Time to anti-cancer treatment resumption after SARS-CoV-2 infection in patients with active haematological diseases undergoing combined antiviral treatments.

Background and objectives: The management of SARS-CoV-2-infected patients with haematological malignancies and active disease is challenging, particularly in determining when to restart cancer therapy. This study evaluated the time to resumption of haematological therapy in adults with active haematological malignancies affected by SARS-CoV-2 infection and treated with either single-drug regimens (SR) or combined regimens (CR).

Materials and methods: An observational cohort study was set up including patients with active haematological disease treated for SARS-CoV-2 infection between January 2022 and December 2023. Kaplan-Meier estimates and Cox regression models were fitted to analyse the time to restarting anti-cancer therapy and factors associated with resumption within 60 days.

Results: Of the 79 patients included, 68 (86%) received SR, and 11 (14%) received CR. Patients on CR were more likely to require oxygen support (P = 0.006) and to have additional causes of immunosuppression (P = <0.001) compared with those on SR. The median time to restart therapy did not significantly differ between groups (38 days [IQR 21-70] for SR versus 30 days [IQR 18-77] for CR; P = 0.46). By Fine-Gray competing risk regression analysis, pneumonia (HR 0.36, 95% CI 0.18-0.71), but not CR (HR 0.62, 95% CI 0.23-1.69), independently reduced the likelihood of restarting therapy within 60 days of SARS-CoV-2 diagnosis.

Conclusions: Combination regimens for SARS-CoV-2 did not affect the time to restart haematological therapy, whereas the occurrence of pneumonia was associated with delayed resumption of chemotherapy. The real benefit of COVID-19 combination therapy in the setting of haematologic malignancies, particularly for early treatment strategies, should be referred to the evidence from randomized controlled trials.