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2542 Outcomes in Patients with Hematologic Disease and COVID-19 in Russia: Interim Analysis of CHRONOS19 Registry

Program: Oral and Poster Abstracts
Session: 904. Outcomes Research—Non-Malignant Conditions: Poster II
Hematology Disease Topics & Pathways:
CRS, Adult, Coronaviruses, SARS-CoV-2/COVID-19, Leukemia, Anemias, Diseases, Bleeding and Clotting, Lymphoma (any), Hodgkin Lymphoma, Adverse Events, Non-Hodgkin Lymphoma, PNH, Study Population, Lymphoid Malignancies, Myeloid Malignancies, Clinically relevant
Sunday, December 6, 2020, 7:00 AM-3:30 PM

Olga A. Gavrilina, MD, PhD1*, Kristina Zakurdaeva2*, Vladimir I. Vorobyev, MD, PhD3, Anastasia N. Vasileva4*, Lev S. Butaev5*, Alena Sukhareva6*, Lubov Gavrilova7*, Olga Samoylova, MD8*, Maria Grishunina, MD9*, Ochsana Ochirova10*, Alina Karpova11*, Olga Panteleeva12*, Mikhail A. Kunst13*, Vasily Shuvaev, MD14,15, Anzhelika Rakhmani16*, Tatiana V. Gaponova, MD, PhD4*, Gennadiy M. Galstyan, MD, PhD4*, Vera V. Troitskaya, MD, PhD1*, Anton V. Luchkin, MD4*, Elena N. Parovichnikova, MD, PhD1* and Valery Savchenko, MD, PhD, Academician4

1National Research Center for Hematology, Moscow, Russian Federation, Moscow, Russian Federation
2RakFond, Moscow, Russia
3Hematology Department, S.P.Botkin City Hospital, Moscow, Russia
4National Research Center for Hematology, Moscow, Russian Federation
5Hematology Department, S.P.Botkin City Hospital, Moscow, Russian Federation
6S.P. Botkin City Hospital, Moscow, Russian Federation
7State Budgetary Healthcare Institution of the Republic of Mordovia "Republican Clinical Hospital No4" of the Ministry of Health of the Russian Federation, Mordovia, Russian Federation
8Regional Clinical Hospital N.A. Semashko, Nizhniy Novgorod, Russian Federation
9Regional Hospital, Nigniy Novgorod, Russian Federation
10Republican Clinical Hospital named after NA Semashko of the city of Ulan-Ude, Ulan-Ude, Russian Federation
11NA Semashko Rpublican Clinical Hospital, Ulan-Ude, Russian Federation
12Regional Clinical Hospital, Vladimir, Russian Federation
13Republican Clinical Hospital of Tatarstan, Kazan, Russian Federation
14City Clinical Hospital n.a. V.V. Veresaev of the Moscow Department of Healthcare, Moscow, Russian Federation
15Federal State Budget Institution “Russian Scientific-Research Institute of Hematology and Transfusiology of Federal Medical-Biological Agency”, St. Petersburg, Russia
16City Clinical Hospital n.a. V.V. Veresaev, Moscow, Russian Federation

Background: Patients (pts) with hematologic disease are at increased risk of severe SARS-CoV-2 infection. Recent observations reported poor outcomes of COVID-19 in pts with various cancer types and higher mortality rates compared with the general population. However, currently available data on COVID-19 in pts with hematologic disease are limited.

Methods: CHRONOS19 registry is an observational prospective cohort study with the primary objective to evaluate the treatment outcomes in adult pts (age 18 or older) with hematologic disease and COVID-19. Secondary objectives are to describe severity and complications of COVID-19 and course of hematologic disease in SARS-CoV-2 infected pts, and to explore importance of various factors for disease severity and mortality. Pts with laboratory-confirmed or suspected (based on clinical symptoms and/or CT) COVID-19 were eligible for enrollment. Data were collected on a web platform and managed in a de-identified manner. Physicians from 8 hematology clinical centers and hospitals from all over Russia (Moscow, Ulan-Ude, Saransk, Vladimir, Nizhniy Novgorod, Kazan) participate in this study. Pts are followed for 30 days (ds) after COVID-19 diagnosis and up to 6 months (mos) for hematologic disease outcomes and overall survival assessment. The results of the first follow-up are presented in this interim analysis.

