Clinical characteristics and risk factors associated with COVID-19 severity in patients with haematological malignancies in Italy: a retrospective, multicentre, cohort study

ITA-HEMA-COV Investigators, Francesco Passamonti, Chiara Cattaneo, Luca Arcaini, Riccardo Bruna, Michele Cavo, Francesco Merli, Emanuele Angelucci, Mauro Krampera, Roberto Cairoli, Matteo Giovanni Della Porta, Nicola Fracchiolla, Marco Ladetto, Carlo Gambacorti Passerini, Marco Salvini, Monia Marchetti, Roberto Lemoli, Alfredo Molteni, Alessandro Busca, Antonio CuneoAlessandra Romano, Nicola Giuliani, Sara Galimberti, Alessandro Corso, Alessandro Morotti, Brunangelo Falini, Atto Billio, Filippo Gherlinzoni, Giuseppe Visani, Maria Chiara Tisi, Agostino Tafuri, Patrizia Tosi, Francesco Lanza, Massimo Massaia, Mauro Turrini, Felicetto Ferrara, Carmela Gurrieri, Daniele Vallisa, Maurizio Martelli, Enrico Derenzini, Attilio Guarini, Annarita Conconi, Attilio Olivieri, Massimo Gentile, Francesco Marchesi, Pellegrino Musto, Antonio Pinto, Patrizia Zappasodi, Paolo Antonio Grossi, Livio Pagano, Paolo Corradini

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Background: Several small studies on patients with COVID-19 and haematological malignancies are available showing a high mortality in this population. The Italian Hematology Alliance on COVID-19 aimed to collect data from adult patients with haematological malignancies who required hospitalisation for COVID-19. Methods: This multicentre, retrospective, cohort study included adult patients (aged ≥18 years) with diagnosis of a WHO-defined haematological malignancy admitted to 66 Italian hospitals between Feb 25 and May 18, 2020, with laboratory-confirmed and symptomatic COVID-19. Data cutoff for this analysis was June 22, 2020. The primary outcome was mortality and evaluation of potential predictive parameters of mortality. We calculated standardised mortality ratios between observed death in the study cohort and expected death by applying stratum-specific mortality rates of the Italian population with COVID-19 and an Italian cohort of 31 993 patients with haematological malignancies without COVID-19 (data up to March 1, 2019). Multivariable Cox proportional hazards model was used to identify factors associated with overall survival. This study is registered with, NCT04352556, and the prospective part of the study is ongoing. Findings: We enrolled 536 patients with a median follow-up of 20 days (IQR 10–34) at data cutoff, 85 (16%) of whom were managed as outpatients. 440 (98%) of 451 hospitalised patients completed their hospital course (were either discharged alive or died). 198 (37%) of 536 patients died. When compared with the general Italian population with COVID-19, the standardised mortality ratio was 2·04 (95% CI 1·77–2·34) in our whole study cohort and 3·72 (2·86–4·64) in individuals younger than 70 years. When compared with the non-COVID-19 cohort with haematological malignancies, the standardised mortality ratio was 41·3 (38·1–44·9). Older age (hazard ratio 1·03, 95% CI 1·01–1·05); progressive disease status (2·10, 1·41–3·12); diagnosis of acute myeloid leukaemia (3·49, 1·56–7·81), indolent non-Hodgin lymphoma (2·19, 1·07–4·48), aggressive non-Hodgkin lymphoma (2·56, 1·34–4·89), or plasma cell neoplasms (2·48, 1·31–4·69), and severe or critical COVID-19 (4·08, 2·73–6·09) were associated with worse overall survival. Interpretation: This study adds to the evidence that patients with haematological malignancies have worse outcomes than both the general population with COVID-19 and patients with haematological malignancies without COVID-19. The high mortality among patients with haematological malignancies hospitalised with COVID-19 highlights the need for aggressive infection prevention strategies, at least until effective vaccination or treatment strategies are available. Funding: Associazione italiana contro le leucemie, linfomi e mieloma–Varese Onlus.
Original languageEnglish
JournalThe Lancet Haematology
Publication statusPublished - 2020


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