(WASHINGTON, December 5, 2020) — A study of 656 people with various types of blood cancers who also had COVID-19 infection found that one out of five had died between April and November, based on an analysis of data from the ASH Research Collaborative COVID-19 Registry for Hematology. For those who needed hospital- or ICU-level care, 33% died. This international registry, which launched in April, is giving near real-time data to hematologists and other clinicians who are caring for patients amid the pandemic and offering important insights into which patients are most vulnerable to severe illness and death.

We have seen and continue to see that individuals with hematologic malignancies and COVID-19 infection appear to have more severe illness and a higher likelihood of death compared to the general population,” said lead study author, William A. Wood, MD, MPH, of the University of North Carolina at Chapel Hill. “This heightened risk of severe infection or death among these patients is concentrated in certain groups of individuals, and data from our global registry has helped to understand this more clearly.

In particular, people with blood cancers who had the highest likelihood of dying 1) were older, 2) had more severe COVID-19 infection, 3) had opted to forgo more intensive treatment, such as the intensive care unit (ICU), and/or 4) had poorer prognosis before their COVID-19 infection as determined by their treating clinician (less than 12 months at the time of COVID-19 diagnosis). Patients with relapsed/treatment-resistant hematologic disease also appear to be disproportionately more likely to develop moderate to severe COVID-19 infection and death.

“This analysis highlights that patients with hematologic diseases are a medically vulnerable population when it comes to COVID-19 infection. It underscores the need for us to continue to encourage our patients to take appropriate precautions to limit exposure to COVID-19, to continue to take precautions in our health care delivery environment to protect these patients, and to prioritize these patients for COVID-19 testing as well as vaccine distribution, once efficacious and safe vaccines are available,” said Dr. Wood. “On the other hand, we also saw that many patients with hematologic malignancies survived COVID-19 infection, including some who had severe disease and received ICU-level care. For this reason, it seems appropriate to pursue maximal care delivery for these patients as long as it aligns with patient preferences.

The present analysis includes registry data for 656 patients (77% aged 40 and older) with various types of blood cancers collected between April and November from over 100 study sites around the world. Of these, 20% died. The most represented malignancies were leukemia (57%), lymphoma (25%), and plasma cell dyscrasia (18%). Patients, who had a laboratory-confirmed or presumptive diagnosis of SARS-CoV-2 infection, presented with a myriad of symptoms, most frequently fever (65%), cough (56%), dyspnea (39%), and fatigue (31%).

Since its launch, the Registry has quickly accrued data, and researchers have been able to track how therapies to treat COVID-19 have evolved and shifted over time, with many patients with hematologic malignancies having received azithromycin (143 patients), hydroxychloroquine (137 patients), convalescent plasma (45 patients) or remdesivir (44 patients).

It is expected that as more patient data is accrued over longer periods of time, researchers can track trends that can help guide practice and treatment decisions and ask more specific questions of the data. For example, the registry data could shed light on how patients with leukemia who have received specific therapies within a month of acquiring COVID-19 infection fare overall and whether their disease course is different. The Registry will also allow clinicians to gain insights into potential regional differences in outcomes as well as the effects of other sociodemographic variables including race and ethnicity.

“This is a collaborative, global effort. We were able to launch this resource quickly and with a spirit of volunteerism and collaboration from around the world. Hematologists recognize the value of these data and continue to contribute cases,” Dr. Wood said. “These data have given us a first look into how COVID-19 infection affects patients with blood cancers and will continue to provide actionable information to guide healthcare delivery during this time.

Still, the database has some inherent limitations in that it is voluntary, so it does not capture all known cases of patients with blood cancers and COVID-19 infection. Dr. Wood said that this also means some of the rates of adverse clinical outcomes such as COVID-19 severity and mortality may be higher in this registry than in a true population-based dataset.

“We now have information from a resource spanning the continents, showing us that we have a high-risk patient population, but that most patients can recover from this infection,” Dr. Wood said, adding that this is particularly true for individuals with younger age, mild or moderate disease, and more than 12 months pre-COVID prognosis. “That should be reassuring.

Moreover, the recorded death rate among patients has improved – dropping from 28%, which was seen among the first 250 patients and published concurrently in Blood Advances, to 20% with more cases included in the present analysis. Dr. Wood explained that while this may represent true improvements in outcomes over time, this cannot be stated with certainty as the precise dates of diagnosis were not recorded due to the de-identified nature of the registry data.

This analysis is limited to patients with blood cancers; however, information from patients with non-malignant blood disorders is also being collected by the registry. The ASH RC COVID-19 Registry encourages ongoing data contribution to the Registry from hematologists around the world.

William A. Wood, MD, MPH, of North Carolina, Chapel Hill, will present this study in an oral presentation on Saturday, December 5, at 12:00 noon Pacific time on the ASH annual meeting virtual platform.