Table 1.
Demographics, baseline characteristics, and clinical outcomes of hematological patients with SARS-CoV-2 infection.
UPN1 | UPN2 | UPN3 | UPN4 | UPN5 | UPN6 | UPN7 | UPN8 | |
---|---|---|---|---|---|---|---|---|
Sex | M | W | M | W | M | M | W | W |
Age | 61 | 63 | 52 | 64 | 54 | 55 | 58 | 56 |
Days from positive NAT to last seen or death | 68 | 66 | 59 | 59 | 23 | 55 | 55 | 55 |
Days from positive NAT to first symptomsa | −5 | −8 | −1 | N/A | −2 | 2 | 7 | 10 |
First symptoms | Fever, cough | Cough, diarrhea | Fever, malaise | None | Fever | Fever | Dyspnea | Dysgeusia, nausea |
Hematological diseaseb | DLBCL (12 months continuous complete remission) | Coombs positive Evans syndrome, Hodgkin lymphoma (10 year continuous complete remission) | DLBCL | Multiple myeloma | AML-MRC, CRi (severe pancytopenia) | Follicular lymphoma | Lymphoid blast crisis of CML, HLA-identical unrelated donor alloHCT, molecular remission, chronic GvHD | AML-MRC, HLA-identical sibling donor alloHCT, acute skin GvHD |
Specific hematologic therapy in the last 12 months before COVID-19 diagnosis | EPOCH-R, high-dose MTX | Eltrombopagc, prednisolonec, intravenous immunoglobulinsc | R-CHOP and pegfilgrastimc | RVD induction; high dose cyclophosphamide (priming therapy) and filgrastimc | daunorubicin, cytarabine (7 + 3 induction) | G-CHOP and lipegfilgrastimc | TBI 8 Gy, fludarabine, rabbit ATG, methotrexate (reduced-intensity myeloablative conditioning); dasatinib; methylprednisolone and cyclosporinec | High-dose cytarabine (consolidation); busulfan, fludarabine (myeloablative conditioning); mycophenolate mofetil and cyclosporinec |
Relevant coexisting disorders | Secondary immunoglobulin deficiency | Iatrogenic Cushing’s syndrome, Parkinson’s disease, severe osteoporosis, recurrent deep vein thrombosis, splenectomy | Obesity | None | Diabetes mellitus, peptic ulcer disease | Chronic obstructive pulmonary disease, arterial hypertension, clear cell renal cell carcinoma (in remission), obesity | Arterial hypertension, QTc-prolongation, extrapulmonary tuberculosis | Arterial hypertension, paroxysmal atrial fibrillation, hyperlipidemia |
Smoking history | No | No | No | No | No | Yes, 122 pack years | No | No |
All symptoms | Fever, cough, sore throat, respiratory distress | Fever, cough, dyspnea, diarrhea | Fever, mailase, cough, respiratory distress | None | Fever, cough, respiratory distress | Fever, cough, dysgeusia, respiratory distress | Dyspnea, cough, malaise, fever, respiratory distress | Dysgeusia, nausea, cough, fever, respiratory distress |
Chest X-ray | Bilateral pneumonia | None | Bilateral pneumonia | None | Bilateral pneumonia | Bilateral pneumonia | Bilateral pneumonia | Bilateral pneumonia |
Abnormal blood countd before SARS-CoV-2 infection | Lymphopenia | Leukocytosis | Lymphopenia | Severe neutropenia, mild anemia, severe thrombocytopenia, lymphopenia | Severe pancytopenia, lymphopenia | No | Anemia | Anemia, lymphopenia, thrombocytopenia |
