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1. Clinical Characteristics and Outcomes of COVID-19 in Turkish Patients with Hematological Malignancies

Author

Sinem Civriz Bozdağ, Güldane Cengiz Seval, İpek Yönal Hindilerden, Fehmi Hindilerden, Neslihan Andıç, Mustafa Baydar, Lale Aydın Kaynar, Selami Koçak Toprak, Hasan Sami Göksoy, Berrin Balık Aydın, Ufuk Demirci, Ferda Can, Vildan Özkocaman, Eren Gündüz, Zeynep Tuğba Güven, Zübeyde Nur Özkurt, Sinan Demircioğlu, Meral Beksaç, İdris İnce, Umut Yılmaz, Hilal Eroğlu Küçükdiler, Elgün Abishov, Boran Yavuz, Ünal Ataş, Yaşa Gül Mutlu, Volkan Baş, Fahir Özkalemkaş, Hava Üsküdar Teke, Vildan Gürsoy, Serhat Çelik, Rafiye Çiftçiler, Münci Yağcı, Pervin Topçuoğlu, Özcan Çeneli, Hamza Abbasov, Cem Selim, Muhlis Cem Ar, Orhan Kemal Yücel, Sevil Sadri, Canan Albayrak, Ahmet Muzaffer Demir, Nil Güler, Muzaffer Keklik, Hatice Terzi, Ali Doğan, Zeynep Arzu Yegin, Meltem Kurt Yüksel, Soğol Sadri, İrfan Yavaşoğlu, Hüseyin Saffet Beköz, Tekin Aksu, Senem Maral, Veysel Erol, Leylagül Kaynar, Osman İlhan, Ali Zahit Bolaman, Ömür Gökmen Sevindik, Arzu Akyay, Muhit Özcan, Günhan Gürman, Şule Ünal, Yasemin Yavuz, Reyhan Diz Küçükkaya, and Güner Hayri Özsan

Subjects
covid-19, sars-cov-2 enfeksiyon, hematolojik malignite, Diseases of the blood and blood-forming organs, RC633-647.5
Abstract

Objective: Patients with solid malignancies are more vulnerable to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection than the healthy population. The outcome of SARS-CoV-2 infection in highly immunosuppressed populations, such as in patients with hematological malignancies, is a point of interest. We aimed to analyze the symptoms, complications, intensive care unit admissions, and mortality rates of patients with hematological malignancies infected with SARS-CoV-2 in Turkey. Materials and Methods: In this multicenter study, we included 340 adult and pediatric patients diagnosed with SARS-CoV-2 from March to November 2020. Diagnosis and status of primary disease, treatment schedules for hematological malignancies, time from last treatment, life expectancy related to the hematological disease, and comorbidities were recorded, together with data regarding symptoms, treatment, and outcome of SARS-CoV-2 infection. Results: Forty four patients were asymptomatic at diagnosis of SARSCoV- 2 infection. Among symptomatic patients, fever, cough, and dyspnea were observed in 62.6%, 48.8%, and 41.8%, respectively. Sixtynine (20%) patients had mild SARS-CoV-2 disease, whereas moderate, severe, and critical disease was reported in 101 (29%), 71 (20%), and 55 (16%) patients, respectively. Of the entire cohort, 251 (73.8%) patients were hospitalized for SARS-CoV-2. Mortality related to SARS-CoV-2 infection was 26.5% in the entire cohort; this comprised 4.4% of those patients with mild disease, 12.4% of those with moderate disease, and 83% of those with severe or critical disease. Active hematological disease, lower life expectancy related to primary hematological disease, neutropenia at diagnosis of SARS-CoV-2, ICU admission, and first-line therapy used for coronavirus disease-2019 treatment were found to be related to higher mortality rates. Treatments with hydroxychloroquine alone or in combination with azithromycin were associated with a higher rate of mortality in comparison to favipiravir use. Conclusion: Patients with hematological malignancy infected with SARS-CoV-2 have an increased risk of severe disease and mortality.

