID-19 treatment | |||||
Outpatient | 72 (25.9) | 11 (14.5) | 61 (30.2) | reference | reference |
Inpatient | 206 (74.1) | 65 (85.5) | 141 (69.8) | 2.56 (1.26–5.18) | 2.37 (1.15–4.90) |
Intensive care unit | 44/206 (21.4) | 17/65 (26.2) | 27/141 (19.1) | 1.50 (0.75–2.99) | 1.59 (0.75–3.31) |
Pharmacologic therapies for COVID-19 | |||||
(Hydroxy)chloroquine | 181 (65.1) | 58 (76.3) | 123 (60.9) | 2.07 (1.14–3.80) | 1.91 (1.03–3.53) |
Azithromycin | 87 (31.3) | 26 (34.2) | 61 (30.2) | 1.20 (0.69–2.11) | 0.99 (0.54–1.80) |
Lopinavir/darunavir | 132 (47.5) | 46 (60.5) | 86 (42.6) | 2.07 (1.21–3.54) | 2.03 (1.16–3.56) |
Remdesivir | 31 (11.2) | 13 (17.1) | 18 (8.9) | 2.11 (0.98–4.55) | 2.26 (1.03–4.98) |
Tocilizumab | 54 (19.4) | 21 (27.6) | 33 (16.3) | 1.96 (1.05–3.66) | 1.97 (1.03–3.77) |
Corticosteroids | 138 (49.6) | 45 (59.2) | 93 (46.0) | 1.70 (1.00–2.90) | 1.68 (0.97–2.92) |
Oxygen support during COVID-19 treatment | |||||
No | 104 (37.4) | 24 (31.6) | 80 (39.6) | reference | reference |
Low-flow oxygen support | 133 (47.8) | 36 (47.4) | 97 (48.0) | 1.24 (0.68–2.24) | 1.24 (0.66–2.35) |
High-flow oxygen support or mechanical ventilation | 41 (14.7) | 16 (21.1) | 25 (12.4) | 2.13 (0.98–4.64) | 2.20 (0.98–4.94) |
Clinical severity of COVID-19 | N = 273 | n = 75 | n = 198 | ||
Mild | 69 (25.3) | 14 (18.7) | 55 (27.8) | reference | reference |
Moderate | 89 (32.6) | 22 (29.3) | 67 (33.8) | 1.29 (0.60–2.76) | 1.48 (0.66–3.37) |
Severe | 83 (30.4) | 24 (32.0) | 59 (29.8) | 1.60 (0.75–3.40) | 1.73 (0.77–3.90) |
Critical | 32 (11.7) | 15 (20.0) | 17 (8.6) | 3.47 (1.40–8.60) | 3.60 (1.35–9.62) |
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Martínez-López, J.; De la Cruz, J.; Gil-Manso, R.; Alegre, A.; Ortiz, J.; Llamas, P.; Martínez, Y.; Hernández-Rivas, J.-Á.; González-Gascón, I.; Benavente, C.; et al. COVID-19 Severity and Survival over Time in Patients with Hematologic Malignancies: A Population-Based Registry Study. Cancers 2023, 15, 1497. https://doi.org/10.3390/cancers15051497
Martínez-López J, De la Cruz J, Gil-Manso R, Alegre A, Ortiz J, Llamas P, Martínez Y, Hernández-Rivas J-Á, González-Gascón I, Benavente C, et al. COVID-19 Severity and Survival over Time in Patients with Hematologic Malignancies: A Population-Based Registry Study. Cancers. 2023; 15(5):1497. https://doi.org/10.3390/cancers15051497
Chicago/Turabian StyleMartínez-López, Joaquín, Javier De la Cruz, Rodrigo Gil-Manso, Adrián Alegre, Javier Ortiz, Pilar Llamas, Yolanda Martínez, José-Ángel Hernández-Rivas, Isabel González-Gascón, Celina Benavente, and et al. 2023. "COVID-19 Severity and Survival over Time in Patients with Hematologic Malignancies: A Population-Based Registry Study" Cancers 15, no. 5: 1497. https://doi.org/10.3390/cancers15051497