Impact of hematologic malignancy and type of cancer therapy on COVID-19 severity and mortality: lessons from a large population-based registry study.
Impact of hematologic malignancy and type of cancer therapy on COVID-19 severity and mortality: lessons from a large population-based registry study.
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DOI：
10.1186/s13045-020-00970-7
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发表时间：
2020-10-08
影响因子：
28.5
通讯作者：
Asociación Madrileña de Hematología y Hemoterapia (AMHH)
中科院分区：
文献类型：
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作者：
García-Suárez J;de la Cruz J;Cedillo Á;Llamas P;Duarte R;Jiménez-Yuste V;Hernández-Rivas JÁ;Gil-Manso R;Kwon M;Sánchez-Godoy P;Martínez-Barranco P;Colás-Lahuerta B;Herrera P;Benito-Parra L;Alegre A;Velasco A;Matilla A;Aláez-Usón MC;Martos-Martínez R;Martínez-Chamorro C;Susana-Quiroz K;Del Campo JF;de la Fuente A;Herráez R;Pascual A;Gómez E;Pérez-Oteyza J;Ruiz E;Alonso A;González-Medina J;Martín-Buitrago LN;Canales M;González-Gascón I;Vicente-Ayuso MC;Valenciano S;Roa MG;Monteliu PE;López-Jiménez J;Escobar CE;Ortiz-Martín J;Diez-Martin JL;Martinez-Lopez J;Asociación Madrileña de Hematología y Hemoterapia (AMHH)
与非癌症的新冠患者相比，癌症患者已被证明具有更高的临床严重程度和死亡风险。血液系统恶性肿瘤患者通常具有更高水平的免疫抑制，可能比实体肿瘤患者发生更严重的呼吸道病毒感染。血液系统恶性肿瘤患者感染新冠的数据有限。在此我们描述疾病严重程度和死亡率，并评估死亡的潜在预后因素。
在这项基于人群的注册研究中，我们收集了西班牙马德里地区成年血液系统恶性肿瘤患者的临床特征、治疗和结局的去识别化数据，这些患者确诊感染了严重急性呼吸综合征冠状病毒2（SARS - CoV - 2）。我们的病例系列包括2020年2月28日至5月25日期间入住22家地区卫生服务医院和5家私立医疗中心的所有患者。主要研究结局是全因死亡率。我们使用针对年龄、性别、合并症、血液系统恶性肿瘤和近期积极癌症治疗进行调整的考克斯回归分析来评估死亡率与潜在预后因素之间的关联。
在报告的833名患者中，697名被纳入分析。中位年龄为72岁（四分位距60 - 79），413名（60%）患者为男性，479名（69%）和218名（31%）分别患有淋巴系统和髓系恶性肿瘤。429名（62%）患者的新冠临床严重程度为重度/危重度。在数据截止时，230名（33%）患者已经死亡。年龄≥60岁（风险比3.17 - 10.1对比＜50岁）、＞2种合并症（1.41对比≤2种）、急性髓系白血病（2.22对比非霍奇金淋巴瘤）以及使用单克隆抗体的积极抗肿瘤治疗（2.02）与死亡率增加相关；常规化疗显示出临界显著性（1.50对比无积极治疗）。相反，费城染色体阴性的骨髓增殖性肿瘤（0.33）以及使用去甲基化药物的积极治疗（0.47）与较低死亡率相关。总体而言，574名（82%）患者接受了抗病毒治疗。未接受治疗与接受任何抗病毒联合治疗相比，重度/危重度新冠患者的死亡率更高（2.20）。
在这一系列血液系统恶性肿瘤合并新冠的患者中，死亡率与较高年龄、更多合并症、血液系统恶性肿瘤类型以及抗肿瘤治疗类型相关。需要进一步的研究和长期随访来验证这些风险分层标准。
Patients with cancer have been shown to have a higher risk of clinical severity and mortality compared to non-cancer patients with COVID-19. Patients with hematologic malignancies typically are known to have higher levels of immunosuppression and may develop more severe respiratory viral infections than patients with solid tumors. Data on COVID-19 in patients with hematologic malignancies are limited. Here we characterize disease severity and mortality and evaluate potential prognostic factors for mortality. In this population-based registry study, we collected de-identified data on clinical characteristics, treatment and outcomes in adult patients with hematologic malignancies and confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection within the Madrid region of Spain. Our case series included all patients admitted to 22 regional health service hospitals and 5 private healthcare centers between February 28 and May 25, 2020. The primary study outcome was all-cause mortality. We assessed the association between mortality and potential prognostic factors using Cox regression analyses adjusted for age, sex, comorbidities, hematologic malignancy and recent active cancer therapy. Of 833 patients reported, 697 were included in the analyses. Median age was 72 years (IQR 60–79), 413 (60%) patients were male and 479 (69%) and 218 (31%) had lymphoid and myeloid malignancies, respectively. Clinical severity of COVID-19 was severe/critical in 429 (62%) patients. At data cutoff, 230 (33%) patients had died. Age ≥ 60 years (hazard ratios 3.17–10.1 vs < 50 years), > 2 comorbidities (1.41 vs ≤ 2), acute myeloid leukemia (2.22 vs non-Hodgkin lymphoma) and active antineoplastic treatment with monoclonal antibodies (2·02) were associated with increased mortality; conventional chemotherapy showed borderline significance (1.50 vs no active therapy). Conversely, Ph-negative myeloproliferative neoplasms (0.33) and active treatment with hypomethylating agents (0.47) were associated with lower mortality. Overall, 574 (82%) patients received antiviral therapy. Mortality with severe/critical COVID-19 was higher with no therapy vs any antiviral combination therapy (2.20). In this series of patients with hematologic malignancies and COVID-19, mortality was associated with higher age, more comorbidities, type of hematological malignancy and type of antineoplastic therapy. Further studies and long-term follow-up are required to validate these criteria for risk stratification.
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DOI：
10.15557/pimr.2020.0003
发表时间：
2020-01-01
影响因子：
3.6
作者：
通讯作者：
--
影响因子：
50.5
作者：
Rodriguez-Abreu, D.;Bordoni, A.;Zucca, E.
通讯作者：
Zucca, E.
影响因子：
4.4
作者：
Fontana, Lauren;Strasfeld, Lynne
通讯作者：
Strasfeld, Lynne
影响因子：
3.8
作者：
Sisk, Jeanne M.;Frieman, Matthew B.;Machamer, Carolyn E.
通讯作者：
Machamer, Carolyn E.
DOI：
10.1001/jama.2020.6775
发表时间：
2020-01-01
期刊：
JAMA, Journal of the American Medical Association
影响因子：
--
作者：
Richardson, Safiya;Hirsch, Jamie S.;,
通讯作者：
,