COVID-19 in haematology patients: A multi-centre West Midlands clinical outcomes analysis on behalf of West Midlands Research Consortium

This is an accepted manuscript of an article published by Wiley in British Journal of Haematology, available online on 05/11/2020 at: https://doi.org/10.1111/bjh.17136 The accepted version of the publication may differ from the final published version

COVID-19 in hematology patients: real world experience in hospitals in the UK West Midlands

© 2021 The Authors. Published by Hilaris. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: [DOI/weblink]Objectives: This study aimed to understand the consequences of coronavirus disease 2019 (COVID-19) in patients diagnosed with haematological conditions, malignant and non-malignant. Method: A detailed insight into the first 112 patients with comorbidity of haematological conditions and COVID-19, admitted into nine National Health Services Trusts in the West Midlands Area of the United Kingdom, between 1st of March 2020 and 31st May 2020. Results: In the study cohort, 82% of patients had a malignant haematological disorder whilst 18% had a non-malignant haematological condition. Increasing age, breathlessness, reduction in oxygen saturation under 90% and abnormal chest x-ray were independently associated with higher mortality. Other long term co-morbidities did not present adverse impacts in this population. Survival analysis demonstrated that the COVID-19 severity score had a significant adverse correlation on patient outcome. COVID-19 patients who were classified as low risk, based on their primary haematological condition, showed significantly shorter survival time than those in the high risk category, which might be due to the shielding strategy for high infection risk patients. Conclusion: The 55% overall mortality in this cohort suggests that patients with haematological conditions had a higher mortality rate than patients with other acute, chronic or long term conditions. Significance: Previous studies have suggested poor outcomes for COVID‐19 infection in patients with haematological cancers, with short‐term mortality rates ranging from 32% to 62%. We report here the outcome of COVID-19 infection in patients with haematological conditions with both malignant and non-malignant, admitted to secondary care in acute care hospitals of the UK West Midlands. This study also examined the impact of chemo immunotherapy on outcomes from COVID-19 infection. This will be useful information to guide decision making during this second UK national lockdow

Underdiagnosed veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) as a major cause of multi-organ failure in acute leukemia transplant patients: an analysis from the EBMT Acute Leukemia Working Party.

Allogeneic hematopoietic cell transplantation (alloHCT) is a complex, potentially fatal therapy featuring a myriad of complications. Triggering event(s) of such complications vary significantly, but often a so-called "multi-organ failure" (MOF) is reported as the leading cause of death. The identification of the exact trigger of MOF is critical towards early and disease-specific intervention to improve outcome. We examined data from 202 alloHCT patients reported to have died of MOF from the EBMT registry aiming to determine their exact cause of death focusing on veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) due to its life-threatening, often difficult to capture yet preventable nature. We identified a total of 70 patients (35%) for whom VOD/SOS could be considered as trigger for MOF and leading cause of death, among which 48 (69%) were previously undiagnosed. Multivariate analysis highlighted history of hepatic comorbidity or gentuzumab use and disease status beyond CR1 as the only significant factors predictive of VOD/SOS incidence (OR = 6.6; p = 0.001 and OR = 3.3; p = 0.004 respectively). VOD/SOS-related MOF was widely under-reported, accounting for 27% of deaths attributed to MOF of unknown origin without a previous VOD/SOS diagnosis. Our results suggest most missed cases developed late VOD/SOS beyond 21 days post-alloHCT, highlighting the importance of the newly revised EBMT criteria

Long-term survival of patients with CLL after allogeneic transplantation: A report from the European Society for Blood and Marrow Transplantation

Even with the availability of targeted drugs, allogeneic hematopoietic cell transplantation (allo-HCT) is the only therapy with curative potential for patients with CLL. Cure can be assessed by comparing long-term survival of patients to the matched general population. Using data from 2589 patients who received allo-HCT between 2000 and 2010, we used landmark analyses and methods from relative survival analysis to calculate excess mortality compared with an age-, sex- and calendar year-matched general population. Estimated event-free survival, overall survival and non-relapse mortality (NRM) 10 years after allo-HCT were 28% (95% confidence interval (CI), 25-31), 35% (95% CI, 32-38) and 40% (95% CI, 37-42), respectively. Patients who passed the 5-year landmark event-free survival (N=394) had a 79% probability (95% CI, 73-85) of surviving the subsequent 5 years without an event. Relapse and NRM contributed equally to treatment failure. Five-year mortality for 45- and 65-year-old reference patients who were event-free at the 5-year landmark was 8% and 47% compared with 3% and 14% in the matched general population, respectively. The prospect of long-term disease-free survival remains an argument to consider allo-HCT for young patients with high-risk CLL, and programs to understand and prevent late causes of failure for long-term survivors are warranted, especially for older patients