Clinical outcomes and risk factors for severe COVID-19 in patients with haematological disorders receiving chemo- or immunotherapy
Clinical outcomes and risk factors for severe COVID-19 in patients with haematological disorders receiving chemo- or immunotherapy
复制标题
DOI：
10.1111/bjh.17027
复制
发表时间：
2020-08-12
影响因子：
6.5
通讯作者：
Ardeshna, Kirit M.
中科院分区：
文献类型：
--
作者：
Fox, Thomas A.;Troy-Barnes, Ethan;Ardeshna, Kirit M.
接受化疗或免疫治疗的血液病患者被认为面临更大的COVID-19相关发病率和死亡率风险。我们旨在确定COVID-19严重程度的风险因素，并评估COVID-19使血液疾病治疗复杂化的患者的结局。在55名血液系统疾病和COVID-19患者中进行了一项回顾性队列研究，其中包括52名恶性肿瘤患者，2名骨髓衰竭患者和1名免疫介导的血栓性血小板减少性紫癜（TTP）患者。在4名患者中，COVID-19诊断与血液学恶性肿瘤的新诊断一致。在患者中，82%的患者在确诊COVID-19时正在接受全身抗癌治疗（SACT）。在住院患者中，37%（19/51）死亡，而所有4名门诊患者均痊愈。严重疾病或死亡率的风险因素与其他已发表的队列相似。诊断时C-反应蛋白升高预示着临床病程的进展。尽管最近接受了SACT，但大多数患者已从COVID-19中康复。这表明，尽管存在并发COVID-19感染，但应根据标准途径管理SACT（紧急情况下）。应根据个体情况考虑延迟或调整治疗。需要在更大的患者队列中进行长期随访研究，以评估大流行期间采用的治疗策略的疗效。
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.