@article{b7b3446cf22c4d1584b5324d55e348af,
title = "Clinical characteristics and risk factors associated with COVID-19 severity in patients with haematological malignancies in Italy: a retrospective, multicentre, cohort study: The Lancet Haematology",
abstract = "Background: Several small studies on patients with COVID-19 and haematological malignancies are available showing a high mortality in this population. The Italian Hematology Alliance on COVID-19 aimed to collect data from adult patients with haematological malignancies who required hospitalisation for COVID-19. Methods: This multicentre, retrospective, cohort study included adult patients (aged ≥18 years) with diagnosis of a WHO-defined haematological malignancy admitted to 66 Italian hospitals between Feb 25 and May 18, 2020, with laboratory-confirmed and symptomatic COVID-19. Data cutoff for this analysis was June 22, 2020. The primary outcome was mortality and evaluation of potential predictive parameters of mortality. We calculated standardised mortality ratios between observed death in the study cohort and expected death by applying stratum-specific mortality rates of the Italian population with COVID-19 and an Italian cohort of 31 993 patients with haematological malignancies without COVID-19 (data up to March 1, 2019). Multivariable Cox proportional hazards model was used to identify factors associated with overall survival. This study is registered with https://urldefense.proofpoint.com/v2/url?u=http-3A__ClinicalTrials.gov&d=DwIGAw&c=5rLNXN0mp_7LMh3Fds96xpjyD06ZuE2RU7zikolS0lg&r=rqnj08HpfXmLGvDDT6LbbU0LrKLuUcd3LNsocvV3n8U&m=gdDaQyAPIpFo-51LfZ4Ly3TMrtMgA90Jw5tJ_sx0bCQ&s=KHRYyGFtSMlOF2_aJQpMoZfR-dHtIl3d5ZTYlhSzpOM&e= , NCT04352556, and the prospective part of the study is ongoing. Findings: We enrolled 536 patients with a median follow-up of 20 days (IQR 10–34) at data cutoff, 85 (16%) of whom were managed as outpatients. 440 (98%) of 451 hospitalised patients completed their hospital course (were either discharged alive or died). 198 (37%) of 536 patients died. When compared with the general Italian population with COVID-19, the standardised mortality ratio was 2·04 (95% CI 1·77–2·34) in our whole study cohort and 3·72 (2·86–4·64) in individuals younger than 70 years. When compared with the non-COVID-19 cohort with haematological malignancies, the standardised mortality ratio was 41·3 (38·1–44·9). Older age (hazard ratio 1·03, 95% CI 1·01–1·05); progressive disease status (2·10, 1·41–3·12); diagnosis of acute myeloid leukaemia (3·49, 1·56–7·81), indolent non-Hodgin lymphoma (2·19, 1·07–4·48), aggressive non-Hodgkin lymphoma (2·56, 1·34–4·89), or plasma cell neoplasms (2·48, 1·31–4·69), and severe or critical COVID-19 (4·08, 2·73–6·09) were associated with worse overall survival. Interpretation: This study adds to the evidence that patients with haematological malignancies have worse outcomes than both the general population with COVID-19 and patients with haematological malignancies without COVID-19. The high mortality among patients with haematological malignancies hospitalised with COVID-19 highlights the need for aggressive infection prevention strategies, at least until effective vaccination or treatment strategies are available. Funding: Associazione italiana contro le leucemie, linfomi e mieloma–Varese Onlus. {\textcopyright} 2020 Elsevier Ltd",
keywords = "C reactive protein, lactate dehydrogenase, acute myeloid leukemia, adult, aged, Article, cohort analysis, coronavirus disease 2019, disease severity, dyspnea, female, follow up, hematologic malignancy, hospitalization, human, intensive care unit, major clinical study, male, middle aged, mortality, multicenter study, multiple myeloma, nonhodgkin lymphoma, overall survival, plasmacytoma, pneumonia, priority journal, real time polymerase chain reaction, retrospective study, risk factor, septic shock, Betacoronavirus, clinical trial, comorbidity, Coronavirus infection, hematologic disease, hospital patient, Italy, leukemia, myeloproliferative disorder, pandemic, very elderly, virus pneumonia, young adult, Adult, Aged, Aged, 80 and over, Comorbidity, Coronavirus Infections, Female, Follow-Up Studies, Hematologic Neoplasms, Humans, Inpatients, Leukemia, Lymphoma, Non-Hodgkin, Male, Middle Aged, Myeloproliferative Disorders, Neoplasms, Plasma Cell, Pandemics, Pneumonia, Viral, Retrospective Studies, Risk Factors, Young Adult",
