COVID-19 Outcomes in Patients with Hematologic Malignancies in the Era of COVID-19 Vaccination and the Omicron Variant
Abstract
:Simple Summary
Abstract
1. Introduction
2. Methods
2.1. Study Design and Participants
2.2. Study Outcomes and Data Collection
2.3. Statistical Analysis
3. Results
3.1. Characteristics of HM Patients with COVID-19 across Time Periods
3.2. Factors Associated with COVID-19 Severity
3.3. Factors Associated with COVID-19 Hospitalization
3.4. Factors Associated with COVID-19 Mortality
3.5. Factors Associated with COVID-19 Mortality in Hospitalized HM Patients
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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Overall Population, n = 1818 | Inpatient Population, n = 1154 | |||||
---|---|---|---|---|---|---|
Time Period (by Dominant SARS-CoV-2 Variant) | Time Period (by Dominant SARS-CoV-2 Variant) | |||||
Pre-Omicron, n = 1281 | Omicron, n = 537 | p-Value * | Pre-Omicron, n = 963 | Omicron, n = 191 | p-Value * | |
Age, y | n = 1281 | n = 536 | n = 963 | n = 191 | ||
Median (IQR) | 70.0 (59–79) | 67.0 (55–77) | <0.001 | 72.0 (62–80) | 73.0 (64–80) | 0.7 |
Age <60 y, n (%) | 333 (26.0) | 175 (32.6) | 197 (20.5) | 34 (17.8) | ||
Age 60–70 y, n (%) | 258 (20.1) | 125 (23.3) | 190 (19.7) | 43 (22.5) | ||
Age 70–80 y, n (%) | 398 (31.1) | 152 (28.4) | 325 (33.7) | 64 (33.5) | ||
Age >80 y, n (%) | 292 (22.8) | 84 (15.7) | 251 (26.1) | 50 (26.2) | ||
Sex, n (%) | n = 1267 | n = 536 | n = 951 | n = 190 | ||
Male | 751 (59.3) | 285 (53.2) | 0.017 | 575 (60.5) | 115 (60.5) | >0.9 |
Female | 516 (40.7) | 251 (46.8) | 376 (39.5) | 75 (39.5) | ||
Comorbidities, n (%) | n = 1281 | n = 537 | n = 963 | n = 191 | ||
0 | 392 (30.6) | 313 (58.3) | <0.001 | 251 (26.1) | 88 (46.1) | <0.001 |
1 | 507 (39.6) | 143 (26.6) | 388 (40.3) | 63 (33.0) | ||
>1 | 382 (29.8) | 81 (15.1) | 324 (33.6) | 40 (20.9) | ||
Hematologic malignancy, n (%) | n = 1281 | n = 536 | n = 963 | n = 191 | ||
Lymphoid malignancy | 929 (72.5) | 422 (78.7) | 0.006 | 686 (71.2) | 149 (78.0) | 0.057 |
Type of lymphoid malignancy | n = 929 | n = 422 | n = 686 | n = 149 | ||
NHL | 366 (39.4) | 188 (44.5) | 277 (40.4) | 84 (56.4) | ||
ALL | 29 (3.1) | 24 (5.7) | 20 (2.9) | 6 (4.0) | ||
CLL | 187 (20.1) | 61 (14.5) | 148 (21.6) | 28 (18.8) | ||
HL | 54 (5.8) | 22 (5.2) | 34 (5.0) | 0 (0) | ||
MM | 293 (31.5) | 127 (30.1) | 207 (30.2) | 31 (20.8) | ||
Myeloid malignancy | 352 (27.5) | 114 (21.3) | 277 (28.8) | 42 (22.0) | ||
Type of myeloid malignancy | n = 352 | n = 114 | n = 277 | n = 42 | ||
AML | 97 (27.6) | 51 (44.7) | 77 (27.8) | 24 (57.1) | ||
CML | 36 (10.2) | 8 (7.0) | 20 (7.2) | 2 (4.8) | ||
MDS | 118 (33.5) | 27 (23.7) | 103 (37.2) | 11 (26.2) | ||
MPN | 101 (28.7) | 28 (24.6) | 77 (27.8) | 5 (11.9) | ||
Cancer therapy, within 30 d, n (%) | n = 1267 | n = 517 | n = 954 | n = 178 | ||
No active therapy | 497 (39.2) | 47 (9.1) | <0.001 | 368 (38.6) | 14 (7.9) | <0.001 |
Active therapy | 770 (60.8) | 470 (90.9) | 586 (61.4) | 164 (92.1) | ||
