Clinical Outcomes in Patients With COVID-19 and Hematologic Disease

• Published in: Clinical lymphoma, myeloma and leukemia myeloma and leukemia, 2023-08, Vol.23 (8), p.589-598
• Main Authors: Aleshina, Olga A., Zakurdaeva, Kristina, Vasileva, Anastasia N., Dubov, Sergey K., Dubov, Vitaly S., Vorobyev, Vladimir I., Butaev, Lev S., Sukhareva, Alena M., Gavrilova, Lubov V., Toropova, Inessa Yu, Popova, Marina O., Siniaev, Aleksandr A., Kulagin, Aleksandr D., Kaplanov, Kamil D., Petrenko, Andrei A., Ochirova, Oksana I., Karpova, Alina, Chelysheva, Ekaterina Yu, Turkina, Anna G., Gurianova, Margarita A., Al-Radi, Liubov S., Gilyazitdinova, Elena A., Egorova, Elena K., Chabaeva, Yulia A., Kulikov, Sergey M., Sveshnikova, Yulia V., Kunst, Mikhail A., Shuvaev, Vasily, Rakhmani, Anzhelika F., Panteleeva, Olga L., Grishunina, Maria E., Samoylova, Olga S., Vorontsova, Ekaterina, Baryshnikova, Daria V., Parovichnikova, Elena N.
• Format: Article
• Language: English
• Subjects: Aged; COVID-19 - complications; Female; Hematologic Diseases - etiology; Humans; Leukemia; Lymphomas; Male; Middle Aged; Mortality; Pandemics; Prospective Studies; Risk factors; SARS-CoV-2
• ISSN: 2152-2650; 2152-2669
• DOI: 10.1016/j.clml.2023.04.002

•Patients with hematologic disease and COVID-19 have high all-cause mortality at short-term follow-up, predominantly due to COVID-19 complications.•Patients with nonmalignant hematologic disease, remission of any hematologic disease, as well as no concomitant conditions have a more favorable prognosis.•At a longer follow-up, no significant impact of COVID-19 on the course of a hematologic disease was demonstrated.•Prevention of SARS-CoV-2 is a crucial part of successful hematologic disease management during the ongoing COVID-19 pandemic. Patients with hematologic diseases are at higher risk of the SARS-CoV-2 infection and more severe clinical outcomes of the coronavirus disease. CHRONOS19 is an observational prospective cohort study with the aim to determine the short and longer-term clinical outcomes, risk factors for disease severity and mortality, and rates of postinfectious immunity in patients with malignant and nonmalignant hematologic diseases and COVID-19. : Overall, 666 patients were enrolled in the study, of which 626 were included in the final data analysis. The primary endpoint was 30-days all-cause mortality. Secondary endpoints included COVID-19 complications, rates of ICU admission and mechanical ventilation, outcomes of a hematologic disease in SARS-CoV-2 infected patients, overall survival, and risk factors for disease severity and mortality. Data from 15 centers were collected at 30, 90, and 180 days after COVID-19 was diagnosed and were managed using a web-based e-data capture platform. All evaluations were performed in the pre-omicron period of COVID-19 pandemic. Thirty-days all-cause mortality was 18.9%. The predominant cause of death (in 80% of cases) were COVID-19 complications. At 180 days, the majority (70%) of additional deaths were due to hematologic disease progression. At a median follow-up of 5.7 [0.03-19.04] months, 6-months overall survival was 72% [95% CI: 0.69-0.76]. One-third of patients had severe SARS-CoV-2 disease. The rate of ICU admission was 22% with 77% of these patients requiring mechanical ventilation, with poor survival rate. A univariate analysis revealed that older age (≥ 60 years), male sex, malignant hematologic disease, myelotoxic agranulocytosis, transfusion dependence, refractory disease or relapse, diabetes among comorbidities, any complications, especially ARDS alone or in combination with CRS, admission to an ICU, and mechanical ventilation were associated with higher risks of mortality. Treatment of t