The outcome of COVID‐19 in patients with hematological malignancy

To the Editor,

I have read with great interest the recently published paper by Yigenoglu et al. entitled, “The outcome of COVID‐19 in patients with hematological malignancy.” The authors used the electronic database of the Ministry of Health for all COVID‐19‐confirmed hospitalizations between 11 March and 22 June 2020; recruited data on all COVID‐19 cases with hematological malignancies (n = 740) and another 740 COVID‐19‐confirmed patients (with no cancer), matched to those with hematological malignancies, on age, sex, and comorbidity status at baseline for four selected noncommunicable diseases. The severity of COVID‐19, hospital stay, and hospital outcomes were compared and contrasted between these two groups. Study findings were in line with a piori expectation that COVID‐19‐related serious event (ICU admission, MV support, or death) risk was higher in patients with hematological malignancy compared with COVID‐19 patients without cancer and, thus, confirmed the high vulnerability of patients with hematological malignancies in the ongoing pandemic.

Tables 1 ¹ and 4 ¹ in the paper contradict on the list of drugs used against COVID‐19 and needs revision. Azithromycin was reportedly used in 50.5% and 68.0% of the deceased patients with and without hematological malignancies, respectively; its use was missing in Table 1, ¹ presenting all study participants. Thus, the association of azithromycin with survivorship cannot be investigated (if any). It is remarkable, however, that the use of azithromycin was 2.12 times lower in deceased patients with hematological cancers than their counterparts (95% confidence interval = 1.05–4.33). The relevant p value in table 4 needs to be corrected as 0.04. We would like to learn whether any of the 152 deaths in the study population was associated with cardiovascular adverse effects during combined use of hydroxychloroquine and azithromycin.

Overall, the study clearly reveals that patients with hematological malignancies are at high risk of severe disease and death, if infected by SARS‐CoV‐2. Unfortunately, it does not provide any evidence on how to improve these patients’ survival. Further cohorts of hematological cancer patients are clearly warranted to identify predictors of COVID‐19 infection and relevant disease severity, effective drug regimens, and clinical outcomes during the ongoing pandemic. Also, their concerns/needs during a pandemic for effective management of their primary disease require further research.