Type of active therapy | n = 770 | n = 470 | n = 586 | n = 164 | ||
Conventional chemotherapy | 293 (38.1) | 120 (25.5) | 216 (36.9) | 43 (26.2) | ||
Low-intensity chemotherapy | 74 (9.6) | 6 (1.3) | 59 (10.1) | 1 (0.6) | ||
Molecular-targeted therapy | 142 (18.4) | 95 (20.2) | 113 (19.3) | 39 (23.8) | ||
Immunotherapy | 77 (10.0) | 147 (31.3) | 59 (10.1) | 53 (32.3) | ||
Immunomodulatory drugs | 78 (10.1) | 39 (8.3) | 56 (9.6) | 9 (5.5) | ||
Hypomethylating agents | 50 (6.5) | 20 (4.3) | 41 (7.0) | 8 (4.9) | ||
Supportive therapy | 38 (4.9) | 10 (2.1) | 32 (5.5) | 3 (1.8) | ||
Active, not detailed | 18 (2.3) | 33 (7.0) | 10 (1.7) | 8 (4.9) | ||
Cellular therapy, n (%) | n = 1241 | n = 517 | n = 936 | n = 181 | ||
No | 1055 (85.0) | 407 (78.7) | 0.001 | 811 (86.6) | 147 (81.2) | 0.057 |
Yes | 186 (15.0) | 110 (21.3) | 125 (13.4) | 34 (18.8) | ||
Type of cellular therapy | n = 186 | n = 110 | n = 125 | n = 34 | ||
Allogenic | 62 (33.3) | 36 (32.7) | 47 (37.6) | 13 (38.2) | ||
Autologous | 118 (63.4) | 58 (52.7) | 73 (58.4) | 15 (44.1) | ||
CAR T cell | 6 (3.2) | 16 (14.5) | 5 (4.0) | 6 (17.6) | ||
Vaccination, n (%) | n = 1273 | n = 481 | n = 959 | n = 169 | ||
0 | 1200 (94.3) | 28 (5.8) | <0.001 | 914 (95.3) | 11 (6.5) | <0.001 |
1–2 | 50 (3.9) | 107 (22.2) | 32 (3.3) | 40 (23.7) | ||
3–4 | 23 (1.8) | 346 (71.9) | 13 (1.4) | 118 (69.8) | ||
Pharmacologic therapies for COVID-19, n (%) | n = 1281 | n = 537 | n = 963 | n = 191 | ||
Nirmatrelvir/ritonavir | 0 (0) | 97 (18.1) | >0.9 | 0 (0) | 10 (5.2) | >0.9 |
Remdesivir | 94 (7.3) | 159 (29.6) | <0.001 | 94 (9.8) | 104 (54.5) | <0.001 |
Tocilizumab | 195 (15.2) | 25 (4.7) | <0.001 | 195 (20.2) | 25 (13.1) | 0.02 |
Monoclonal antibodies | 2 (0.2) | 32 (6.0) | <0.001 | 2 (0.2) | 27 (14.1) | <0.001 |
Corticosteroids | 680 (53.1) | 119 (22.2) | <0.001 | 633 (65.7) | 114 (59.7) | 0.1 |
Care setting of COVID-19 treatment, n(%) | n = 1279 | n = 535 | n = 963 | n = 191 | ||
Outpatient | 316 (24.7) | 344 (64.3) | <0.001 | 0 (0) | 0 (0) | n/a |
Hospitalized | 963 (75.3) | 191 (35.7) | <0.001 | 963 (100) | 191 (100) | <0.001 |
Intensive care unit | 289 (22.6) | 28 (5.2) | 289 (30.0) | 28 (14.7) | ||
Maximum clinical severity of COVID-19, n (%) | n = 1246 | n = 535 | n = 963 | n = 191 | ||
Mild/Moderate | 579 (46.5) | 441 (82.4) | <0.001 | 286 (29.7) | 100 (52.4) | <0.001 |
Severe/Critical | 667 (53.5) | 94 (17.6) | 667 (69.3) | 91 (47.6) |
Overall Population | Pre-Omicron Time Period | Omicron Time Period | |||||||
---|---|---|---|---|---|---|---|---|---|
Survival Estimate, % (95% CI) | p-Value * | Survival Estimate, % (95% CI) | p-Value * | Survival Estimate, % (95% CI) | p-Value * | ||||
30 Days | 60 Days | 30 Days | 60 Days | 30 Days | 60 Days | ||||
Overall | 67 (65–70) | 57 (53–60) | 64 (60–67) | 52 (48–56) | 87 (82–93) | 79 (72–86) | |||
Age | <0.001 | <0.001 | 0.3 | ||||||
<60 y | 87 (82–92) | 76 (69–83) | 85 (80–91) | 74 (67–82) | 96 (89–100) | 88 (76–100) | |||
60–70 y | 77 (72–83) | 66 (59–73) | 73 (66–80) | 61 (53–70) | 95 (88–100) | 83 (71–96) | |||
