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Leukemia and MDS Acute Supportive Treatment of COVID-19

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The following factors are linked to the most severe COVID-19-related outcomes for patients suffering from acute leukemias or myelodysplastic disorders: neutropenia and pre-COVID-19 prognosis. Also the deferral of ICU treatment is possible, according to an American Society of Hismatology COVID-19 registry study.

Patients with active disease or neutropenia had significantly higher rates of severe COVID-19. The study results revealed that mortality from COVID-19 was due to neutropenia, a diagnosis less than 6 months old, and deferral ICU treatment.

By contrast, mortality was not associated with primary disease that was active or its treatment, according to researcher Pinkal Desai, MD, MPH.

Taken together, these findings provide preliminary evidence to support the use of aggressive supportive treatment of COVID-19 in patients with acute leukemias and myelodysplastic syndromes, said Desai, a hematologist-oncologist with Weill Cornell Medicine and NewYork-Presbyterian in New York.

“If requested by patients, aggressive support for hospitalized patients with COVID-19 is appropriate regardless of the status of their remission, given the findings of our study,” Desai said in a press conference during the annual meeting of the American Society of Hematology.

In the non-cancer patient population, advanced age and cytopenias have been linked to mortality in COVID-19-related diseases, Desai said. Likewise, patients with acute leukemias and myelodysplastic syndrome tend to be older and have cytopenias that are related to treatment or the disease which could affect the severity of and mortality from COVID-19, she said.

Desai and coinvestigators pondered this concern when they studied predictors for severe COVID-19-related death in patients of the ASH research Collaborative (ASH RC), COVID-19 Registry of Hematology.

According to an ASH news release the registry was created in the early days after the pandemic to provide actual time COVID-19 observations for healthcare professionals.

Desai and his co-authors analyzed 257 patients with COVID-19, which was diagnosed by their doctor. There were 135 patients with a diagnosis of acute myeloidleukemia, the 82 patients with acute lymphocyticleukemia and 40 patients with myelodysplastic diseases. Sixty percent were hospitalized because of COVID-19.

At the time of the COVID-19 diagnosis, 46 percent of patients were in remission, and 44% were suffering from active disease, according to the report.

Both neutropenia and active disease status at the time of COVID-19 diagnosis were linked to severe COVID-19, which is defined as ICU admission due to a COVID-19-related cause according to the results of multivariable analysis. In the case of patients suffering from severe COVID-19, 67% had active disease, which meant just 33% were in Remission, Desai noted.

She further stated that two factors were related to mortality in multivariable analysis including having a pre-COVID-19 estimate prognosis for the primary disease that was less than 6 months , and deferral of ICU treatment when it was recommended to the patient.

Mortality was at 21% overall, higher than would be expected in a population with no cancer, Desai said. Patients with COVID-19 who required hospitalization had a rate of mortality of 34 percent. For patients who didn’t go to the ICU it was 68%.

In contrast there was no significant correlation between mortality and active disease compared to disease in remission, Desai noted in her presentation. Also, mortality was not linked to active treatment at the time of COVID-19 diagnosis in comparison to no treatment.

Gwen Nichols MD, executive vice chief medical officer, president of The Leukemia and Society, New York said that these are reassuring numbers for patients suffering from acute and myelodysplastic illnesses and their healthcare providers.

Nichols spoke in an interview she believes “it helps us to say”Don’t stop treatment due to concerns regarding COVID-19. It’s much more important to treat your cancer.” “We are now aware that we can help people through COVID-19 and I think this is a an important piece of evidence to prove it,” she added.

Desai disclosed information about Agios, Kura Oncology and Bristol Myers Squibb, (consultancy), as well as Janssen R&D (research funding) and Astex (research funding).

This article originally appeared on MDedge.com, part of the Medscape Professional Network.

Content Source: https://www.medscape.com/viewarticle/964653?src=rss

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