{"title":"Outcomes and Risk Factors in Patients with Hematologic Malignancies Following Late-Stage SARS-CoV-2 Infection.","authors":"Lina Wang, Jiang Liu, Yafang Guo, Meiling Zhao, Bozheng Zhang, Junyan Zhang, Ruijuan Zhang","doi":"10.2147/JMDH.S491098","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the outcomes and risk factors for patients with hematologic malignancies (HM) following late-stage SARS-CoV-2 infection.</p><p><strong>Background: </strong>Patients with HM such as lymphoproliferative malignancies (including acute lymphoblastic leukemia and multiple myeloma) and myeloproliferative malignancies (including acute myeloid leukemia, myeloproliferative neoplasm, and myelodysplastic syndrome) are at increased risk of severe illness and high mortality from COVID-19. This study examines the impact of SARS-CoV-2 infection severity on HM prognosis during the late phase of COVID-19, using data from 203 patients at Shanxi Bethune Hospital.</p><p><strong>Methods: </strong>This is a retrospective cohort study. Data was collected from hospitalized HM patients at a single center from December 1, 2023, to December 31, 2023. The primary outcome was overall survival (OS). Multivariable Cox regression was used to identify risk factors.</p><p><strong>Results: </strong>This analysis includes data from 203 hospitalized patients with HM aged 36 to 67 years (median, 58 years). SARS-CoV-2 infection was observed in 42.86% (87/203) of the patients, among whom severe/critical cases accounted for 14.29% (29/203). Multivariable Cox regression shows active disease (hazard ratio [HR] 2.16, 95% confidence interval [CI] 1.00-4.64, p = 0.049), hematopoietic stem cell transplantation (HSCT) (HR 4.06, 95% CI 1.02-16.12, p = 0.047), and targeted therapy (HR 2.60, 95% CI 1.23-5.50, p = 0.012) were associated with a higher incidence of progression. In contrast, individuals whose platelets count ≥50×10<sup>9</sup>/L at baseline (HR = 0.36, 95% CI 0.17-0.78, p = 0.009) and ferritin levels less than 500 µg/L (HR = 0.54, 95% CI 0.34-0.86, p = 0.010) were associated with a lower incidence of progression. Active status (HR 7.06, 95% CI 2.10-23.76, p = 0.002), HSCT (HR 7.17, 95% CI 1.10-46.63, p = 0.039), and severe/critical SARS-CoV-2 infection in HM patients (HR 11.98, 95% CI 2.57-55.82, p = 0.002) were associated with higher incidences of all cause of mortality. While a higher platelet level (≥50×10<sup>9</sup>/L) was linked to a lower mortality (HR 0.16, 95% CI 0.05-0.49, p = 0.002).</p><p><strong>Conclusion: </strong>In the late stage of the COVID-19 pandemic, active disease status, recent HSCT, and severe/critical SARS-CoV-2 infection significantly increased the risks of disease progression and mortality in HM patients. Higher baseline platelet counts were associated with improved outcomes.</p>","PeriodicalId":16357,"journal":{"name":"Journal of Multidisciplinary Healthcare","volume":"17 ","pages":"5853-5865"},"PeriodicalIF":2.7000,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11636247/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Multidisciplinary Healthcare","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2147/JMDH.S491098","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: To investigate the outcomes and risk factors for patients with hematologic malignancies (HM) following late-stage SARS-CoV-2 infection.
Background: Patients with HM such as lymphoproliferative malignancies (including acute lymphoblastic leukemia and multiple myeloma) and myeloproliferative malignancies (including acute myeloid leukemia, myeloproliferative neoplasm, and myelodysplastic syndrome) are at increased risk of severe illness and high mortality from COVID-19. This study examines the impact of SARS-CoV-2 infection severity on HM prognosis during the late phase of COVID-19, using data from 203 patients at Shanxi Bethune Hospital.
Methods: This is a retrospective cohort study. Data was collected from hospitalized HM patients at a single center from December 1, 2023, to December 31, 2023. The primary outcome was overall survival (OS). Multivariable Cox regression was used to identify risk factors.
