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Patients with haematological malignancy are most vulnerable to COVID-19

The UKCCMP is a national monitoring project of patients with cancer who develop COVID-19. The database was utilised to consider the effect of primary tumour subtype, on COVID-19 prevalence and case–fatality rate during hospital admission. Data for the UKCCMP is gathered via case reporting by local oncologists across the UK using information from clinical records or from direct assessment. This study looked at a cohort 1044 patients with active cancer and documented COVID-19 disease who were registered in the UKCCMP database between March 2020 and May 2020. The demographics and cancer subtype of this group of patients with cancer with COVID-19 were compared with those from a population of patients represented in a 2017 UK cancer census, which was used as a control group.

 

The results showed that patients with different tumour types have differing susceptibility to COVID-19 disease with notable increased hospital presentations in patients with haematological cancers. Patients with haematological malignancies were at a greater risk of having a more severe COVID-19 clinical presentation, required more intensive supportive interventions, and had an increased risk of death compared with patients with non-haematological malignancies. Previously, large COVID-19 cohorts of predominantly solid organ tumours have shown no significant excess mortality risk from recent chemotherapy, but this paper found that risk appeared to be increased by recent (within 4 weeks) or current chemotherapy in patients with haematological cancers.

 

The authors postulated that there may be several reasons for these observations including immunological disruption observed in patients with leukaemia, which, combined with using of intensely myelosuppressive treatment regimens, might result in increased risks. There is also an increased likelihood of initial infection, and an increased ability of this novel coronavirus to gain a foothold in the patient. In terms of the disease course there is a higher likelihood of severe consequences, such as cytokine storm and multi-organ failure. The authors also believed that more in-depth research into the possible causes is important.

 

It is known that morbidity and case–fatality rates from COVID-19 in UK hospital patients with cancer who attend hospital are high. This is particularly the case in older patients and those with haematological malignancies. From this study it is clear that not all cancer patients are affected equally. This important finding could allow clinicians some ability to risk-stratify their patients and make informed decisions on appropriate levels of social isolation and shielding.

The complete paper can be seen here -: https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(20)30442-3/fulltext