Caution justified over intensive cancer therapy in pandemic: UK clinicians

Patients with blood cancers and COVID-19 have double the risk of death compared with general medical patients  admitted to hospital at the same time, the largest study to date has shown.

Data from 80 haemato-oncology patients from King’s College Hospital, London, also found that those undergoing intensive treatments had a four-fold higher risk of dying than other patients admitted to the hospital with COVID-19.

The researchers said the analysis suggests that the current caution around use of intensive treatments during the pandemic is justified, and that continuation of shielding in these patients should be considered.

Unlike previous smaller studies, there was no link between gender or age and risk of death, the researchers reported in the British Journal of Haematology.

Of the first 80 patients with haematological malignancy admitted to King’s College Hospital with COVID-19, the mean age was 69 years and 76% had at least one comorbidity.

Overall, 62 (77%) patients had lymphoid malignancies or plasma cell dyscrasias and 18 (23%) had myeloid neoplasms.

Nine of the patients had previously undergone a stem cell transplant (6 allogeneic and 3 autologous) and one had received CAR T-cell therapy.

They reported that 29% of patients had mild COVID-19 infection, 27% had moderate disease requiring care on a ward and needing oxygen and 44% had severe disease.

When compared with general medical patients admitted to the hospital with COVID-19, there was no difference in age, gender or co-morbidities.

But the mortality rate of 39% was significantly worse in the haematology group than in the comparison group which had a mortality rate of 20%.

And while the type of malignancy was not a factor, those on the intensive treatment were at more than four times higher the risk of death than non-haematology patients.

The team also found that haemato-oncology patients were not clearing the infection as rapidly, with virus still detectable in substantial number of patients six weeks – a finding that “has significant implications for scheduling subsequent chemotherapies, shielding and self-isolation,” they concluded.

Study leader Dr Austin Kulasekararaj, consultant haematologist at King’s College Hospital, said understanding of COVID-19 was rapidly changing but the data would help in advising patients and making decisions around treatment.

He added that their team’s approach to going ahead with immunosuppressive treatments was a cautious one and based on how urgent the patients need was.

“If someone needs urgent treatment then they need it but for non-urgent treatment you would want to delay until you are sure, or at least proceed with your eyes open,” he said.

“Patients can’t wait for too long but that is where it is important to take other measures such as swabbing and screening them and keeping them in separate rooms and so on.”

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