eLife (Jan 2023)

International multicenter study comparing COVID-19 in patients with cancer to patients without cancer: Impact of risk factors and treatment modalities on survivorship

  • Issam I Raad,
  • Ray Hachem,
  • Nigo Masayuki,
  • Tarcila Datoguia,
  • Hiba Dagher,
  • Ying Jiang,
  • Vivek Subbiah,
  • Bilal Siddiqui,
  • Arnaud Bayle,
  • Robert Somer,
  • Ana Fernández Cruz,
  • Edward Gorak,
  • Arvinder Bhinder,
  • Nobuyoshi Mori,
  • Nelson Hamerschlak,
  • Samuel Shelanski,
  • Tomislav Dragovich,
  • Yee Elise Vong Kiat,
  • Suha Fakhreddine,
  • Abi Hanna Pierre,
  • Roy F Chemaly,
  • Victor Mulanovich,
  • Javier Adachi,
  • Jovan Borjan,
  • Fareed Khawaja,
  • Bruno Granwehr,
  • Teny John,
  • Eduardo Yepez Yepez,
  • Harrys A Torres,
  • Natraj Reddy Ammakkanavar,
  • Marcel Yibirin,
  • Cielito C Reyes-Gibby,
  • Mala Pande,
  • Noman Ali,
  • Raniv Dawey Rojo,
  • Shahnoor M Ali,
  • Rita E Deeba,
  • Patrick Chaftari,
  • Takahiro Matsuo,
  • Kazuhiro Ishikawa,
  • Ryo Hasegawa,
  • Ramón Aguado-Noya,
  • Alvaro Garcia García,
  • Cristina Traseira Puchol,
  • Dong Gun Lee,
  • Monica Slavin,
  • Benjamin Teh,
  • Cesar A Arias,
  • Data-Driven Determinants for COVID-19 Oncology Discovery Effort (D3CODE) Team,
  • Dimitrios P Kontoyiannis,
  • Alexandre E Malek,
  • Anne-Marie Chaftari

DOI
https://doi.org/10.7554/eLife.81127
Journal volume & issue
Vol. 12

Abstract

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Background: In this international multicenter study, we aimed to determine the independent risk factors associated with increased 30 day mortality and the impact of cancer and novel treatment modalities in a large group of patients with and without cancer with COVID-19 from multiple countries. Methods: We retrospectively collected de-identified data on a cohort of patients with and without cancer diagnosed with COVID-19 between January and November 2020 from 16 international centers. Results: We analyzed 3966 COVID-19 confirmed patients, 1115 with cancer and 2851 without cancer patients. Patients with cancer were more likely to be pancytopenic and have a smoking history, pulmonary disorders, hypertension, diabetes mellitus, and corticosteroid use in the preceding 2 wk (p≤0.01). In addition, they were more likely to present with higher inflammatory biomarkers (D-dimer, ferritin, and procalcitonin) but were less likely to present with clinical symptoms (p≤0.01). By country-adjusted multivariable logistic regression analyses, cancer was not found to be an independent risk factor for 30 day mortality (p=0.18), whereas lymphopenia was independently associated with increased mortality in all patients and in patients with cancer. Older age (≥65y) was the strongest predictor of 30 day mortality in all patients (OR = 4.47, p<0.0001). Remdesivir was the only therapeutic agent independently associated with decreased 30 day mortality (OR = 0.64, p=0.036). Among patients on low-flow oxygen at admission, patients who received remdesivir had a lower 30 day mortality rate than those who did not (5.9 vs 17.6%; p=0.03). Conclusions: Increased 30 day all-cause mortality from COVID-19 was not independently associated with cancer but was independently associated with lymphopenia often observed in hematolgic malignancy. Remdesivir, particularly in patients with cancer receiving low-flow oxygen, can reduce 30 day all-cause mortality. Funding: National Cancer Institute and National Institutes of Health.

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