70–80 y | 66 (61–71) | 54 (48–60) | 62 (56–68) | 48 (42–56) | 84 (74–94) | 77 (66–89) | |||
>80 y | 48 (42–55) | 39 (33–46) | 43 (37–50) | 33 (27–41) | 78 (66–93) | 71 (57–88) | |||
Sex | 0.7 | 0.7 | 0.7 | ||||||
Male | 67 (63–71) | 56 (51–60) | 63 (59–68) | 51 (46–56) | 86 (79–93) | 77 (69–86) | |||
Female | 68 (64–73) | 58 (53–64) | 64 (59–69) | 53 (48–60) | 90 (83–98) | 81 (71–93) | |||
Comorbidities | <0.001 | <0.001 | 0.1 | ||||||
0 | 79 (75–84) | 70 (64–76) | 74 (69–81) | 65 (58–72) | 93 (87–99) | 83 (75–93) | |||
1 | 67 (63–72) | 54 (49–60) | 66 (61–71) | 51 (45–57) | 78 (67–90) | 73 (62–86) | |||
>1 | 57 (51–63) | 47 (41–53) | 53 (47–59) | 43 (37–50) | 91 (81–100) | 78 (64–96) | |||
Hematologic malignancy | 0.2 | 0.4 | 0.8 | ||||||
Lymphoid malignancy | 67 (64–71) | 57 (53–61) | 63 (59–67) | 51 (47–56) | 88 (82–94) | 80 (73–88) | |||
NHL | 71 (66–76) | 60 (54–66) | 65 (59–72) | 53 (46–60) | 87 (79–95) | 80 (72–90) | |||
ALL | 82 (67–100) | 45 (25–80) | 76 (58–100) | 48 (27–87) | 100 (100–100) | 50 (19–100) | |||
CLL | 61 (54–70) | 56 (48–65) | 56 (48–65) | 49 (40–60) | 91 (80–100) | 91 (80–100) | |||
HL | 67 (53–86) | 63 (47–83) | 67 (53–86) | 63 (47–83) | NE (NE-NE) | NE (NE-NE) | |||
MM | 66 (60–73) | 54 (47–62) | 63 (57–71) | 51 (43–59) | 85 (73–100) | 75 (59–95) | |||
Myeloid malignancy | 68 (62–73) | 56 (50–63) | 65 (59–71) | 53 (47–61) | 86 (75–100) | 74 (60–93) | |||
AML | 65 (56–76) | 57 (48–69) | 59 (48–72) | 50 (39–64) | 89 (76–100) | 83 (68–100) | |||
CML | 84 (69–100) | 84 (69–100) | 82 (66–100) | 82 (66–100) | 100 (100–100) | 100 (100–100) | |||
MDS | 58 (48–68) | 45 (35–58) | 56 (47–68) | 44 (34–58) | 75 (50–100) | 56 (28–100) | |||
MPN | 82 (73–92) | 62 (49–79) | 81 (72–92) | 64 (51–81) | 100 (100–100) | NE (NE-NE) | |||
Cancer therapy, within 30 d | 0.2 | >0.9 | 0.8 | ||||||
No active therapy | 63 (58–68) | 53 (47–60) | 62 (56–67) | 52 (46–59) | 100 (100–100) | 88 (67–100) | |||
Active therapy | 69 (65–73) | 58 (54–62) | 64 (60–69) | 52 (47–57) | 86 (80–92) | 78 (71–85) | |||
Conventional chemotherapy | 63 (57–69) | 49 (42–56) | 61 (54–68) | 46 (39–55) | 75 (62–90) | 61 (47–80) | |||
Low-intensity chemotherapy | 72 (61–86) | 55 (39–76) | 74 (62–88) | 56 (40–78) | NE (NE-NE) | NE (NE-NE) | |||
Molecular-targeted therapy | 73 (65–81) | 65 (57–75) | 67 (58–77) | 60 (50–72) | 90 (79–100) | 81 (68–98) | |||
Immunotherapy | 81 (73–89) | 72 (64–82) | 68 (57–82) | 56 (44–72) | 94 (87–100) | 89 (81–99) | |||
Immunomodulator drugs | 62 (50–76) | 51 (39–68) | 62 (50–77) | 49 (35–68) | 58 (31–100) | 58 (31–100) | |||
Hypomethylating agents | 66 (53–82) | 62 (48–80) | 60 (45–79) | 54 (39–76) | 100 (100–100) | 100 (100–100) | |||
Supportive therapy | 62 (47–83) | 43 (27–69) | 61 (46–82) | 43 (27–68) | NE (NE-NE) | NE (NE-NE) | |||
Active, not detailed | 92 (79–100) | 69 (44–100) | 89 (71–100) | 76 (52–100) | 100 (100–100) | 67 (30–100) | |||
Cellular therapy | <0.001 | <0.001 | 0.2 | ||||||
No | 64 (61–68) | 54 (51–58) | 61 (57–64) | 50 (46–54) | 86 (80–92) | 79 (71–87) | |||
