COVID-19 Outcomes in Patients with Hematologic Malignancies in the Era of COVID-19 Vaccination and the Omicron Variant.
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Martínez-López Joaquín, de la Cruz Javier, Gil-Manso Rodrigo, Yuste Víctor Jiménez, Aspa-Cilleruelo José María, Escobar Cristian Escolano, López-Jiménez Javier, Duarte Rafael, Yerovi Cristina Jacome, Hernández-Rivas José-Ángel, Herráez Regina, Quiroz-Cervantes Keina, Bustelos-Rodriguez Rosalía, Benavente Celina, Martínez Barranco Pilar, Bastos Oteiro Mariana, Alegre Adrián, Pérez-Oteyza Jaime, Ruiz Elena, Marcheco-Pupo Eriel Alexis, Cedillo Ángel, de Soto Álvarez Teresa, García Ramirez Patricia, Alonso Trillo Rosalía, Herrera Pilar, Bengochea Casado María Luisa, Arroyo Barea Andrés, Martin De Bustamante Jose Manuel, Ortiz Javier, Calbacho Robles María, García-Suárez Julio, Asociación Madrileña de Hematología y Hemoterapia (AMHH)
Аннотация
A greater understanding of clinical trends in COVID-19 outcomes among patients with hematologic malignancies (HM) over the course of the pandemic, particularly the Omicron era, is needed. This ongoing, observational, and registry-based study with prospective data collection evaluated COVID-19 clinical severity and mortality in 1818 adult HM patients diagnosed with COVID-19 between 27 February 2020 and 1 October 2022, at 31 centers in the Madrid region of Spain. Of these, 1281 (70.5%) and 537 (29.5%) were reported in the pre-Omicron and Omicron periods, respectively. Overall, patients aged ≥70 years (odds ratio 2.16, 95% CI 1.64-2.87), with >1 comorbidity (2.44, 1.85-3.21), or with an underlying HM of chronic lymphocytic leukemia (1.64, 1.19-2.27), had greater odds of severe/critical COVID-19; odds were lower during the Omicron BA.1/BA.2 (0.28, 0.2-0.37) or BA.4/BA.5 (0.13, 0.08-0.19) periods and among patients vaccinated with one or two (0.51, 0.34-0.75) or three or four (0.22, 0.16-0.29) doses. The hospitalization rate (75.3% [963/1279], 35.7% [191/535]), rate of intensive care admission (30.0% [289/963], 14.7% [28/191]), and mortality rate overall (31.9% [409/1281], 9.9% [53/536]) and in hospitalized patients (41.3% [398/963], 22.0% [42/191]) decreased from the pre-Omicron to Omicron period. Age ≥70 years was the only factor associated with higher mortality risk in both the pre-Omicron (hazard ratio 2.57, 95% CI 2.03-3.25) and Omicron (3.19, 95% CI 1.59-6.42) periods. Receipt of prior stem cell transplantation, COVID-19 vaccination(s), and treatment with nirmatrelvir/ritonavir or remdesivir were associated with greater survival rates. In conclusion, COVID-19 mortality in HM patients has decreased considerably in the Omicron period; however, mortality in hospitalized HM patients remains high. Specific studies should be undertaken to test new treatments and preventive interventions in HM patients.