Risk factors and outcome of COVID-19 in patients with hematological malignancies

被引：128

作者：

Pinana, Jose Luis ^{[1
,2
,3
,6
,36
]}

Martino, Rodrigo ^{[3
]}

Garcia-Garcia, Irene ^{[4
]}

Parody, Rocio ^{[5
]}

Morales, Maria Dolores ^{[6
]}

Benzo, Gonzalo ^{[7
]}

Gomez-Catalan, Irene ^{[8
]}

Coll, Rosa ^{[9
]}

De la Fuente, Ignacio ^{[10
]}

Luna, Alejandro ^{[4
]}

Merchan, Beatriz ^{[6
]}

Chinea, Anabelle ^{[4
]}

de Miguel, Dunia ^{[6
]}

Serrano, Ana ^{[8
]}

Perez, Carmen ^{[10
]}

Diaz, Carola ^{[11
]}

Lopez, Jose Luis ^{[12
]}

Saez, Adolfo Jesus ^{[4
]}

Bailen, Rebeca ^{[13
]}

Zudaire, Teresa ^{[14
]}

Martinez, Diana ^{[15
]}

Jurado, Manuel ^{[16
]}

Calbacho, Maria ^{[17
]}

Vazquez, Lourdes ^{[18
]}

Garcia-Cadenas, Irene ^{[3
]}

Fox, Laura ^{[19
]}

Pimentel, Ana I. ^{[20
]}

Bautista, Guiomar ^{[21
]}

Nieto, Agustin ^{[22
]}

Fernandez, Pascual ^{[23
]}

Vallejo, Juan Carlos ^{[24
]}

Solano, Carlos ^{[25
]}

Valero, Marta ^{[26
]}

Espigado, Ildefonso ^{[27
]}

Saldana, Raquel ^{[28
]}

Sisinni, Luisa ^{[29
]}

Ribera, Josep Maria ^{[30
]}

Jimenez, Maria Jose ^{[30
]}

Trabazo, Maria ^{[31
]}

Gonzalez-Vicent, Marta ^{[32
]}

Fernandez, Noemi ^{[33
]}

Talarn, Carme ^{[34
]}

Montoya, Maria Carmen ^{[8
]}

Cedillo, Angel ^{[35
]}

Sureda, Anna ^{[5
]}

机构：

[1] Hosp Univ & Politecn La Fe, Inst Invest Sanit La Fe, Hematol Div, Valencia, Spain

