Evaluation of the impact of Covid-19 infection on the evolution and prognosis of patients with acute leukaemia

Viola Popov* 1 , Meilin Omer1 , Lelia Iliescu2 , Mihaela Andreescu1 , Daniela Georgescu1 , Felicia Mihai1,  Mihaela Popescu1, Catalina Pirvu2 , Andra Grigorie , Ana Rus2 , Mihaela Dana Badoiu Niculae2,  Oana Constantin2 , Adriana Badea2 , Andreea Calen2 , Oana Patrinoiu1 , Silvia Ciortan1 , Claudia Despan1, Geanina Ofiteru1 , Silvia Ion1 , Marius Balea1 , Horia Bumbea3


The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was first reported in Wuhan, China in December 2019  and represented the pathogen agent that induced COVID-19. The onset and evolution of COVID -19 is severe when is associated with another comorbidities. Patients with acute leukemia present high risk for severe form of COVID-19
The main objective was to evaluate the particularities of COVID-19 in patients with acute leukemia.
Our study was retrospective and included 49 patients with acute leukemia ( 27 male median age 64 and 22 female median age 54,5) who also were SARS CoV2 positive between April 2020- February 2021 admitted in Hematology and Intensive Care Unit Departments of Colentina Clinical Hospital Bucharest. The diagnosis was established using molecular test for SARS-Cov2. Severe forms of COVID-19 or the presence of newly diagnosed acute leukaemia were predictive factors for adverse outcomes (hospitalization in ICU 12.03, p = 0.0005 Exp (b) = 20.95 95% CI of Exp (b) = 3.75-116.9, acute onset leukaemia Wald 8.24, p = 0.004, Exp (b) = 49.5, 95% CI of Exp (b) = 3.45-709.77). Patients with ALL had a shorter survival curve compared to patients with AML, Chi-squared = 7.37, p=0.007 Fig.3.
In the group was included 32 patients diagnosed with acute myeloid leukemia (AML), 9 patients with acute lymphoid leukemia (ALL), 6 patients with acut promyelocytic leukemia and 2 patients with acute bifenotypic leukemia.  Severe form of COVID-19 with ICU addmission was diagnosed in 16 patients (32,17%), almost all of them (15 patients) had unfavourable evolution compared with non-ICU patients group with only 1 deceased patient, p<0.0001. The recent chemotherapy followed by severe aplasia was the main negative factor that impacted patient evolution (rho=0.508, p=0.0002), 13 patients admitted in ICU Department and 12 patients in non-ICU. Severe pneumonia (more than 30% lung field) was diagnosed in 17 patients with recent chemotherapy and 4 untreated patients. The type of leukemia or refractory status have not any impact of patient evolution. Antiviral therapy – Remdesivir rapidly introduced in patient’s therapy was followed by favourable evolution. Patients with unfavourable outcomes had significantly increased median values of C-reactive protein, procalcitonin and interleukin 6: CRP 117.98 mg / dl (min 2.22, max 321.32) vs 34.45 mg / dl (min 1.55, max 284.18) p0.03 Fig.1; procalcitonin 0.29 mg / dl (min 0.07, max 12.6) vs 0.04 mg / dl (min 1.55, max 8.23) p0.01; IL6 65.27 pg / ml (min 8, max 887.9) vs 18.46 mg / dl (min 1.5, max 774.2) p0.05 Fig.2 The remaining haematological, biochemical and coagulation parameters are not significantly different between groups identified by the type of evolution of COVID-19 (favourable/unfavourable).
Patients with acute leukemia are negatively impacted by intensive chemotherapy during COVID-19 evolution. The key for good prognosis of these patients during COVID-19 are rapid diagnosis and antiviral therapy at the onset of the disease.
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The data in this poster was presented at EHA 2021. Published with permission from the Copyright owner.