Results: As of July 30, 2020, 184 pts were enrolled (females/males [n(%)]: 80(44%)/104 (56%); median [range] age: 55 [18-83] years. Disease type (malignant/non-malignant [n(%)]): 164(89%)/20(11%), including AML 36(20%), ALL 16(9%), MDS 5(2%), APL 5(2%), MM 38(21%), HL 4(2%), NHL 38(21%), MPN 9(5%), CLL 13(7%), others 20(11%). Concomitant diseases were in 95(52%) pts: cardiovascular 56(59%), pulmonary 6(6%), hepatic 6(6%) or renal 5(5%), diabetes 17(18%), obesity 4(4%), other 16(17%). 176 patients were evaluable for the primary outcome assessment with a median follow-up of 41(1-125) ds. Thirty-day all-cause mortality was 23% (41 pts died). Death due to COVID-19 complications occurred in 34 (83%) pts, 7(17%) pts died due to progression of hematologic disease. Fifty (28%) pts experienced COVID-19 complications, the most common were pneumonia in 125 (71%) pts, respiratory failure in 82(47%) pts, ARDS in 11(6%) pts, cytokine release syndrome in 15(9%) pts, multiple organ failure in 10(6%) pts, sepsis in 6(3%) pts, and pulmonary bleeding in 1(0,6%). Specific anti-COVID-19 treatment was given to 117 pts(67%) pts: most common first-line treatment was hydroxichloroquine+azithromycin in 84(72%) pts, azithromycin monotherapy in 27(23%) pts, other drugs in 6(5%) pts; second-line treatment comprised lopinavir+ritonavir in 38 pts, tocilizumab in 29 pts, umifenovir in 5 pts, baricitinib in 5 pts, canakinumab in 1pt, sarilumab in 1 pt. The rate of ICU admissions was 27%(47 pts), among them only 11(23%) pts survived, 36(20%) pts required mechanical ventilation, only 2(5.5%) pts survived. Eighty-eight(50%) pts received anticoagulants. With regard to the blood disease, treatment delays occurred in 101(57%) pts with a median 4 weeks, 6(3%) pts required change of treatment. At the first follow-up (30 ds) the rate of relapse / progression of hematologic disease was 16 of 151 evaluable pts (10.6%). Thirty-day overall survival was 75%. At the data cutoff, median overall survival was not reached. Antibody detection was performed in 70 pts: 53(76%) pts had IgG SARS-CoV-2 antibodies. Among factors possibly associated with poor survival were: stage of COVID-19 1(n=41) - 91,8%/ 2(n=75) - 90%/ 3(n=36) - 56,5%/ 4(n=22) - 13,6% (p<0,0001), concomitant diseases (n=93/81): 59,5% vs. 87% (p=0,0001), transfusion dependence (n=65/104): 58,1% vs. 81,8% (p=0,0007), prior steroid therapy (n=73/90): 64,6% vs. 82% (p=0,019), older age (<60 (n=108)/≥60 (n=68) years): 80% vs. 60% (p=0,048). Sex, disease type, myelotoxic agranulocytosis, and prior hematopoietic stem cell transplantation were not associated with worse outcomes. Data on the longer follow-up (90 and 180 ds) will be presented.

Conclusions: Patients with hematologic disease and SARS-CoV-2 infection have high 30-day all-cause mortality predominantly due to COVID-19 complications. Stage of COVID-19, concomitant diseases, transfusion dependence, prior steroid therapy, and older age were associated with poor outcomes.

Disclosures: Shuvaev: Novartis: Honoraria, Speakers Bureau; BMS: Honoraria, Speakers Bureau; Pfizer: Honoraria, Speakers Bureau.

OffLabel Disclosure: hydroxichloroquine, azithromycin, lopinavir+ritonavir, tocilizumab, umifenovir, baricitinib, canakinumab, sarilumab for COVID-19 treatment

*signifies non-member of ASH