Published
2022
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2. Clinical Characteristics and Outcomes of COVID-19 in Turkish Patients with Hematological Malignancies

Author

Ali Zahit Bolaman, İdris İnce, Zübeyde Nur Özkurt, Elgün Abishov, Ömür Gökmen Sevindik, Hüseyin Saffet Beköz, Ahmet Muzaffer Demir, Irfan Yavasoglu, Veysel Erol, Muzaffer Keklik, Zeynep Arzu Yegin, Arzu Akyay, Vildan Ozkocaman, Hilal Eroğlu Küçükdiler, Münci Yağcı, Meral Beksac, Gunhan Gurman, Cem Selim, Meltem Kurt Yuksel, Ali Dogan, Vildan Gürsoy, Serhat Çelik, Senem Maral, Umut Yilmaz, Leylagül Kaynar, Osman Ilhan, Hava Üsküdar Teke, Güner Hayri Özsan, Berrin Balık Aydın, Ufuk Demirci, Unal Atas, Selami Kocak Toprak, Sinem Civriz Bozdag, Fahir Özkalemkaş, Tekin Aksu, Nil Güler, Guldane Cengiz Seval, Reyhan Diz Küçükkaya, Özcan Çeneli, Yaşa Gül Mutlu, Eren Gündüz, Lale Aydın Kaynar, Sule Unal, Volkan Baş, Boran Yavuz, Pervin Topcuoglu, Hatice Terzi, Fehmi Hindilerden, Zeynep Tuğba Güven, Canan Albayrak, Yasemin Yavuz, Ferda Can, Muhlis Cem Ar, Neslihan Andic, İpek Yönal Hindilerden, Sinan Demircioğlu, Hasan Sami Goksoy, Rafiye Ciftciler, Mustafa Baydar, Soğol Sadri, Muhit Ozcan, Hamza Abbasov, Orhan Kemal Yücel, Sevil Sadri, and Tıp Fakültesi

Subjects
myalgia, Turkey, retrospective study, hematologic disease, serology, thrombocytopenia, mortality rate, Disease, Azithromycin, intensive care unit, law.invention, computer assisted tomography, sepsis, Hematological malignancy, cardiovascular disease, law, Severe acute respiratory syndrome coronavirus 2, Medicine, Child, fever, adult, Mortality rate, clinical trial, Hematology, anemia, Intensive care unit, aged, comorbidity, female, risk factor, Hematologic Neoplasms, Pyrazines, Cohort, disease severity, epidemiology, SARSCOV2 Infection, medicine.symptom, hospitalization, Hydroxychloroquine, medicine.drug, medicine.medical_specialty, hypertension, hematocrit, seizure, complication, acute myeloid leukemia, favipiravir, Neutropenia, Favipiravir, Asymptomatic, Article, Hematologicalmalignancy, coronavirus disease 2019, male, turkey (bird), Internal medicine, malaise, neutropenia, Humans, allogeneic hematopoietic stem cell transplantation, human, coughing, outcome assessment, hypoxia, SARS-CoV-2, business.industry, SARS-CoV-2 infection, neutrophil count, COVID-19, dyspnea, platelet count, medicine.disease, major clinical study, mortality, amide, Amides, breathing rate, multicenter study, adolescent, pyrazine derivative, hematologic malignancy, business
Abstract

