COVID-19 May Increase Mortality Risk in Older Patients With B-Cell Malignancies, Among Others

Patients aged 60 years and older with B-cell malignancies and those who were current or former smokers may have an increased risk for death after a COVID-19 infection, also outcomes may be better for those diagnosed after June 2020.

Older patients with B-cell malignancies who were diagnosed with COVID-19 during treatment had an increased risk for death compared with those with metastatic solid tumors, study results demonstrated.

Researchers of the study, which was published in JCO Oncology Practice, also found that patients who were diagnosed with SARS-CoV-2 in the later part of 2020 had more favorable rates of 30-day and 90-day mortality compared with those diagnosed in early 2020.

“The most important finding is that patients with B-cell malignancies and increased age are at higher risk for poor outcomes and need careful surveillance and early intervention if they get COVID-19,” Dr. Kathryn F. Mileham, chief of thoracic medical oncology and associate professor at Atrium Health’s Levine Cancer Institute in Charlotte, North Carolina, told CURE®. “It should be more possible to receive COVID-19 specific care now than in the early months of the pandemic with the availability of therapeutic antibodies and soon to be available oral therapies.”

Researchers analyzed data from the American Society of Clinical Oncology (ASCO) COVID-19 registry to learn more about the impact of the virus in patients with cancer undergoing treatment in 2020.

Mileham, who is also the immediate past chair of the ASCO’s Cancer Research Committee, noted that she and her team started the registry in April 2020, when there was little information on the risk for COVID-19 in patients with cancer and its impact on cancer care.

“We wanted to provide evidence for patients and their care providers to determine which patients needed more stringent strategies to avoid exposure to the virus and realistic expectations for what it meant to have a SARS-CoV-2 infection as a patient with cancer,” Mileham said. “We also wanted to share our findings of the change in mortality in patients with cancer and SARS-CoV-2 infection in 2020 —comparing the early part of the pandemic to later in 2020 – as diagnostic testing and treatment strategies improved, and the risk of severe outcomes decreased.”

In this particular study, 38 practices provided information on 453 patients (median age, 64 years) with cancer from April to October 2020. Of these patients, 62% had regional or metastatic solid tumors and 43% were current or previous cigarette users.

Researchers found that patients with B-cell malignancies between ages 61 and 70 years had a two-times increased risk for mortality compared with those with other cancer types. In addition, patients older than 70 years had a 4.5-times increased risk for death versus those aged 60 years and younger. The link between survival and age was not significant in patients with metastatic solid tumors.

“This is an observational study, so causality cannot be easily inferred,” Mileham said. “However, patients with B-cell malignancies may be receiving treatment that is depleting B cells, further compromising the ability to neutralize the COVID-19 viral replication. Also, some studies have suggested that these patients have a longer time clearing the viral shedding because of the reduced B cells, which may lead to higher risk of severe and prolonged COVID-19 infection (and) ultimately increasing risk for death.”

Patients who used tobacco had an estimated risk for death at 30 days of 21% compared with 11% in those who never used tobacco products. Causality could not be easily inferred for this finding as well, Mileham said.

“Most importantly, this finding should prioritize another opportunity to encourage, educate and provide resources toward smoking prevention and cessation,” she added.

The mortality rate at 30 days decreased from 20% in patients diagnosed with COVID-19 before June 2020 to 13% in those diagnosed after June 2020. The risk for mortality at 90 days also decreased during this time period (28% to 21%).

Mileham explained that as the COVID-19 vaccine became more prominent in 2021, it is somewhat difficult to determine whether increased vaccination rates would potentially change outcomes in this study.

“It is hard to say given the dynamics of the virus and the changes in treatment strategies over the past 18 months, but given what we’ve seen from patients who have been vaccinated and still were infected with the virus (ie, breakthrough cases), our hope is that mortality and hospitalizations in patients with cancer and COVID-19 would decrease,” she said.

Mileham added that she and her team are still collecting data on patients with cancer who were infected with SARS-CoV-2 and on those who were vaccinated before and after infection. This information will help her team compare outcomes in patients with cancer and breakthrough infections with those in patients with cancer who were unvaccinated when diagnosed with COVID-19.

Lastly, she explained the importance of vaccination especially in patients with B-cell malignancies who may not have as strong of a response to it as those with other cancer types.

“Specific to patients with B-cell malignancies, antibody response to the vaccines in these patients has been shown to be poor, so the three- rather than two-shot series might be particularly important,” Mileham said. “Additionally, early intervention with therapeutic antibodies and the soon to be available oral antivirals should diminish their risk for severe outcomes going forward.”

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