Chemotherapy as a Risk Factor for Severe COVID-19 Course?
During the coronavirus pandemic, patients with malignant neoplastic diseases are considered an at-risk group. Whether chemotherapy is a risk factor for a more severe course of COVID-19 was the subject of the study presented below.
Study Methodology
A total of 309 patients (51.5% men) treated on an outpatient basis or hospitalized for (histopathologically verified) malignant neoplastic disease at the New York Memorial Sloan Kettering Cancer Center were included in the retrospective observational study. All of these patients were diagnosed with COVID-19 between March 8 and 31, 2020; their clinical status was analyzed based on medical documentation up to April 13, 2020. The primary parameter monitored was a severe or critical course of COVID-19, defined as:
- hypoxemia (SpO2 ≤ 93%),
- tachypnea (RR ≥ 30/minute),
- respiratory failure (pO2/FiO2 < 300),
- admission to the ICU for endotracheal intubation, or
- death.
The control group consisted of a total of 917 COVID-19– patients with malignant neoplastic diseases. The aim of the study was to assess whether patients undergoing chemotherapy are at increased risk for a severe course of COVID-19.
Findings
Out of 309 COVID-19+ patients, 147 (47.6%) were hospitalized, 120 (38.8%) experienced a severe or critical course of the disease, and 31 (10%) died. The time from the first symptoms to a severe or critical course averaged 12.6 days. Within 5 weeks of testing positive for COVID-19, 102 (33.0%) patients initiated cytotoxic chemotherapy, with no observed association between this treatment and a severe or critical disease course (hazard ratio [HR] 1.10; 95% confidence interval [CI] 0.73–1.60; p = 0.74). Similarly, no association was identified for immunotherapy (HR 1.80; 95% CI 0.89–3.50; p = 0.11), though this group included only 8 patients.
A diagnosis of hematological malignancy, however, was associated with a severe or critical course of COVID-19 (HR 1.90; 95% CI 1.30–2.80; p < 0.01). This included 7 out of 8 patients with a diagnosis of acute myeloid leukemia (AML; 10.8%). A similar trend was observed for malignant lung neoplasms (HR 2.00; 95% CI 1.20–3.30; p = 0.01), but not for patients with lung metastases (HR 1.30; 95% CI 0.81–2.10; p = 0.27). Generally better clinical outcomes were observed in patients in remission (HR 0.63; CI 0.41–0.98; p = 0.04) compared to those with active neoplastic disease.
Poorer outcomes were evident in patients with baseline neutropenia (HR 4.20; 95% CI 1.70–11.00; p < 0.01) or in cases where lymphopenia developed during COVID-19 (HR 2.10; 95% CI 1.50–3.10; p < 0.01). Neutropenia was observed in only 4 patients, 3 of whom had AML. If neutropenia developed during COVID-19, it was not significantly linked to poorer outcomes (HR 1.70; 95% CI 0.85–3.60; p = 0.13).
The absolute number of neutrophils at the time of COVID-19 diagnosis was elevated in patients who subsequently experienced a severe or critical disease course. Thirteen out of 17 patients with an absolute neutrophil count > 5000/µl had solid malignancies. Similarly, interleukin IL-6, lactate dehydrogenase (LDH), D-dimers, aspartate aminotransferase (AST), troponin I, and procalcitonin were significantly elevated.
Out of 36 patients (11.7%) with a history of thromboembolism, 20 (55.6%) developed a severe or critical course of COVID-19.
Conclusion
According to the study's results, cytotoxic chemotherapy is not associated with a severe or critical course of COVID-19. However, poorer outcomes were observed in patients with hematological or lung malignancies, baseline neutropenia, or lymphopenia developing during the disease.
(mafi)
Source: Jee J., Foote M. B., Lumish M. et al. Chemotherapy and COVID-19 outcomes in patients with cancer. J Clin Oncol 2020; 38 (30): 3538–3547, doi: 10.1200/JCO.20.01307.
Did you like this article? Would you like to comment on it? Write to us. We are interested in your opinion. We will not publish it, but we will gladly answer you.