Results: This analysis includes data from 203 hospitalized patients with HM aged 36 to 67 years (median, 58 years). SARS-CoV-2 infection was observed in 42.86% (87/203) of the patients, among whom severe/critical cases accounted for 14.29% (29/203). Multivariable Cox regression shows active disease (hazard ratio [HR] 2.16, 95% confidence interval [CI] 1.00-4.64, p = 0.049), hematopoietic stem cell transplantation (HSCT) (HR 4.06, 95% CI 1.02-16.12, p = 0.047), and targeted therapy (HR 2.60, 95% CI 1.23-5.50, p = 0.012) were associated with a higher incidence of progression. In contrast, individuals whose platelets count ≥50×109/L at baseline (HR = 0.36, 95% CI 0.17-0.78, p = 0.009) and ferritin levels less than 500 µg/L (HR = 0.54, 95% CI 0.34-0.86, p = 0.010) were associated with a lower incidence of progression. Active status (HR 7.06, 95% CI 2.10-23.76, p = 0.002), HSCT (HR 7.17, 95% CI 1.10-46.63, p = 0.039), and severe/critical SARS-CoV-2 infection in HM patients (HR 11.98, 95% CI 2.57-55.82, p = 0.002) were associated with higher incidences of all cause of mortality. While a higher platelet level (≥50×109/L) was linked to a lower mortality (HR 0.16, 95% CI 0.05-0.49, p = 0.002).
Conclusion: In the late stage of the COVID-19 pandemic, active disease status, recent HSCT, and severe/critical SARS-CoV-2 infection significantly increased the risks of disease progression and mortality in HM patients. Higher baseline platelet counts were associated with improved outcomes.
目的:探讨晚期SARS-CoV-2感染后血液系统恶性肿瘤(HM)患者的预后及危险因素。背景:HM患者,如淋巴增生性恶性肿瘤(包括急性淋巴细胞白血病和多发性骨髓瘤)和骨髓增生性恶性肿瘤(包括急性髓性白血病、骨髓增生性肿瘤和骨髓增生异常综合征),患COVID-19严重疾病和高死亡率的风险增加。本研究利用山西白求恩医院203例患者的数据,研究了COVID-19晚期SARS-CoV-2感染严重程度对HM预后的影响。方法:回顾性队列研究。数据收集自2023年12月1日至2023年12月31日在单一中心住院的HM患者。主要终点是总生存期(OS)。采用多变量Cox回归分析确定危险因素。结果:本分析包括203例住院HM患者的数据,年龄36 - 67岁(中位年龄58岁)。42.86%(87/203)的患者存在SARS-CoV-2感染,其中重症/危重症患者占14.29%(29/203)。多变量Cox回归显示,活动性疾病(风险比[HR] 2.16, 95%可信区间[CI] 1.00-4.64, p = 0.049)、造血干细胞移植(HR 4.06, 95% CI 1.02-16.12, p = 0.047)和靶向治疗(HR 2.60, 95% CI 1.23-5.50, p = 0.012)与较高的进展发生率相关。相比之下,基线血小板计数≥50×109/L (HR = 0.36, 95% CI 0.17-0.78, p = 0.009)和铁蛋白水平低于500µg/L (HR = 0.54, 95% CI 0.34-0.86, p = 0.010)的个体与较低的进展发生率相关。HM患者的活动状态(HR 7.06, 95% CI 2.10-23.76, p = 0.002)、HSCT (HR 7.17, 95% CI 1.10-46.63, p = 0.039)和严重/危重SARS-CoV-2感染(HR 11.98, 95% CI 2.57-55.82, p = 0.002)与较高的全因死亡率相关。而较高的血小板水平(≥50×109/L)与较低的死亡率相关(HR 0.16, 95% CI 0.05-0.49, p = 0.002)。结论:在COVID-19大流行晚期,活动性疾病状态、近期HSCT和严重/危重型SARS-CoV-2感染显著增加了HM患者疾病进展和死亡的风险。较高的基线血小板计数与改善的预后相关。
期刊介绍:
The Journal of Multidisciplinary Healthcare (JMDH) aims to represent and publish research in healthcare areas delivered by practitioners of different disciplines. This includes studies and reviews conducted by multidisciplinary teams as well as research which evaluates or reports the results or conduct of such teams or healthcare processes in general. The journal covers a very wide range of areas and we welcome submissions from practitioners at all levels and from all over the world. Good healthcare is not bounded by person, place or time and the journal aims to reflect this. The JMDH is published as an open-access journal to allow this wide range of practical, patient relevant research to be immediately available to practitioners who can access and use it immediately upon publication.