author = "F. Passamonti and C. Cattaneo and L. Arcaini and R. Bruna and M. Cavo and F. Merli and E. Angelucci and M. Krampera and R. Cairoli and {Della Porta}, M.G. and N. Fracchiolla and M. Ladetto and {Gambacorti Passerini}, C. and M. Salvini and M. Marchetti and R. Lemoli and A. Molteni and A. Busca and A. Cuneo and A. Romano and N. Giuliani and S. Galimberti and A. Corso and A. Morotti and B. Falini and A. Billio and F. Gherlinzoni and G. Visani and M.C. Tisi and A. Tafuri and P. Tosi and F. Lanza and M. Massaia and M. Turrini and F. Ferrara and C. Gurrieri and D. Vallisa and M. Martelli and E. Derenzini and A. Guarini and A. Conconi and A. Cuccaro and L. Cudillo and D. Russo and F. Ciambelli and A.M. Scattolin and M. Luppi and C. Selleri and {Ortu La Barbera}, E. and C. Ferrandina and {Di Renzo}, N. and A. Olivieri and M. Bocchia and M. Gentile and F. Marchesi and P. Musto and A.B. Federici and A. Candoni and A. Venditti and C. Fava and A. Pinto and P. Galieni and L. Rigacci and D. Armiento and F. Pane and M. Oberti and P. Zappasodi and C. Visco and M. Franchi and P.A. Grossi and L. Bert{\`u} and G. Corrao and L. Pagano and P. Corradini and ITA-HEMA-COV Investigators",
note = "Cited By :25 Export Date: 24 February 2021 Correspondence Address: Passamonti, F.; Department of Medicine and Surgery, Italy; email: francesco.passamonti@uninsubria.it Chemicals/CAS: C reactive protein, 9007-41-4; lactate dehydrogenase, 9001-60-9; lactate dehydrogenase A Funding text 1: The study is supported by the charity Associazione italiana contro le leucemie, linfomi e mieloma–Varese Onlus. We thank Roberta Mattarucchi and Alessia Ingrassia from the Clinical Trial Center of the ASST Sette Laghi of Varese for managing study protocol and procedures across many institutional review boards. References: Huang, C., Wang, Y., Li, X., Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China (2020) Lancet, 395, pp. 497-506; Wu, Z., McGoogan, J.M., Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention (2020) JAMA, , published online Feb 24; Richardson, S., Hirsch, J.S., Narasimhan, M., Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City Area (2020) JAMA, 323, pp. 2052-2059; Goyal, P., Choi, J.J., Pinheiro, L.C., Clinical characteristics of Covid-19 in New York City (2020) N Engl J Med, 382, pp. 2372-2374; Zhou, F., Yu, T., Du, R., Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study (2020) Lancet, 395, pp. 1054-1062; Guan, W.J., Liang, W.H., Zhao, Y., Comorbidity and its impact on 1590 patients with Covid-19 in China: a nationwide analysis (2020) Eur Respir J, 55; Moore, B.J.B., June, C.H., Cytokine release syndrome in severe COVID-19 (2020) Science, 368, pp. 473-474; Preliminary estimates of the prevalence of selected underlying health conditions among patients with coronavirus disease 2019—United States, February 12–March 28, 2020 (2020) MMWR Morb Mortal Wkly Rep, 69, pp. 382-386; Liang, W., Guan, W., Chen, R., Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China (2020) Lancet Oncol, 21, pp. 335-337; Kuderer, N.M., Choueiri, T.K., Shah, D.P., Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study (2020) Lancet, 395, pp. 1907-1918; Lee, L.Y.W., Cazier, J.B., Starkey, T., COVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments: a prospective cohort study (2020) Lancet, 395, pp. 1919-1926; Tian, J., Yuan, X., Xiao, J., Clinical characteristics