Clinical manifestations and risk factors for COVID-19 and its severity in patients with hematological malignancies

Tzong-Yow Wu; Wan-Ting Tsai; Kai-Hsiang Chen; Szu-Ting Huang; Chun-Fu Huang; Po-Hsien Kuo; Ming-Jui Tsai; Wang-Da Liu; Kuan-Yin Lin; Yu-Shan Huang; Aristine Cheng; Pao-Yu Chen; Hsin-Yun Sun; Huai-Hsuan Huang; Tai-Chung Huang; Shang-Ju Wu; Ming Yao; Jann-Tay Wang; Wang-Huei Sheng; Chien-Ching Hung; Yee-Chun Chen; Shan-Chwen Chang

doi:10.1016/j.jmii.2024.03.001

Clinical manifestations and risk factors for COVID-19 and its severity in patients with hematological malignancies

J Microbiol Immunol Infect. 2024 Jun;57(3):403-413. doi: 10.1016/j.jmii.2024.03.001. Epub 2024 Mar 8.

Authors

Tzong-Yow Wu¹, Wan-Ting Tsai², Kai-Hsiang Chen³, Szu-Ting Huang³, Chun-Fu Huang⁴, Po-Hsien Kuo⁵, Ming-Jui Tsai⁴, Wang-Da Liu⁶, Kuan-Yin Lin¹, Yu-Shan Huang¹, Aristine Cheng¹, Pao-Yu Chen¹, Hsin-Yun Sun¹, Huai-Hsuan Huang¹, Tai-Chung Huang¹, Shang-Ju Wu¹, Ming Yao¹, Jann-Tay Wang⁷, Wang-Huei Sheng⁸, Chien-Ching Hung⁹, Yee-Chun Chen¹⁰, Shan-Chwen Chang¹¹

Affiliations

¹ Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
² Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan.
³ Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan.
⁴ Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan.
⁵ Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan.
⁶ Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan. Electronic address: b95401043@ntu.edu.tw.
⁷ Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan.
⁸ Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; School of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Medical Education, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
⁹ Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan; Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan.
¹⁰ Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan.
¹¹ Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; School of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.

PMID: 38480093
DOI: 10.1016/j.jmii.2024.03.001

Abstract

Background: Patients with hematological malignancies (HM) were at a high risk of developing severe disease from coronavirus disease 2019 (COVID-19). We aimed to assess the clinical outcome of COVID-19 in hospitalized patients with HM.

Methods: Adult patients with HM who were hospitalized with a laboratory-confirmed COVID-19 between May, 2021 and November, 2022 were retrospectively identified. Primary outcome was respiratory failure requiring mechanical ventilation or mortality within 60 days after hospitalization. We also analyzed associated factors for de-isolation (defined as defervescence with a consecutive serial cycle threshold value > 30) within 28 days.

Results: Of 152 eligible patients, 22 (14.5%) developed respiratory failure or mortality in 60 days. Factors associated with developing respiratory failure that required mechanical ventilation or mortality included receipt of allogeneic hematopoietic stem-cell transplantation (allo-HSCT) (adjusted hazards ratio [aHR], 5.10; 95% confidence interval [CI], 1.64-15.85), type 2 diabetes mellitus (aHR, 2.47; 95% CI, 1.04-5.90), lymphopenia at admission (aHR, 6.85; 95% CI, 2.45-19.15), and receiving <2 doses of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines (aHR, 3.00; 95% CI, 1.19-7.60). Ninety-nine (65.1%) patients were de-isolated in 28 days, against which two hazardous factors were identified: receipt of B-cell depletion therapies within one year prior to COVID-19 (aHR, 0.55, 95% CI, 0.35-0.87) and lymphopenia upon admission (aHR, 0.65; 95% CI, 0.43-1.00).

Conclusion: We found a high rate of respiratory failure and mortality among patients with HM who contracted the SARS-CoV-2. Factors associated with developing respiratory failure or mortality in 60 days included receipt of allo-HSCT, type 2 diabetes mellitus and lymphopenia upon admission. Having received ≥2 doses of vaccination conferred protection against clinical progression.

Keywords: Lymphoma; Respiratory failure; SARS-CoV-2; Stem cell transplant; Vaccination.

MeSH terms

Adult
Aged
COVID-19* / complications
COVID-19* / epidemiology
COVID-19* / mortality
Diabetes Mellitus, Type 2 / complications
Female
Hematologic Neoplasms* / complications
Hematopoietic Stem Cell Transplantation* / adverse effects
Hospitalization / statistics & numerical data
Humans
Lymphopenia
Male
Middle Aged
Respiration, Artificial
Respiratory Insufficiency / epidemiology
Retrospective Studies
Risk Factors
SARS-CoV-2*
Severity of Illness Index