4CPS-287 Impact of SARS-CoV-2 infection in acute myeloid leukaemia patients: experience of the Pethema registry. (14th March 2021)

• Record Type: Journal Article
• Authors: Palanques Pastor, T; Megias Vericat, J; Martinez, P; Cornago Navascués, J; López Lorenzo, JL; Rodríguez, G; Cano, I; Arnan Sangerman, M; Poveda Andrés, JL; Montestinos, P
• Is Part Of: European journal of hospital pharmacy. Volume 28(2021)Supplement 1
• Page Start: A58
• Page End: A59
• Publication Date: 2021-03-14
• Subjects: Pharmacy -- Periodicals; Hospital pharmacies -- Periodicals; 615.1
• DOI: 10.1136/ejhpharm-2021-eahpconf.119
• Languages: English
• ISSNs: 2047-9956

Abstract

Abstract : Background and importance: SARS-CoV-2 infection can impact the survival of patients with acute myeloid leukaemia (AML) but there is little published evidence in AML. Aim and objectives: To analyse the clinical futures and outcome of SARS-CoV-2 infection in AML patients. Material and methods: An observational multicentre study was conducted between March and May 2020 with 117 patients reported from 47 Spanish centres. Leukaemic and viral infections were studied, and inter-relationships were established. Results: Median age was 68 years, men (56.7% vs 43.3%), median time from AML diagnosis to SARS-CoV-2 was 4 months and mean number of comorbidities was 1.2. Cytogenetic risk was low in 16.9%, intermediate in 57.1% and high in 26.0%; 55.7% had active disease, 39.2% complete remission and 5.1% partial response. 29.4% were off-therapy and 70.6% were receiving anti-leukaemic treatment: induction chemotherapy (25.3%), hypomethylating (19.3%), clinical trial (17.0%), consolidation chemotherapy (14.8%), venetoclax (3.4%), FLT3 inhibitors (3.4%) and/or maintenance (1.1%). Overall, 3.7% were newly diagnosed, 77.8% had received one line of treatment, 14.8% two and 3.7% four. 15.4% had prior allogeneic transplantation. Only 4.0% of patients were asymptomatic, while the main signs and symptoms were fever (77.8%), pneumonia (75.0%), cough (65.3%), dyspnoea (52.0%), diarrhoea (20.4%), nausea/vomiting (12.2%), rhinorrhoea (10.2%) and headache (7.4%). Analytical parameters were: neutrophils 3112 cells/μL (1900–7300), lymphocytes 1090 cells/μL (1000–3000), interleukin 6 118 pg/mL (0–100), ferritin 4505 ng/mL (15–150) and D-dimer 2823 ng/mL (20–500), with liver enzymes altered in 23.9% of cases. 84.2% received specific treatment for coronavirus infection: chloroquine or hydroxychloroquine (82.2%), lopinavir/ritonavir (54.0%), corticosteroids (39.6%), azithromycin (33.0%), tocilizumab (15.8%), plasma convalescent (3.0%), clinical trial medication (3.0%), remdesivir (2.0%) and/or anakinra (1.0%). The course was mild in 14.7%, moderate in 32.0% and severe in 53.3%. Mean time to negativisation was 20.5 days, duration of symptoms 17.6 days and hospital stay 11.1 days. In 48.1% of cases treatment for AML was maintained, in 26.6% delayed and in 25.3% modified due to coronavirus disease. 47.5% died, establishing an association between mortality and age over 60 years (58.3% vs 36.4%, p=0.043), ≥2 lines of treatment (72.7% vs 44.3%, p=0.020), active disease (62.5% vs 29.4%, p=0.002) and pneumonia (61.2% vs 22.7%, p=0.002). Overall, 47.5% overcame the infection, and in 5.0% SARS-CoV-2 genetic material was still detected at the time of analysis. A non-significant lower mortality rate was observed among: previous transplantation (45.7% vs 64.3%, p=0.19), neutrophil >1900 cells/μL (41.1% vs 60.0%, p=0.09), lymphocyte >1000 cells/μL (42.9% vs 63.6%, p=0.09) and hydroxychloroquine or chloroquine plus azithromycin (35.3% vs 60.0%, p=0.10). Conclusion and relevance: SARS-CoV-2 infection produced high mortality among AML patients. Mortality was correlated with age, active disease and pneumonia. References and/or acknowledgements: Acknowledgements: Pethema Foundation Conflict of interest: No conflict of interest