BACKGROUND: Patients with hematological malignancies (HM) are at high risk of mortality from SARS-CoV-2 disease 2019 (COVID-19). A better understanding of risk factors for adverse outcomes may improve clinical management in these patients. We therefore studied baseline characteristics of HM patients developing COVID-19 and analyzed predictors of mortality. METHODS: The survey was supported by the Scientific Working Group Infection in Hematology of the European Hematology Association (EHA). Eligible for the analysis were adult patients with HM and laboratory-confirmed COVID-19 observed between March and December 2020. RESULTS: The study sample includes 3801 cases, represented by lymphoproliferative (mainly non-Hodgkin lymphoma n = 1084, myeloma n = 684 and chronic lymphoid leukemia n = 474) and myeloproliferative malignancies (mainly acute myeloid leukemia n = 497 and myelodysplastic syndromes n = 279). Severe/critical COVID-19 was observed in 63.8% of patients (n = 2425). Overall, 2778 (73.1%) of the patients were hospitalized, 689 (18.1%) of whom were admitted to intensive care units (ICUs). Overall, 1185 patients (31.2%) died. The primary cause of death was COVID-19 in 688 patients (58.1%), HM in 173 patients (14.6%), and a combination of both COVID-19 and progressing HM in 155 patients (13.1%). Highest mortality was observed in acute myeloid leukemia (199/497, 40%) and myelodysplastic syndromes (118/279, 42.3%). The mortality rate significantly decreased between the first COVID-19 wave (March-May 2020) and the second wave (October-December 2020) (581/1427, 40.7% vs. 439/1773, 24.8%, p value < 0.0001). In the multivariable analysis, age, active malignancy, chronic cardiac disease, liver disease, renal impairment, smoking history, and ICU stay correlated with mortality. Acute myeloid leukemia was a higher mortality risk than lymphoproliferative diseases. CONCLUSIONS: This survey confirms that COVID-19 patients with HM are at high risk of lethal complications. However, improved COVID-19 prevention has reduced mortality despite an increase in the number of reported cases.

Amsterdam UMC Location VUmc Amsterdam Netherlands

Ankara University Ankara Turkey

ASST Grande Ospedale Metropolitano Niguarda Milan Italy

ASST Spedali Civili Brescia Italy

AZ Klina Brasschaat Belgium

Azienda Ospedaliera San Gerardo Monza Monza Italy

Azienda Sanitaria Universitaria del Friuli Centrale Udine Italy

Cancer Drug Resistance Group IPATIMUP Institute of Molecular Pathology and Immunology University of Porto Porto Portugal

Cell Therapy and Hematology San Bortolo Hospital Vicenza Italy

Center for Molecular Medicine Cologne University of Cologne Faculty of Medicine and University Hospital Cologne Cologne Germany

Centre Hospitalier de Versailles Versailles France

Centro de Investigación del Cáncer IBMCC Hospital Universitario de Salamanca IBSAL Salamanca Spain

Chair Translational Research Cologne Excellence Cluster On Cellular Stress Responses in Aging Associated Diseases University of Cologne Faculty of Medicine and University Hospital Cologne Cologne Germany

Clinic of Hematology University Clinical Center of Serbia Belgrade Serbia

Clinical and Translational Fungal Working Group University of California San Diego La Jolla CA USA

Clinical Hematology Centro Hospitalar E Universitário São João Porto Portugal

Clinical Hematology Faculty of Medicine University of Porto Porto Portugal

Clinical Microbiology and Infectious Diseases Department Hospital General Universitario Gregorio Marañón Madrid Spain

Clinical Trials Centre Cologne University of Cologne Faculty of Medicine and University Hospital Cologne Cologne Germany

Cologne Excellence Cluster On Cellular Stress Responses in Aging Associated Diseases University of Cologne Faculty of Medicine and University Hospital Cologne Cologne Germany

Communicable Disease Center Hamad Medical Corporation Doha Qatar

Complejo Hospitalario de Navarra Iruña Pamplona Spain

Croatian Cooperative Group for Hematological Diseases Zagreb Croatia

Departament de Medicina Universitat Autònoma de Barcelona Bellaterra Spain

Departement d'Hematologie Clinique CHU de Montpellier UMR CNRS 5535 Universite de Montpellier Montpellier France