Yes | 85 (79–91) | 72 (64–81) | 82 (74–90) | 69 (59–80) | 97 (91–100) | 84 (71–100) | |||
Allogenic | 89 (81–98) | 72 (59–86) | 86 (76–97) | 70 (56–87) | 100 (100–100) | 80 (59–100) | |||
Autologous | 80 (72–90) | 74 (64–86) | 77 (67–89) | 72 (60–86) | 93 (80–100) | 84 (65–100) | |||
CAR T cell | 100 (100–100) | 60 (29–100) | 100 (100–100) | NE (NE-NE) | 100 (100–100) | 100 (100–100) | |||
Vaccinations | <0.001 | 0.003 | 0.6 | ||||||
0 | 63 (60–67) | 51 (47–55) | 63 (60–67) | 51 (47–55) | 88 (67–100) | 88 (67–100) | |||
1–2 | 82 (73–92) | 74 (64–86) | 74 (60–91) | 65 (50–84) | 89 (80–100) | 83 (71–96) | |||
3–4 | 85 (79–92) | 77 (69–86) | 85 (67–100) | 85 (67–100) | 85 (79–93) | 76 (67–86) | |||
COVID-19 therapies | |||||||||
Nirmatrelvir/ritonavir | 0.3 | n/a | 0.8 | ||||||
No | 67 (64–70) | 56 (53–60) | NE (NE-NE) | NE (NE-NE) | 87 (82–93) | 79 (73–86) | |||
Yes | 89 (71–100) | 71 (43–100) | NE (NE-NE) | NE (NE-NE) | 89 (71–100) | 71 (43–100) | |||
Remdesivir | <0.001 | 0.002 | 0.6 | ||||||
No | 64 (60–67) | 54 (50–58) | 62 (58–65) | 51 (47–55) | 83 (75–92) | 80 (71–89) | |||
Yes | 87 (82–92) | 71 (64–80) | 82 (73–91) | 65 (54–77) | 92 (86–98) | 78 (69–88) | |||
Tocilizumab | 0.5 | 0.14 | 0.3 | ||||||
No | 67 (64–71) | 56 (53–60) | 63 (59–66) | 51 (47–56) | 89 (84–94) | 80 (73–87) | |||
Yes | 69 (63–76) | 58 (51–65) | 68 (61–75) | 55 (48–64) | 78 (63–97) | 73 (57–94) | |||
Monoclonal antibodies | 0.02 | n/a | 0.7 | ||||||
No | 67 (64–70) | 56 (53–60) | NE (NE-NE) | NE (NE-NE) | 87 (81–93) | 80 (73–87) | |||
Yes | 92 (81–100) | 77 (61–97) | NE (NE-NE) | NE (NE-NE) | 92 (81–100) | 77 (61–97) | |||
Corticosteroids | <0.001 | <0.001 | 0.2 | ||||||
No | 76 (72–81) | 68 (63–73) | 72 (67–78) | 64 (58–71) | 92 (86–99) | 83 (73–93) | |||
Yes | 63 (59–67) | 51 (47–55) | 60 (56–64) | 46 (42–51) | 84 (77–92) | 76 (68–86) |
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Martínez-López, J.; de la Cruz, J.; Gil-Manso, R.; Yuste, V.J.; Aspa-Cilleruelo, J.M.; Escobar, C.E.; López-Jiménez, J.; Duarte, R.; Yerovi, C.J.; Hernández-Rivas, J.-Á.; et al. COVID-19 Outcomes in Patients with Hematologic Malignancies in the Era of COVID-19 Vaccination and the Omicron Variant. Cancers 2024, 16, 379. https://doi.org/10.3390/cancers16020379
Martínez-López J, de la Cruz J, Gil-Manso R, Yuste VJ, Aspa-Cilleruelo JM, Escobar CE, López-Jiménez J, Duarte R, Yerovi CJ, Hernández-Rivas J-Á, et al. COVID-19 Outcomes in Patients with Hematologic Malignancies in the Era of COVID-19 Vaccination and the Omicron Variant. Cancers. 2024; 16(2):379. https://doi.org/10.3390/cancers16020379
Chicago/Turabian StyleMartínez-López, Joaquín, Javier de la Cruz, Rodrigo Gil-Manso, Víctor Jiménez Yuste, José María Aspa-Cilleruelo, Cristian Escolano Escobar, Javier López-Jiménez, Rafael Duarte, Cristina Jacome Yerovi, José-Ángel Hernández-Rivas, and et al. 2024. "COVID-19 Outcomes in Patients with Hematologic Malignancies in the Era of COVID-19 Vaccination and the Omicron Variant" Cancers 16, no. 2: 379. https://doi.org/10.3390/cancers16020379