Outcomes of patients with hematologic malignancies and COVID-19: a systematic review and meta-analysis of 3377 patients

Author:

Vijenthira Abi1ORCID,Gong Inna Y.2ORCID,Fox Thomas A.3ORCID,Booth Stephen4ORCID,Cook Gordon5ORCID,Fattizzo Bruno67,Martín-Moro Fernando8ORCID,Razanamahery Jerome9,Riches John C.10,Zwicker Jeff11ORCID,Patell Rushad11,Vekemans Marie Christiane12,Scarfò Lydia13,Chatzikonstantinou Thomas14,Yildiz Halil15ORCID,Lattenist Raphaël15,Mantzaris Ioannis16,Wood William A.17,Hicks Lisa K.218

Affiliation:

1. Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada;

2. Department of Medicine, University of Toronto, Toronto, ON, Canada;

3. Department of Haematology, University College London Hospital, London, United Kingdom;

4. Department of Oncology, University of Oxford, Oxford, United Kingdom;

5. Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom;

6. Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy;

7. Ca’ Granda Ospedale Maggiore Policlinico, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy;

8. Department of Hematology, Ramón y Cajal University Hospital, Madrid, Spain;

9. Department of Internal Medicine, Besançon University Hospital, Besançon, France;

10. Centre for Hemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom;

11. Beth Israel Deaconess Medical Center, Boston, MA;

12. Department of Hematology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium;

13. Strategic Research Program on CLL, Università Vita Salute and IRCCS Ospedale San Raffaele, Milan, Italy;

14. HCT Unit, Hematology Department, G. Papanicolaou Hospital, Thessaloniki, Greece;

15. Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium;

16. Department of Oncology, Montefiore Medical Center, Bronx, NY;

17. Division of Hematology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; and

18. Division of Hematology/Oncology, St. Michael’s Hospital, Toronto, ON, Canada

Abstract

AbstractOutcomes for patients with hematologic malignancy infected with COVID-19 have not been aggregated. The objective of this study was to perform a systematic review and meta-analysis to estimate the risk of death and other important outcomes for these patients. We searched PubMed and EMBASE up to 20 August 2020 to identify reports of patients with hematologic malignancy and COVID-19. The primary outcome was a pooled mortality estimate, considering all patients and only hospitalized patients. Secondary outcomes included risk of intensive care unit admission and ventilation in hospitalized patients. Subgroup analyses included mortality stratified by age, treatment status, and malignancy subtype. Pooled prevalence, risk ratios (RRs), and 95% confidence intervals (CIs) were calculated using a random-effects model. Thirty-four adult and 5 pediatric studies (3377 patients) from Asia, Europe, and North America were included (14 of 34 adult studies included only hospitalized patients). Risk of death among adult patients was 34% (95% CI, 28-39; N = 3240) in this sample of predominantly hospitalized patients. Patients aged ≥60 years had a significantly higher risk of death than patients <60 years (RR, 1.82; 95% CI, 1.45-2.27; N = 1169). The risk of death in pediatric patients was 4% (95% CI, 1-9; N = 102). RR of death comparing patients with recent systemic anticancer therapy to no treatment was 1.17 (95% CI, 0.83-1.64; N = 736). Adult patients with hematologic malignancy and COVID-19, especially hospitalized patients, have a high risk of dying. Patients ≥60 years have significantly higher mortality; pediatric patients appear to be relatively spared. Recent cancer treatment does not appear to significantly increase the risk of death.

Publisher

American Society of Hematology

Subject

Cell Biology,Hematology,Immunology,Biochemistry

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