Patients with solid malignancies are more vulnerable to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection than the healthy population. The outcome of SARS-CoV-2 infection in highly immunosuppressed populations, such as in patients with hematological malignancies, is a point of interest. We aimed to analyze the symptoms, complications, intensive care unit admissions, and mortality rates of patients with hematological malignancies infected with SARS-CoV-2 in Turkey.In this multicenter study, we included 340 adult and pediatric patients diagnosed with SARS-CoV-2 from March to November 2020. Diagnosis and status of primary disease, treatment schedules for hematological malignancies, time from last treatment, life expectancy related to the hematological disease, and comorbidities were recorded, together with data regarding symptoms, treatment, and outcome of SARS-CoV-2 infection.Forty four patients were asymptomatic at diagnosis of SARS-CoV- 2 infection. Among symptomatic patients, fever, cough, and dyspnea were observed in 62.6%, 48.8%, and 41.8%, respectively. Sixty-nine (20%) patients had mild SARS-CoV-2 disease, whereas moderate, severe, and critical disease was reported in 101 (29%), 71 (20%), and 55 (16%) patients, respectively. Of the entire cohort, 251 (73.8%) patients were hospitalized for SARS-CoV-2. Mortality related to SARS-CoV-2 infection was 26.5% in the entire cohort; this comprised 4.4% of those patients with mild disease, 12.4% of those with moderate disease, and 83% of those with severe or critical disease. Active hematological disease, lower life expectancy related to primary hematological disease, neutropenia at diagnosis of SARS-CoV-2, ICU admission, and first-line therapy used for coronavirus disease-2019 treatment were found to be related to higher mortality rates. Treatments with hydroxychloroquine alone or in combination with azithromycin were associated with a higher rate of mortality in comparison to favipiravir use.Patients with hematological malignancy infected with SARS-CoV-2 have an increased risk of severe disease and mortality.Solid malignite hastalarının şiddetli akut solunum yolu enfeksiyonu-koronavirüs-2 (SARS-CoV-2) enfeksiyonuna sağlıklı bireylerden daha yatkın oldukları gösterilmiştir. Bu verilerin ardından oldukça yoğun immünosupresif olan hematolojik malignite hastalarında SARS-CoV-2 infeksiyonu sonuçları ilgi konusu olmuştur. Biz de bu makalede Türkiye’de hematolojik malignite tanısı ile takip ve tedavi edilirken SARS-CoV-2 enfeksiyonu saptanan hastaların semptom, komplikasyon, yoğun bakım ünitesine yatış ve mortalite oranlarını değerlendirmeyi amaçladık.Çok merkezli çalışmamıza Mart-Kasım 2020 tarihleri arasında SARS-CoV-2 enfeksiyonu tanısı alan erişkin ve pediatrik 340 hastayı dahil ettik. Hastaların hematolojik malignite tanıları, hastalık statusları, tedavileri, son tedaviden enfeksiyona kadar geçen süre, komorbiditeleri, yaşam beklentileri değerlendirildi. Semptomları, oluşan komplikasyonlar ve sonuçlar analiz edildi.Kırk-dört hasta semptomsuz olarak enfeksiyonu geçirirken, semptomatik hastaların ateş, öksürük, ve dispne oranları sırasıyla %62,6, %48,8 ve %41,8 idi. Altmış altı hasta (%20) hastalığı hafif geçirirken, orta, ciddi ve kritik hastalık tanısı alanların oranı sırasıyla %29, %20 ve %16 idi. Tüm kohortta ölüm oranı %26,6 idi; ölüm hafif hastalığı olanlarda %4,4 , orta derece hastalık geçirenlerde %12 ve ciddi/kritik hastalık geçirenlerde ise %83 olarak saptandı. Aktif hematolojik hastalık olması, primer hematolojik hastalığa bağlı düşük hayat beklentisi, SARS-CoV-2 tanısı aldığında nötropenik olmak, yoğun bakıma alınmış olmak ve ilk sıra koronavirüs hastalığı-2019 tedavisi yüksek ölüm riski ile ilişkilendirilen faktörlerdendi. Tek başına veya azitromisin ile kombine olarak hidroksiklorokin kullanan hastaların sadece favipiravir kullananlara göre ölüm riskleri daha yüksek saptandı.SARS-CoV-2 infeksiyonu geçiren hematolojik malignite hastalarında daha yüksek oranda ciddi hastalık ve ölüm riski gözlenmektedir.

Published
2022

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