Department 1 of Internal Medicine Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf Excellence Center for Medical Mycology University of Cologne Faculty of Medicine and University Hospital Cologne Cologne Germany

Department of Biomedicine and Prevention University of Rome Tor Vergata Rome Italy

Department of Cell Therapy and Allogenic Stem Cell Transplantation Karolinska University Hospital Stockholm Sweden

Department of Haematology Blood Neoplasms and Bone Marrow Transplantation Wroclaw Medical University Wrocław Poland

Department of Hemato Oncology Faculty of Medicine and Dentistry Palacky University and University Hospital Olomouc Olomouc Czech Republic

Department of Hematological Medicine King's College Hospital NHS Foundation Trust London UK

Department of Hematology and Oncology Medical University of Innsbruck Innsbruck Austria

Department of Hematology University Hospital Dubrava Zagreb Croatia

Department of Hematology Vall d'Hebron Hospital Universitari Experimental Hematology Vall d'Hebron Institute of Oncology Vall d'Hebron Barcelona Hospital Campus Barcelona Spain

Department of Infectious Diseases Karolinska University Hospital Stockholm Sweden

Department of Internal Medicine Albert Szent Györgyi Health Center Faculty of Medicine University of Szeged Szeged Hungary

Department of Internal Medicine Hematology and Oncology Masaryk University and University Hospital Brno Brno Czech Republic

Department of Medicine and Surgery University of Insubria ASST Sette Laghi Ospedale Di Circolo of Varese Varese Italy

Department of Oncology Hematology and Bone Marrow Transplantation With Section of Pneumology University Medical Center Hamburg Eppendorf Hamburg Germany

Division of Infectious Diseases and Global Public Health Department of Medicine University of California San Diego San Diego CA USA

Division of Infectious Diseases and Hospital Epidemiology Department of Clinical Research University and University Hospital of Basel Basel Switzerland

Ematologia Con Trapianto Ospedale Dimiccoli Barletta Barletta Italy

Faculty of Medicine and Faculty of Health Studies University of Rijeka Rijeka Croatia

Faculty of Medicine University of Belgrade Belgrade Serbia

Faculty of Medicine University of Zagreb Zagreb Croatia

Federal University of Rio de Janeiro Rio de Janeiro Brazil

Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy

Fondazione IRCCS Istituto Nazionale Dei Tumori Milan Italy

Fundacion Jimenez Diaz University Hospital Health Research Institute IIS FJD Madrid Spain

Fundacion Jimenez Díaz University Hospital Health Research Institute IIS FJD Madrid Spain

German Centre for Infection Research Partner Site Bonn Cologne Cologne Germany

Gomel State Medical University Gomel Belarus

Haematology and Haemotherapy Department Hospital General Universitario Gregorio Marañón Madrid Spain

Hematology and BMT Unit Azienda Ospedaliera Nazionale SS Antonio E Biagio E Cesare Arrigo Alessandria Italy

Hematology and Bone Marrow Transplantation IRCCS San Raffaele Scientific Institute Milan Italy

Hematology and Stem Cell Transplant Unit IRCCS Regina Elena National Cancer Institute Rome Italy

Hematology and Transplantation Raisa Gorbacheva Research Institute of Pediatric Oncology Pavlov University St Petersburg Russia

Hematology Department Hospital Universitario de Salamanca Salamanca Spain

Hematology Fondazione Policlinico Universitario Agostino Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy

Hematology Service Instituto Nacional Do Cancer Rio de Janeiro Brazil

Hematology Unit Center for Translational Medicine Azienda USL Toscana NordOvest Livorno Italy

