Patients with acute myeloid leukaemia (AML) are at high risk of dying from COVID-19. Results from the largest observational study looking into patients with AML and COVID-19 to date were recently published in Haematologica. According to these findings, the best approach to improve survival is to delay AML treatment, whenever possible.
Acute myeloid leukaemia (AML) is an aggressive haematologic malignancy that often requires immediate chemotherapy due to its high risk of early life-threatening complications and death. AML patients are severely immunocompromised, and infections are frequently associated with both the disease-related weakened immunity and the aggressive chemotherapeutic regimen. Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is associated with a severe clinical presentation in AML patients. However, long-term follow-up studies on large cohorts of patients with AML and COVID-19 are still missing. With 388 patients, this is the largest observational study of patients with AML and COVID-19 up to date.
This observational study used data from EPICOVIDEHA, an international open web-based registry for haematologic malignancies and COVID-19 patients initiated in February 2020 by EHA members. In total, 388 adult patients with AML and diagnosed with COVID-19 between February 2020 and October 2021 were included. Most participants were receiving or had received AML treatment in the preceding three months. COVID-19 was severe in 41.2% and critical in 21.1% of cases. The chemotherapeutic schedule was modified in 174 patients, delayed in 68 and permanently discontinued in 106.
After a median follow-up of 325 days, 180 patients (46.4%) had died. The reported primary reason for death was COVID-19 (43.3%), AML (26.1%), a combination of both (26.7%), or unknown (3.9%). Interestingly, patients in whom chemotherapy was delayed had a lower overall mortality, compared to those whose treatment was not delayed (18.4% and 37.5%, respectively). In the 79 patients with a simultaneous AML and COVID-19 diagnosis, a better survival was observed when AML treatment could be delayed (80% vs. 64%; p<0.001). In a multivariable model, active disease (HR: 4.197), older age (HR: 1.016), and treatment discontinuation (HR: 4.417) were associated with a higher mortality, while treatment delay was found to be protective (HR: 0.367). Overall survival in patients with a diagnosis of COVID-19 between January 2020 and August 2020 (38%) was significantly lower than that in those diagnosed between September 2020 and February 2021 (60%) and between March 2021 and September 2021 (61.9%).
This study suggests that the best approach to improve survival is to delay AML treatment, whenever possible. On a positive note, the mortality rate has decreased over the course of the pandemic, which can be explained by the improvement in the management of the disease and the detection of a larger number of asymptomatic/mild cases by screening programs.
Marchesi F, Salmanton-García J, Emarah Z et al. COVID-19 in adult acute myeloid leukemia patients: a long-term follow-up study from the European Hematology Association survey (EPICOVIDEHA). Haematologica. 2023;108(1):22-33.