Session: 637. Myelodysplastic Syndromes—Clinical Studies: Poster III
Hematology Disease Topics & Pathways:
Coronaviruses, SARS-CoV-2/COVID-19, Adult, Diseases, Elderly, MDS, Study Population, Myeloid Malignancies, Clinically relevant
The COVID-19 (SARS-CoV-2) pandemic has affected cancer patients (pts) in a myriad of ways, including diagnostic & treatment delays, scarcity of blood products, and most importantly, higher risks of morbidity and mortality from the viral infection itself. Though COVID-19’s effects on many specific cancers has previously been described, there has been little reported on its effects on pts with MDS.
We prospectively reviewed the records of all pts seen in the MDS clinic of a large New York City tertiary academic medical center between March 12 and May 07 2020. A confirmed case of COVID-19 was defined by a positive (+) result on a real-time reverse-transcriptase polymerase chain reaction (PCR) assay of a specimen collected on a nasopharyngeal swab, or detectable COVID-19 antibodies. COVID-19 antibodies were determined via an IgG assay developed at Mount Sinai with the ability to detect antibody titers to a dilution of 1:2880. Initially, only symptomatic pts were screened due to limited testing availability. However, after April 7, all clinic pts were screened by PCR.
Among 85 pts seen in the clinic, 23 were found to have COVID-19 (27.1%). The median age of all pts was 72 years (range 20-90); racial breakdown included 58.8% Caucasian, 12.9% Hispanic, 10.6% African-American, 7.1% Asian, and 10.6% other. Of note, 65.2% of COVID-19+ pts were Caucasian, 13.0% Hispanic, and 17.4% other. The most common diagnoses were MDS (n=61), AML (n=10), multiple myeloma (MM) (n=9), large granular lymphocytic leukemia (LGL) (n=6), ALL (n=6), MPN (n=4), NHL (n=3), and CML (n=2). Forty-two of the MDS patients had no other malignancies; co-diagnoses among the remaining MDS patients included MM (n=8), LGL (n=6), & T-cell dyscrasias (n=5).
Of the 23 COVID-19+ pts, 11 (47.8%) were hospitalized and 4 (17.4%) were asymptomatic. Common symptoms were URI symptoms (15) and fever (14). ARDS and pneumonia occurred in 4 pts. The most common treatments were hydroxychloroquine (n=4), steroids (n=3), and azithromycin (n=2). Eighteen of the 23 + pts (78.3%) had MDS; the others included pts with MPN, APL, ALL, AML, or NHL. Among the COVID-19+ MDS pts, IPSS-R was very low (n=5), low (n=3), intermediate (n=1), high (n=2), and very high risk (n=5) in evaluable patients. MDS directed treatment included azacitidine (8) (2 with venetoclax), erythropoietin stimulating agents (3), best-supportive care (4), intravenous immunoglobulin (3), and lenalidomide (1). Disease status at diagnosis was stable disease (SD; n=9), hematologic improvement (HI; n=6), progressive disease (PD; n=1), and complete response (CR; n=1). The median number of co-morbidities per pt was 2. Major co-morbidities included cardiac disease (n=5), hypertension (n=5), diabetes (n=5), and dementia (n=2). COVID-19+ pts remained PCR+ for a range of 14-42 days in those with available serial testing (n=8). Of the PCR+ pts, 14 were tested for the presence of COVID-19 antibodies; 12 were +, with a range of titers from <1:80 to 1:2880. Three patients were PCR negative at least once but tested antibody positive.
Nine of 23 (39%) COVID-19+ pts died; mortality among MDS patients included 6/18 (33%) COVID-19+ and 6/61 (9.8%) from the overall cohort. Among the 9 who died, the median number of co-morbidities was 3 and the median age was 75 years-old. Disease status in these patients was SD (2), CR (1), HI (1), and PD (1). IPSS-R was very high (n=4), high (n=1), and intermediate (n=1) in the MDS pts who died.
This represents the first reported large case series regarding the risks of developing COVID-19 and its effects at an MDS clinic in the initial US epicenter of the pandemic. Overall, 27.1% of the pt population was diagnosed with COVID-19; 39.1% of these pts died, or 10.6% of the overall cohort. A retrospective study across the US reported a 16% mortality rate of COVID-19 in cancer pts (Dr Rivera et al, 2020). The mortality rate reported here is higher, but with a smaller sample size. The clinical significance of persistently + PCR tests up to 6 weeks is unclear. COVID-19 antibodies were found in 85.7% of COVID-19 PCR+ pts tested, showing MDS pts can mount a humoral response. Likely factors contributing to the high mortality of MDS pts were co-morbidities and age. The majority of pts recovered and have resumed MDS directed therapy. Protecting MDS pts from COVID-19 infection must be a primary overall therapeutic approach until there are more effective COVID-19 treatment strategies.
Disclosures: Navada: Onconova Therapeutics Inc: Research Funding. Silverman: Medimmune: Research Funding; Onconova Therapeutics Inc: Patents & Royalties, Research Funding; Celgene: Research Funding.
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