Cancers (Jan 2024)

COVID-19 Outcomes in Patients with Hematologic Malignancies in the Era of COVID-19 Vaccination and the Omicron Variant

  • Joaquín Martínez-López,
  • Javier de la Cruz,
  • Rodrigo Gil-Manso,
  • Víctor Jiménez Yuste,
  • José María Aspa-Cilleruelo,
  • Cristian Escolano Escobar,
  • Javier López-Jiménez,
  • Rafael Duarte,
  • Cristina Jacome Yerovi,
  • José-Ángel Hernández-Rivas,
  • Regina Herráez,
  • Keina Quiroz-Cervantes,
  • Rosalía Bustelos-Rodriguez,
  • Celina Benavente,
  • Pilar Martínez Barranco,
  • Mariana Bastos Oteiro,
  • Adrián Alegre,
  • Jaime Pérez-Oteyza,
  • Elena Ruiz,
  • Eriel Alexis Marcheco-Pupo,
  • Ángel Cedillo,
  • Teresa de Soto Álvarez,
  • Patricia García Ramirez,
  • Rosalía Alonso Trillo,
  • Pilar Herrera,
  • María Luisa Bengochea Casado,
  • Andrés Arroyo Barea,
  • Jose Manuel Martin De Bustamante,
  • Javier Ortiz,
  • María Calbacho Robles,
  • Julio García-Suárez

DOI
https://doi.org/10.3390/cancers16020379
Journal volume & issue
Vol. 16, no. 2
p. 379

Abstract

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A greater understanding of clinical trends in COVID-19 outcomes among patients with hematologic malignancies (HM) over the course of the pandemic, particularly the Omicron era, is needed. This ongoing, observational, and registry-based study with prospective data collection evaluated COVID-19 clinical severity and mortality in 1818 adult HM patients diagnosed with COVID-19 between 27 February 2020 and 1 October 2022, at 31 centers in the Madrid region of Spain. Of these, 1281 (70.5%) and 537 (29.5%) were reported in the pre-Omicron and Omicron periods, respectively. Overall, patients aged ≥70 years (odds ratio 2.16, 95% CI 1.64–2.87), with >1 comorbidity (2.44, 1.85–3.21), or with an underlying HM of chronic lymphocytic leukemia (1.64, 1.19–2.27), had greater odds of severe/critical COVID-19; odds were lower during the Omicron BA.1/BA.2 (0.28, 0.2–0.37) or BA.4/BA.5 (0.13, 0.08–0.19) periods and among patients vaccinated with one or two (0.51, 0.34–0.75) or three or four (0.22, 0.16–0.29) doses. The hospitalization rate (75.3% [963/1279], 35.7% [191/535]), rate of intensive care admission (30.0% [289/963], 14.7% [28/191]), and mortality rate overall (31.9% [409/1281], 9.9% [53/536]) and in hospitalized patients (41.3% [398/963], 22.0% [42/191]) decreased from the pre-Omicron to Omicron period. Age ≥70 years was the only factor associated with higher mortality risk in both the pre-Omicron (hazard ratio 2.57, 95% CI 2.03–3.25) and Omicron (3.19, 95% CI 1.59–6.42) periods. Receipt of prior stem cell transplantation, COVID-19 vaccination(s), and treatment with nirmatrelvir/ritonavir or remdesivir were associated with greater survival rates. In conclusion, COVID-19 mortality in HM patients has decreased considerably in the Omicron period; however, mortality in hospitalized HM patients remains high. Specific studies should be undertaken to test new treatments and preventive interventions in HM patients.

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