Coronavirus-2019 (COVID-19) mortality is higher in patients with cancer than in the general population, yet the cancer-associated risk factors for COVID-19 adverse outcomes are not fully characterized.
We reviewed clinical characteristics and outcomes from patients with cancer and concurrent COVID-19 at Memorial Sloan Kettering Cancer Center until March 31, 2020 (n = 309), and observed clinical end points until April 13, 2020. We hypothesized that cytotoxic chemotherapy administered within 35 days of a COVID-19 diagnosis is associated with an increased hazard ratio (HR) of severe or critical COVID-19. In secondary analyses, we estimated associations between specific clinical and laboratory variables and the incidence of a severe or critical COVID-19 event.
Cytotoxic chemotherapy administration was not significantly associated with a severe or critical COVID-19 event (HR, 1.10; 95% CI, 0.73 to 1.60). Hematologic malignancy was associated with increased COVID-19 severity (HR, 1.90; 95% CI, 1.30 to 2.80). Patients with lung cancer also demonstrated higher rates of severe or critical COVID-19 events (HR, 2.0; 95% CI, 1.20 to 3.30). Lymphopenia at COVID-19 diagnosis was associated with higher rates of severe or critical illness (HR, 2.10; 95% CI, 1.50 to 3.10). Patients with baseline neutropenia 14-90 days before COVID-19 diagnosis had worse outcomes (HR, 4.20; 95% CI, 1.70 to 11.00). Findings from these analyses remained consistent in a multivariable model and in multiple sensitivity analyses. The rate of adverse events was lower in a time-matched population of patients with cancer without COVID-19.
Recent cytotoxic chemotherapy treatment was not associated with adverse COVID-19 outcomes. Patients with active hematologic or lung malignancies, peri-COVID-19 lymphopenia, or baseline neutropenia had worse COVID-19 outcomes. Interactions among antineoplastic therapy, cancer type, and COVID-19 are complex and warrant further investigation.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2020 Aug 14 [Epub ahead of print]
Justin Jee, Michael B Foote, Melissa Lumish, Aaron J Stonestrom, Beatriz Wills, Varun Narendra, Viswatej Avutu, Yonina R Murciano-Goroff, Jason E Chan, Andriy Derkach, John Philip, Rimma Belenkaya, Marina Kerpelev, Molly Maloy, Adam Watson, Chris Fong, Yelena Janjigian, Luis A Diaz, Kelly L Bolton, Melissa S Pessin
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY., Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY., Department of Health Informatics, Memorial Sloan Kettering Cancer Center, New York, NY., Department of Information Systems, Memorial Sloan Kettering Cancer Center, New York, NY., Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.