Hospital Clinic Barcelona Spain

Hospital Escuela de Agudos Dr Ramón Madariaga Posadas Argentina

Hospital Rey Juan Carlos Móstoles Spain

Hospital Universitario 12 de Octubre Madrid Spain

Hospital Universitario Marqués de Valdecilla Santander Spain

Hospital Universitario Puerta de Hierro Majadahonda Spain

IBSAL Centro de Investigación del Cáncer IBMCC Salamanca Spain

ICANS Strasbourg France

Institute of Hematology and Blood Transfusion Prague Czech Republic

King's College Hospital London UK

King's College London London UK

KU Leuven Leuven Belgium

La Paz University Hospital Madrid Spain

Marmara University Istanbul Turkey

National Center for Cancer Care and Research Hamad Medical Corporation Doha Qatar

NIHR Oxford Biomedical Research Centre Churchill Hospital Oxford UK

North Western State Medical University Named After Iliá Ilich Méchnikov Saint Petersburg Russia

Oncology Center Mansoura University Mansoura Egypt

Policlinico Borgo Roma Verona Verona Italy

Portuguese Institute of Oncology Lisbon Portugal

Rigshospitalet Copenhagen Denmark

S Instituto de Investigação E Inovação Em Saúde Universidade Do Porto Porto Portugal

San Luigi Gonzaga Hospital Orbassano Orbassano Italy

Scientific and Practical Center for Surgery Transplantology and Hematology Minsk Belarus

Section of Infectious Diseases and Tropical Medicine Department of Internal Medicine Medical University of Graz Graz Austria

Service d'Hématologie Clinique Et de Thérapie Cellulaire Hôpital Saint Antoine Assistance Publique Hôpitaux de Paris Sorbonne Université Inserm UMRs 938 Paris France

Stem Cell Transplant Center AOU Citta' Della Salute E Della Scienza Turin Italy

Sultan Qaboos University Hospital Muscat Oman

U O Ematologia E Centro Trapianti Midollo Osseo Ospedale Maggiore Parma Italy

Università Cattolica del Sacro Cuore Rome Italy

Università Milano Bicocca Milan Italy

University Hospital Centre Rijeka Rijeka Croatia

University Hospital Centre Zagreb Zagreb Croatia

University Hospital Hradec Králové Hradec Králové Czech Republic

University Hospital of Královské Vinohrady Prague Czech Republic

University Hospital Ostrava Ostrava Czech Republic

University Medical Center Groningen Groningen Netherlands

University of Milan and Fondazione IRCCS Istituto Nazionale Dei Tumori Milan Italy

Zealand University Hospital Roskilde Roskilde Denmark

Zobrazit více v PubMed

“WHO announces COVID-19 outbreak a pandemic www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/news/news/2020/3/who-announces-covid-19-outbreak-a-pandemic (Last access: May 31, 2021)

Vijenthira A, Gong IY, Fox TA, et al. Outcomes of patients with hematologic malignancies and COVID-19: a systematic review and meta-analysis of 3377 patients. Blood. 2020;136:2881–2892. doi: 10.1182/blood.2020008824. PubMed DOI PMC

Cattaneo C, Daffini R, Pagani C, et al. Clinical characteristics and risk factors for mortality in hematologic patients affected by COVID-19. Cancer. 2020;126:5069–5076. doi: 10.1002/cncr.33160. PubMed DOI

Borah P, Mirgh S, Sharma SK, et al. Effect of age, comorbidity and remission status on outcome of COVID-19 in patients with hematological malignancies. Blood Cells Mol Dis. 2021;87:102525. doi: 10.1016/j.bcmd.2020.102525. PubMed DOI PMC

Wood WA, Neuberg DS, Thompson JC, et al. Outcomes of patients with hematologic malignancies and COVID-19: a report from the ASH Research Collaborative Data Hub. Blood Adv. 2020;4:5966–5975. doi: 10.1182/bloodadvances.2020003170. PubMed DOI PMC

Kuderer NM, Choueiri TK, Shah DP, et al. Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study. Lancet. 2020;395:1907–1918. doi: 10.1016/S0140-6736(20)31187-9. PubMed DOI PMC

Lee LYW, Cazier JB, Starkey T, et al. COVID-19 prevalence and mortality in patients with cancer and the effect of primary tumour subtype and patient demographics: a prospective cohort study. Lancet Oncol. 2020;21:1309–1316. doi: 10.1016/S1470-2045(20)30442-3. PubMed DOI PMC