and risk factors associated with COVID-19 disease severity in patients with cancer in Wuhan, China: a multicentre, retrospective, cohort study (2020) Lancet Oncol, 21, pp. 893-903; Yang, K., Sheng, Y., Huang, C., Clinical characteristics, outcomes, and risk factors for mortality in patients with cancer and COVID-19 in Hubei, China: a multicentre, retrospective, cohort study (2020) Lancet Oncol, 21, pp. 904-913; Zhang, X., Song, K., Tong, F., First case of COVID-19 in a patient with multiple myeloma successfully treated with tocilizumab (2020) Blood Adv, 4, pp. 1307-1310; Jin, X.H., Zheng, K.I., Pan, K.H., Xie, Y.P., Zheng, M.H., COVID-19 in a patient with chronic lymphocytic leukaemia (2020) Lancet Haematol, 7, pp. e351-e352; Huang, J., Lin, H., Wu, Y., COVID-19 in posttransplant patients-report of 2 cases (2020) Am J Transplant, 20, pp. 1879-1881; He, W., Chen, L., Yuan, G., COVID-19 in persons with haematological cancers (2020) Leukemia, 34, pp. 1637-1645; Mart{\'i}n-Moro, F., Marquet, J., Piris, M., Survival study of hospitalized patients with concurrent Covid-19 and haematological malignancies (2020) Br J Haematol, 190, pp. e16-e20; Malard, F., Genthon, A., Brissot, E., COVID-19 outcomes in patients with hematologic disease (2020) Bone Marrow Transplant, 6, pp. 1-5; Arber, D.A., Orazi, A., Hasserjian, R., The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia (2016) Blood, 127, pp. 2391-2405; Swerdlow, S.H., Campo, E., Pileri, S.A., The 2016 revision of the World Health Organization classification of lymphoid neoplasms (2016) Blood, 127, pp. 2375-2390; Rapporto ISS COVID-19 n. 11/2020 Rev. 2. Raccomandazioni per il corretto prelievo, conservazione e analisi sul tampone oro/rino-faringeo per la diagnosi di COVID-19 (2020), https://urldefense.proofpoint.com/v2/url?u=https-3A__www.iss.it_rapporti-2Dcovid-2D19_-2D_asset-5Fpublisher_btw1J82wtYzH_content_id_5329985&d=DwIGAw&c=5rLNXN0mp_7LMh3Fds96xpjyD06ZuE2RU7zikolS0lg&r=rqnj08HpfXmLGvDDT6LbbU0LrKLuUcd3LNsocvV3n8U&m=gdDaQyAPIpFo-51LfZ4Ly3TMrtMgA90Jw5tJ_sx0bCQ&s=WVKGyG6mMumLEtn0RlR0M25zkHjARGKuFT8gM-Rq5SQ&e= , (Accessed 4 August 2020); Sorveglianza Integrata COVID-19 in Italia (2020), https://urldefense.proofpoint.com/v2/url?u=https-3A__www.epicentro.iss.it_coronavirus_bollettino_Infografica-5F22giugno-2520ITA.pdf&d=DwIGAw&c=5rLNXN0mp_7LMh3Fds96xpjyD06ZuE2RU7zikolS0lg&r=rqnj08HpfXmLGvDDT6LbbU0LrKLuUcd3LNsocvV3n8U&m=gdDaQyAPIpFo-51LfZ4Ly3TMrtMgA90Jw5tJ_sx0bCQ&s=lf8vbK9ju6fxQy5c_WZ5quSsMZCgWYuBERmcQy7VJRA&e= , (Accessed 28 July 2020); Pereira, M.R., Mohan, S., Cohen, D.J., COVID-19 in solid organ transplant recipients: initial report from the US epicenter (2020) Am J Transplant, 20, pp. 1800-1808; Latif, F., Farr, M.A., Clerkin, K.J., Characteristics and outcomes of recipients of heart transplant with coronavirus disease 2019 (2020) JAMA Cardiol, 13; Wang, Y., Zhang, D., Du, G., Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial (2020) Lancet, 395, pp. 1569-1578; Cao, B., Wang, Y., Wen, D., A trial of lopinavir-ritonavir in adults hospitalized with severe Covid-19 (2020) N Engl J Med, 382, pp. 1787-1799; Geleris, J., Sun, Y., Platt, J., Observational study of hydroxychloroquine in hospitalized patients with Covid-19 (2020) N Engl J Med, 382, pp. 2411-2418; Xu, X., Han, M., Li, T., Effective treatment of severe COVID-19 patients with tocilizumab (2020) Proc Natl Acad Sci USA, 117, pp. 10970-10975; Passamonti, F., Maffioli, M., The role of JAK2 inhibitors in MPNs 7 years after approval (2018) Blood, 131, pp. 2426-2435; Mato, A.R., Roeker, L.E., Lamanna, N., Outcomes of COVID-19 in patients with CLL: a multicenter, international experience (2020) Blood, , published online July 20",
year = "2020",
doi = "10.1016/S2352-3026(20)30251-9",
language = "English",
volume = "7",
pages = "e737--e745",
journal = "Lancet Haematol.",
issn = "2352-3026",
publisher = "Elsevier Ltd",
number = "10",
}