In a UK study reported in The Lancet Oncology, Lee et al in the UK Coronavirus Cancer Monitoring Project (UKCCMP) found an increased prevalence of COVID-19 infection among patients with hematologic malignancies and increased risk of death from COVID-19 in patients with leukemia and those with hematologic malignancies who had recently received chemotherapy.<\/p>\n
Study Details<\/strong><\/p>\n The study involved a comparison of data from 1,044 adult patients with cancer and a positive SARS-CoV-2 test enrolled in the UKCCMP cohort between March 18 and May 8, 2020, with data from a parallel non\u2013COVID-19 UK cancer control population (n = 282,878) from the UK Office for National Statistics (ONS; 2017 data) to determine potential increased risk of COVID-19 infection by cancer type. Patients in the UKCCMP cohort were aged \u2265 18 years, had active cancer, and had presented to a UKCCMP network center. All patients attended secondary care to be reviewed for potential admission to hospital. Characteristics potentially associated with increased risk of severe COVID-19 infection and mortality among patients in the UKCCMP cohort were assessed.<\/p>\n Key Findings<\/strong><\/p>\n In the comparison of representation in the UKCMMP cohort vs the ONS cohort, patients with hematologic malignancies appeared to be at significantly increased risk of COVID-19 infection, including those with leukemia (odds ratio [OR] = 2.82, P < .0001), multiple myeloma (OR = 2.03, P = .0001), and lymphoma (OR = 1.63, P < .0001). Patients with lung cancer (OR = 0.75, P = .003) and those with prostate cancer (OR = 0.72, P = .0008) appeared to be at lower risk. Men were over-represented in the UKCMMP cohort (56.9% vs 51.3%, OR = 1.26, P = .0002). Age distribution did not differ between the two cohorts.<\/p>\n In the UKCMMP cohort, patients with hematologic malignancies (leukemia, lymphoma, and multiple myeloma) had an increased risk for severe or critical COVID-19 infection vs patients with solid organ tumors (OR = 1.57, P < .0043).<\/p>\n Death occurred in 319 patients (30.6%) in the UKCCMP cohort, with 295 (92.5%) having COVID-19 as recorded cause of death. The all-cause case fatality rate was significantly associated with age, increasing from 0.10 in the 40-to-49 year age group to 0.48 in \u2265 80-year age group. The rate was also significantly higher in men vs women (OR = 1.92, P < .0001).<\/p>\n On multivariate analysis, patients with leukemia had a significantly increased case fatality rate (OR = 2.25, P = .023). After correction for age and sex, patients with hematologic malignancies who had recent chemotherapy (within 4 weeks of COVID-19 presentation) had increased risk of death during hospital admission for COVID-19 vs those without recent chemotherapy (OR = 2.09, P = .028).<\/p>\n The investigators formulated a risk table showing case fatality rates after presentation with COVID-19 according to tumor type, age, and sex.<\/p>\n The investigators concluded: \u201cPatients with cancer with different tumour types have differing susceptibility to SARS-CoV-2 infection and COVID-19 phenotypes. We generated individualised risk tables for patients with cancer, considering age, sex, and tumour subtype. Our results could be useful to assist physicians in informed risk-benefit discussions to explain COVID-19 risk and enable an [evidence-based] approach to national social isolation policies.\u201d<\/p>\n Gary Middleton, FRCP, of the Institute of Immunology and Immunotherapy, University of Birmingham, is the corresponding author for The Lancet Oncology article.<\/p>\n Disclosure: The study was funded by the University of Birmingham and University of Oxford. For full disclosures of the study authors, visit www.thelancet.com.<\/p>\n