Laboratory changes since SARS-CoV-2 infection | Increased CRP, d-dimers, ferritin, LDH, PCT (IL-6, sIL-2R not measured) | Lymphocytosis, thrombocytopenia; increased IL-6 (ferritin, sIL-2R not measured) | Neutropenia, thrombocytopenia; increased AST, ALT, CRP, d-dimers, ferritin, HSTT, IL-6, LDH, PCT, sIL-2R | Increased CRP (ferritin, IL-6 and sIL-2r not measured) | Increased CRP, d-dimers, ferritin, HSTT, IL-6, LDH, sIL-2R; decreased fibrinogen | Neutropenia, thrombocytopenia, lymphocytopenia; increased AST, ALT, CRP, d-dimers, ferritin, fibrinogen, HSTT, IL-6, LDH (sIL-2R not measured) | Lymphocytopenia; increased CRP, ferritin, IL-6, sIL-2R | Increased CRP, ferritin, IL-6 (sIL-2R not measured) |
Complications | Bacterial pneumonia | None | Severe ARDS, cytokine release syndrome, ventilator associated pneumonia | None | Severe ARDS, extubation failure, cytokine release syndrome, multi organ failure, death | Severe ARDS, cytokine release syndrome | None | CMV reactivation, bacterial enterocolitis |
Days to ARDSe | N/A | N/A | 7 | N/A | 7 | 6 | N/A | N/A |
Treatment of COVID-19 | Hydroxychloroquine, clarithromycin, zinc | None | Hydroxychloroquine, azithromycin, zinc, tocilizumab (three doses), prednisolone, convalescent plasma with prednisolone | None | Hydroxychloroquine, azithromycin, zinc, tocilizumab (three doses), dexamethasone | Hydroxychloroquine, azithromycin, zinc, tocilizumab (two doses), convalescent plasma with prednisolone | Hydroxychloroquine, zinc | Hydroxychloroquine, azithromycin, zinc |
SARS-CoV-2 S1/S2 IgG (EIA) at time of last NAT | N/A | Positive | Weakly positive | N/A | N/A | Negative | Negative | Positive |
Days to negative NATf | 11 | N/R | 34 | 7 | N/R | 48 | N/R | N/R |
Outcome | Cured, well, discharged | Alive, well, outpatient | Cured, well, rehabilitation | Cured, well, outpatient | Dead | Cured, well, rehabilitation | Alive, well, discharged | Alive, well, discharged |
AlloHCT allogeneic hematopoietic cell transplantation, ALT alanine aminotransferase, AML-MRC acute myeloid leukemia with myelodysplasia-related changes, ARDS acute respiratory distress syndrome, AST aspartate aminotransferase, ATG anti-thymocyte globulin, CRi complete remission with incomplete hematologic recovery, CRP C-reactive protein, CML chronic myeloid leukemia, DLBCL diffuse large B-cell lymphoma, EIA enzyme immunoassay, EPOCH-R etoposide, prednisolone, vincristine, cyclophosphamide, doxorubicin, rituximab, G-CHOP obinutuzumab, cyclophosphamide, doxorubicin, vincristine, prednisolone, GvHD graft versus host disease, HLA human leukocyte antigen, HSTT highly sensitive troponin t, IgG immunoglobulin G, IL-6 interleukin-6, LDH lactate dehydrogenase, NAT nucleic acid test, N/A not applicable, N/R not reached, PBSC peripheral blood stem cell, PCT procalcitonin, R-CHOP rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone, RVD lenalidomide, bortezomib, dexamethasone, sIL-2R soluble interleukin-2 receptor, TBI total body irradiation, UPN unique patient number.
aSome patients were identified by NAT screening after contact with infected patient before development of symptoms.
bHematologic disease were classified according to WHO classification.
cAdministered in the 14 days prior to COVID-19 onset.
dLymphocytopenia was defined as a lymphocyte count of <1000 per cubic millimeter. Thrombocytopenia was defined as a platelet count of <150,000 per cubic millimeter.
eDays to ARDS were counted from onset of clinical symptoms.
fDays to negative NAT were counted from first positive NAT until the first of two consecutive negative NAT 24 h apart.