key: cord-0992136-4phiinbo
authors: van Doesum, Jaap; Chinea, Anabelle; Pagliaro, Maria; Pasquini, Maria Cristina; van Meerten, Tom; Bakker, Martijn; Ammatuna, Emanuele
title: Clinical characteristics and outcome of SARS-CoV-2-infected patients with haematological diseases: a retrospective case study in four hospitals in Italy, Spain and the Netherlands
date: 2020-07-08
journal: Leukemia
DOI: 10.1038/s41375-020-0960-4
sha: 6e9b49056eb751e56b4e6cb25105974d027f2008
doc_id: 992136
cord_uid: 4phiinbo

nan

with a positive RT-PCR assay. Clinical data were retrospectively retrieved from the medical records, including clinical features, laboratory findings, imaging, treatment and outcome.

We identified 59 patients with a haematological disease and concomitant COVID-19 infection. Their mean age was 67 years (range 32-92) and 54% were male. Thirty-three patients (56%) had a lymphoid malignancy and 20 patients (34%) suffered from a myeloid malignancy. A relative high incidence of patients (10%) had an idiopathic thrombocytopenic purpura (Table 1) .

Thirty-nine (66%) patients were being treated for their underlying disease at the time of COVID-19 diagnosis ( Table 1 ). The mean duration of symptoms before the diagnosis of COVID-19 was 5.8 days (range 0-34). Eightyeight percent of patients had a community-acquired infection and 54% had metabolic comorbidity (e.g. hypertension, diabetes, obesity or cardiovascular events). The most common presenting symptoms were fever (93%), dyspnoea (62%), dry cough (47%) and diarrhoea (29%). Almost all patients (94%) had CT imaging abnormalities characteristic of COVID-19. The most common radiologic findings were ground glass opacifications. Four patients (7%) had a neutropenia at presentation and 23 (40%) a lymphopenia. The different treatments given for COVID-19 and their outcome are shown in Table 2 .

Seven patients with respiratory failure did not start mechanical ventilation due to the underlying advanced haematological disease. Five patients (8.5%) developed a thrombotic event during follow-up, mostly pulmonary embolisms.

At last follow-up 20 patients (34%) died due to COVID-19. The mortality rate for patients above 60 years was 45%, and that for patients below 60 years was 11%. There was no difference in survival between lymphoid and myeloid malignancies. In addition, we did not observe any difference in survival between the different treatment strategies of COVID-19 infection.

To the best of our knowledge this is the second European series of patients with COVID-19 and a haematological disease [3] . The estimated 1-month overall survival is 71%, which conforms to the survival rate of haematological patients published by Lee et al. and that of other series of patients with a malignancy [2] [3] [4] . It must be noted that like other case series the average age of our series is above 60 years and more than 50% of patients had metabolic comorbidities. In the series of Malard et al. there was an overrepresentation of patients with a multiple myeloma [2] . This could not be confirmed in our multinational cohort, although lymphoid malignancies seem to be more common. In our series 92% of the patients needed to be hospitalised, so our data is biased due to the fact that only patients with severe or critical illness were tested due to the limited availability of test capacity. This is also represented in the presenting symptoms: in the series by Lee et al. 61% had a fever, 47% a dry cough, 39% dyspnoea and 6% diarrhoea; these symptoms were all more frequently present in our series at presentation [3] .

We did not observe any benefit of the given specific treatments for COVID-19. However, for the role of possible interventions in this category of patients, trials with larger, more uniform cohorts or randomised trials need to be conducted.

Overall, patients with a haematological disease seem to be more vulnerable to a more severe course of COVID-19 compared to patients without a malignancy, as already shown in the report by He et al. [1] . Pending a vaccine or treatment for COVID-19, precautions should be taken. Haematology departments should remain a COVID-19-free zone, patients and personnel should strictly comply with hygienic advices and social distancing, and patients and personnel should be tested even upon the mildest symptoms. Because of the expected long duration before normalisation of hospital care, treatment of the underlying disease should be continued when possible.

COVID-19 in persons with haematological cancers

COVID-19 outcomes in patients with hematologic disease

COVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments: a prospective cohort study

Clinical characteristics of COVID-19-infected cancer patients: a retrospective case study in three hospitals within Wuhan

Clinical characteristics and outcome of SARS-CoV-2-infected patients with haematological diseases: a

Conflict of interest The authors declare that they have no conflict of interest. Mortality rate > 60 years, %Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.