Glenthøj A, Jakobsen LH, Sengeløv H, et al. SARS-CoV-2 infection among patients with hematological disorders: severity and one-month outcome in 66 Danish patients in a nationwide cohort study. Eur J Haematol. 2021;106:72–81. doi: 10.1111/ejh.13519. PubMed DOI

Regalado-Artamendi I, Jiménez-Ubieto A, Hernández-Rivas JÁ, et al. Risk factors and mortality of COVID-19 in patients with lymphoma: a multicenter study. Hemasphere. 2021;5:e538. doi: 10.1097/HS9.0000000000000538. PubMed DOI PMC

Chari A, Samur MK, Martinez-Lopez J, et al. Clinical features associated with COVID-19 outcome in multiple myeloma: first results from the International Myeloma Society data set. Blood. 2020;136:3033–3040. doi: 10.1182/blood.2020008150. PubMed DOI PMC

Sharma A, Bhatt NS, St Martin A, et al. Clinical characteristics and outcomes of COVID-19 in hematopoietic stem-cell transplantation recipients: an observational cohort study. Lancet Haematol. 2021;8:e185–e193. doi: 10.1016/S2352-3026(20)30429-4. PubMed DOI PMC

Ljungman P, de la Camara R, Mikulska M, et al. COVID-19 and stem cell transplantation; results from an EBMT and GETH multicentre prospective study. Leukemia 2021. Online ahead of print. PubMed PMC

Yigenoglu TN, Ata N, Altuntas F, et al. The outcome of COVID-19 in patients with hematological malignancy. J Med Virol. 2021;93:1099–1104. doi: 10.1002/jmv.26404. PubMed DOI PMC

García-Suárez J, de la Cruz J, Cedillo Á, et al. Impact of hematologic malignancy and type of cancer therapy on COVID-19 severity and mortality: lessons from a large population-based registry study. J Hematol Oncol. 2020;13:133. doi: 10.1186/s13045-020-00970-7. PubMed DOI PMC

Piñana JL, Martino R, García-García I, et al. Risk factors and outcome of COVID-19 in patients with hematological malignancies. Exp Hematol Oncol. 2020;9:21. doi: 10.1186/s40164-020-00177-z. PubMed DOI PMC

Passamonti F, Cattaneo C, Arcaini L, et al. Clinical characteristics and risk factors associated with COVID-19 severity in patients with hematological malignancies in Italy: a retrospective, multicentre, cohort study. Lancet Haematol. 2020;7:e737–e745. doi: 10.1016/S2352-3026(20)30251-9. PubMed DOI PMC

https://www.ashresearchcollaborative.org/s/covid-19-registry/data-summaries (Last access: May 25, 2021)

Barbui T, De Stefano V, Alvarez-Larran A, et al. Among classic myeloproliferative neoplasms, essential thrombocythemia is associated with the greatest risk of venous thromboembolism during COVID-19. Blood Cancer J. 2021;11:21. doi: 10.1038/s41408-021-00417-3. PubMed DOI PMC

Galimberti S, Petrini M, Baratè C, et al. Tyrosine kinase inhibitors play an antiviral action in patients affected by chronic myeloid leukemia: a possible model supporting their use in the fight against SARS-CoV-2. Front Oncol. 2020;10:1428. doi: 10.3389/fonc.2020.01428. PubMed DOI PMC

Salmanton-García J, Busca A, Cornely OA, et al. EPICOVIDEHA: a ready-to use platform for epidemiological studies in hematological patients with COVID-19. Hemasphere. 2021;5(7):e612. doi: 10.1097/HS9.0000000000000612. PubMed DOI PMC

COVID-19 clinical management. Living guidance World Health Organization. January 15, 2021. WHO/2019-nCoV/clinical/2021.1.

Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323:1239–1242. doi: 10.1001/jama.2020.2648. PubMed DOI

Sanchez-Pina JM, Rodríguez Rodriguez M, Castro Quismondo N, et al. Clinical course and risk factors for mortality from COVID-19 in patients with hematological malignancies. Eur J Haematol. 2020;105:597–607. doi: 10.1111/ejh.13493. PubMed DOI

Infante MS, González-Gascón Y, Marín I, et al. COVID‐19 in patients with hematological malignancies: a retrospective case series. Int J Lab Hematol. 2020;42:e256–e259. doi: 10.1111/ijlh.13301. PubMed DOI PMC

Palanques-Pastor T, Megías-Vericat JE, Martínez P, et al. Characteristics, clinical outcomes, and risk factors of SARS-COV-2 infection in adult acute myeloid leukemia patients: experience of the PETHEMA group. Leuk Lymphoma 2021. 10.1080/10428194.2021.1948031. Online ahead of print. PubMed

Herishanu Y, Avivi I, Aharon A, et al. Efficacy of the BNT162b2 mRNA COVID-19 vaccine in patients with chronic lymphocytic leukemia. Blood. 2021;137:3165–3173. doi: 10.1182/blood.2021011568. PubMed DOI PMC

Pimpinelli F, Marchesi F, Piaggio G, et al. Fifth-week-immunogenicity and safety of anti-SARS-CoV-2 BNT162b2 vaccine in patients with multiple myeloma and myeloproliferative malignancies on active treatment: preliminary data from a single Institution. J Hematol Oncol. 2021;14:81. doi: 10.1186/s13045-021-01090-6. PubMed DOI PMC

Bergwerk M, Gonen T, Lustig Y, et al. Covid-19 Breakthrough Infections in Vaccinated Health Care Workers. N Engl J Med. 2021. 10.1056/NEJMoa2109072. Online ahead of print. PubMed PMC

Brown CM, Vostok J, Johnson H, et al. Outbreak of SARS-CoV-2 infections, including COVID-19 vaccine breakthrough infections, associated with large public gatherings—Barnstable County, Massachusetts, July 2021. MMWR Morb Mortal Wkly Rep. 2021;70:1059–1062. doi: 10.15585/mmwr.mm7031e2. PubMed DOI PMC

Terpos E, Trougakos IP, Gavriatopoulou M, et al. Low neutralizing antibody responses against SARS-CoV-2 in elderly myeloma patients after the first BNT162b2 vaccine dose. Blood. 2021;137:3674–3676. doi: 10.1182/blood.2021011904. PubMed DOI PMC

Respiratory Viruses in Patients With Hematological Malignancy in Boreal Autumn/Winter 2023-2024: EPICOVIDEHA-EPIFLUEHA Report

Need for ICU and outcome of critically ill patients with COVID-19 and haematological malignancies: results from the EPICOVIDEHA survey

Decoding the historical tale: COVID-19 impact on haematological malignancy patients-EPICOVIDEHA insights from 2020 to 2022

Management of patients with multiple myeloma and COVID-19 in the post pandemic era: a consensus paper from the European Myeloma Network (EMN)

Nirmatrelvir/ritonavir in COVID-19 patients with haematological malignancies: a report from the EPICOVIDEHA registry

Outcomes of SARS-CoV-2 infection in Ph-neg chronic myeloproliferative neoplasms: results from the EPICOVIDEHA registry

Outcome of COVID-19 in allogeneic stem cell transplant recipients: Results from the EPICOVIDEHA registry

COVID-19 in adult acute myeloid leukemia patients: a long-term follow-up study from the European Hematology Association survey (EPICOVIDEHA)

Breakthrough COVID-19 in vaccinated patients with hematologic malignancies: results from the EPICOVIDEHA survey

Simultaneous Onset of Haematological Malignancy and COVID: An Epicovideha Survey

B-cell malignancies treated with targeted drugs and SARS-CoV-2 infection: A European Hematology Association Survey (EPICOVIDEHA)

Breakthrough COVID-19 in Vaccinated Patients with Haematologic Malignancies-The First Single-Centre Experience from the Czech Republic

Outcome of infection with omicron SARS-CoV-2 variant in patients with hematological malignancies: An EPICOVIDEHA survey report

Successful early use of anti-SARS-CoV-2 monoclonal neutralizing antibodies in SARS-CoV-2 infected hematological patients - A Czech multicenter experience

COVID-19 in vaccinated adult patients with hematological malignancies: preliminary results from EPICOVIDEHA