Infectious Disease

Inpatient hospitalization, high cancer mortality, COVID-19

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Mark NM et al. Abstract 6566. Presented at: ASCO Annual Meeting (virtual meeting); 4-8 June 2021.

Disclosure:
NIH funded this study. Khorana reports his institution’s research funding from, advisory / advisory roles, fees or travel, accommodations or expenses from Anthos Therapeutics, Array BioPharma, Bayer, Bristol Myers Squibb, Halozyme, Janssen, Leap Oncology, Medscape, Merck, Nektar Therapeutics, Pfizer, Pharmacyclics, Pharmacyte Biotech and Seagen. Please refer to the executive summary for all relevant financial information from the other researchers.

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Cancer patients infected with COVID-19 were at high risk of inpatient hospitalization and high death, according to study results presented during ASCO’s annual virtual meeting.

Only a quarter of patients admitted to the intensive care unit received invasive mechanical ventilation, preliminary results of the longitudinal NCI COVID-19 in Cancer Patients Study (NCCAPS) showed.

Infographic with key findings from the NCCAPS study

Data from Mark NM et al. Abstract 6566. Presented at: ASCO Annual Meeting (virtual meeting); 4-8 June 2021.

“COVID-19 in patients with solid tumors and hematologic malignancies undergoing active therapy is associated with poor outcomes, including high risk [for] inpatient mortality “, Alok A. Khorana, MD, Professor of medicine at Cleveland Clinic Lerner College of Medicine, Healio said. “Constant efforts to get mass vaccinations are essential to reducing the risk for [patients with cancer]. “

Alok A. Khorana, MD

Alok A. Khorana

People with cancer and COVID-19 often experience severe disease and an increased risk of death. Previous research suggested that the risks may be higher based on the type of cancer and the presence of metastatic disease.

The NCCAPS study is designed to provide detailed prospective inpatient data that could reveal which patients are at greatest risk for poor outcomes.

The researchers hope to attract 2,000 adults with COVID-19 to undergo cancer treatment. The cohort includes patients with solid tumors or blood cancer.

Investigators are collecting clinical data, imaging, and blood samples during the patients’ first COVID-19 hospitalization. You will collect additional clinical information on subsequent hospitalizations.

“Although much has been researched about the results of COVID-19, detailed prospective data specific to the results” [among patients with cancer] missing, ”said Khorana. “NCI started this large national prospective cohort study to explore the epidemiology and results of and [patients with cancer] hospitalized with COVID-19. “

The researchers ingested 757 adults from 204 locations on Jan. 22.

According to the data cut-off, 124 patients (16.3%) reported at least one hospital stay for COVID-19. The investigators had discharge data for a total of 98 hospital admissions of 88 patients (mean age 67 years; range 21-93; 40% women).

The most common malignancies in those requiring a COVID-19 hospital stay included lymphoma (18.2%), lung cancer (15.9%), and multiple myeloma (10.2%).

“[This suggests] Susceptibility to serious illness in patients with these diagnoses, ”said Khorana.

Sixteen (16.3%) of a total of 98 inpatient hospital stays resulted in death, a rate Khorana described as “particularly worrying”.

“Identifying predictors of poor outcomes, especially inpatient mortality, is critical,” said Khorana.

About two-thirds of the patients who had to be hospitalized showed shortness of breath (65%) or tiredness / malaise (64%) and almost half (49%) had a fever. Seventeen patients (19%) were thrombocytopenic and eight (9%) were neutropenic, defined as absolute neutrophil counts less than 1,000.

Patients stayed in hospital for a median of 6.5 days (range 1-41).

The researchers received inpatient medication data from 63 patients (71.5%). In this subgroup, the most common treatments included corticosteroids (63%), remdesivir (46%), and convalescent plasma (14%).

One patient received the monoclonal antibody Bamlanivimab (Eli Lilly) and two patients received the immunosuppressant tocilizumab (Actemra, Genentech).

Almost three quarters (73%) received anticoagulation, most often prophylactic low molecular weight heparin. Eleven patients (17%) received anticoagulation at therapeutic doses.

Approximately one in five hospitalized patients (22.7%) were cared for in the intensive care unit or in the intensive care unit (median intensive care stay 7 days; range 1-22); 25% of ICU-admitted patients received invasive mechanical ventilation, a percentage that Khorana said was lower than expected.

“We don’t really know [why invasive mechanical ventilation was not used more frequently]“, Khorana said to Healio. “One might speculate that the underlying diagnosis / stage might have led doctors to [or] Families making ventilation decisions that are different from those of the non-cancer population. “

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Lee Greenberger, PhD)

Lee Greenberger, PhD

This study highlights that cancer patients – and especially those with lymphoma – are at high risk of hospitalization and death after COVID-19 infection.

The Leukemia & Lymphoma Society encourages all blood cancer patients to get vaccinated because the side effect profile for them is no different from that of the general population.

However, based on previously published reports, we have learned that certain blood cancer patients do not produce antibodies to the spike protein after being fully vaccinated with the SARS-CoV-2 vaccines. This ability of patients to produce antibodies after the SARS-CoV-2 vaccination is being further investigated in a large study of all blood cancers with the LLS National Patient Registry, a project of the Michael J. Garil Patient Data Collective.

Further studies on other arms of the immune system – particularly T cells – as well as alternative therapies for such patients are actively being investigated.

References:

NIH. The Lymphoma and Leukemia Society’s COVID-19 Registry. Available at Clinicaltrials.gov/ct2/show/NCT04794387. Retrieved June 4, 2021.

The Leukemia and Lymphoma Society. COVID-19 vaccine safety in blood cancer patients. Available at: www.lls.org/news/covid-19-vaccine-safety-among-blood-cancer-patients. Retrieved June 4, 2021.

Lee Greenberger, PhD

The Leukemia and Lymphoma Society

Disclosure: Greenberger does not report any relevant financial information.

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ASCO annual meeting

ASCO annual meeting

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