[2] Inst Carlos III, CIBERONC, Madrid, Spain

[3] Hosp Santa Creu Sant & Pau, Hematol Div, Barcelona, Spain

[4] Hosp Ramon & Cajal, Hematol Div, Madrid, Spain

[5] Hosp Duran & Reynals, Hematol Div, Inst Catala Oncol, Barcelona, Spain

[6] Hosp Guadalajara, Hematol Div, Guadalajara, Spain

[7] Hosp La Princesa, Hematol Div, Madrid, Spain

[8] Hosp Albacete, Hematol Div, Albacete, Spain

[9] Hosp Josep Trueta, Hematol Div, Inst Catala Oncol, Girona, Spain

[10] Hosp Clin Valladolid, Hematol Div, Valladolid, Spain

[11] Hosp Carlos Haya, Hematol Div, Malaga, Spain

[12] Hosp Fdn Jimenez Diaz, Hematol Div, Madrid, Spain

[13] Hosp Gregorio Maranon, Hematol Div, Madrid, Spain

[14] Hosp Navarra, Hematol Div, Navarra, Spain

[15] Hosp Coruna, Hematol Div, Coruna, Spain

[16] Hosp Virgen Nieves, Hematol Div, Granada, Spain

[17] Hosp 12 Octubre, Hematol Div, Madrid, Spain

[18] Hosp Univ Salamanca, Hematol Div, Salamanca, Spain

[19] Hosp Valle De Hebron, Hematol Div, Barcelona, Spain

[20] Hosp Clin Univ Lozano Blesa, IIS Aragon, Hematol Div, Zaragoza, Spain

[21] Hosp Puerta Hierro, Hematol Div, Madrid, Spain

[22] Hosp Vigo, Hematol Div, Vigo, Spain

[23] Hosp Gen Alicante, Hematol Div, Alicante, Spain

[24] Hosp Donostia, Hematol Div, Donostia San Sebastian, Spain

[25] Hosp Clin Univ Valencia, Hematol Div, Valencia, Spain

[26] Hosp Arnau Vilanova, Hematol Div, Valencia, Spain

[27] Univ Seville, CSIC, Univ Hosp Virgen Rocio, Dept Hematol,Inst Biomed Sevilla, Seville, Spain

[28] Hosp Jerez, Hematol Div, Jerez de la Frontera, Spain

[29] Hosp Paz, Pediat Hematol Oncol Div, Madrid, Spain

[30] Hosp Badalona Germans Trias & Pujol, Josep Carreras Res Inst, ICO, Hematol Div, Badalona, Spain

[31] Hosp Santa Creu & Sant Pau, Pediat Div, Barcelona, Spain

[32] Hosp Nino Jesus, Pediat Div, Madrid, Spain

[33] Hosp Marques Valdecilla, Hematol Div, Santander, Spain

[34] Hosp Joan 23, Hematol Div, Tarragona, Spain

[35] Hematopoiet Stem Cell Transplantat & Cell Therapy, Madrid, Spain

[36] Hosp Univ Fe Valencia, Div Clin Hematol, Avda Fernando Abril Martorell 106, Valencia 46026, Spain

来源：

EXPERIMENTAL HEMATOLOGY & ONCOLOGY | 2020年 / 9卷 / 01期

关键词：

SARS-COV-2; RECOMMENDATIONS; MANAGEMENT; CRITERIA;

D O I：

10.1186/s40164-020-00177-z

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background Prognostic factors of poor outcome in patients with hematological malignancies and COVID-19 are poorly defined. Patients and methods This was a Spanish transplant group and cell therapy (GETH) multicenter retrospective observational study, which included a large cohort of blood cancer patients with laboratory-confirmed SARS-CoV-2 infection through PCR assays from March 1st 2020 to May 15th 2020. Results We included 367 pediatric and adult patients with hematological malignancies, including recipients of autologous (ASCT) (n = 58) or allogeneic stem cell transplantation (allo-SCT) (n = 65) from 41 hospitals in Spain. Median age of patients was 64 years (range 1-93.8). Recipients of ASCT and allo-SCT showed lower mortality rates (17% and 18%, respectively) compared to non-SCT patients (31%) (p = 0.02). Prognostic factors identified for day 45 overall mortality (OM) by logistic regression multivariate analysis included age > 70 years [odds ratio (OR) 2.1, 95% confidence interval (CI) 1.2-3.8, p = 0.011]; uncontrolled hematological malignancy (OR 2.9, 95% CI 1.6-5.2, p < 0.0001); ECOG 3-4 (OR, 2.56, 95% CI 1.4-4.7, p = 0.003); neutropenia (< 0.5 x 10(9)/L) (OR 2.8, 95% CI 1.3-6.1, p = 0.01); and a C-reactive protein (CRP) > 20 mg/dL (OR 3.3, 95% CI 1.7-6.4, p < 0.0001). In multivariate analysis of 216 patients with very severe COVID-19, treatment with azithromycin or low dose corticosteroids was associated with lower OM (OR 0.42, 95% CI 0.2-0.89 and OR 0.31, 95% CI 0.11-0.87, respectively, p = 0.02) whereas the use of hidroxycloroquine did not show significant improvement in OM (OR 0.64, 95% CI 0.37-1.1, P = 0.1). Conclusions In most patients with hematological malignancies COVID-19 mortality was directly driven by older age, disease status, performance status, as well as by immune (neutropenia) parameters and level of inflammation (high CRP). Use of azithromycin and low dose corticosteroids may be of value in very severe COVID-19.

引用

页数：16

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