Lina Wang,1 Jiang Liu,1 Yafang Guo,1 Meiling Zhao,1 Bozheng Zhang,2 Junyan Zhang,3 Ruijuan Zhang1 

1Department of Hematology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China; 2Department of Pediatrics, College of Arts and Sciences, Emory University, Atlanta, GA, USA; 3Department of Clinical Epidemiology and Evidence-Based Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China

Correspondence: Ruijuan Zhang; Junyan Zhang, Email 13593169668@163.com; richard.zhang@both-win.net

Purpose: To investigate the outcomes and risk factors for patients with hematologic malignancies (HM) following late-stage SARS-CoV-2 infection.
Background: Patients with HM such as lymphoproliferative malignancies (including acute lymphoblastic leukemia and multiple myeloma) and myeloproliferative malignancies (including acute myeloid leukemia, myeloproliferative neoplasm, and myelodysplastic syndrome) are at increased risk of severe illness and high mortality from COVID-19. This study examines the impact of SARS-CoV-2 infection severity on HM prognosis during the late phase of COVID-19, using data from 203 patients at Shanxi Bethune Hospital.
Methods: This is a retrospective cohort study. Data was collected from hospitalized HM patients at a single center from December 1, 2023, to December 31, 2023. The primary outcome was overall survival (OS). Multivariable Cox regression was used to identify risk factors.
Results: This analysis includes data from 203 hospitalized patients with HM aged 36 to 67 years (median, 58 years). SARS-CoV-2 infection was observed in 42.86% (87/203) of the patients, among whom severe/critical cases accounted for 14.29% (29/203). Multivariable Cox regression shows active disease (hazard ratio [HR] 2.16, 95% confidence interval [CI] 1.00– 4.64, p = 0.049), hematopoietic stem cell transplantation (HSCT) (HR 4.06, 95% CI 1.02– 16.12, p = 0.047), and targeted therapy (HR 2.60, 95% CI 1.23– 5.50, p = 0.012) were associated with a higher incidence of progression. In contrast, individuals whose platelets count ≥ 50× 109/L at baseline (HR = 0.36, 95% CI 0.17– 0.78, p = 0.009) and ferritin levels less than 500 μg/L (HR = 0.54, 95% CI 0.34– 0.86, p = 0.010) were associated with a lower incidence of progression. Active status (HR 7.06, 95% CI 2.10– 23.76, p = 0.002), HSCT (HR 7.17, 95% CI 1.10– 46.63, p = 0.039), and severe/critical SARS-CoV-2 infection in HM patients (HR 11.98, 95% CI 2.57– 55.82, p = 0.002) were associated with higher incidences of all cause of mortality. While a higher platelet level (≥ 50× 109/L) was linked to a lower mortality (HR 0.16, 95% CI 0.05– 0.49, p = 0.002).
Conclusion: In the late stage of the COVID-19 pandemic, active disease status, recent HSCT, and severe/critical SARS-CoV-2 infection significantly increased the risks of disease progression and mortality in HM patients. Higher baseline platelet counts were associated with improved outcomes.

Keywords: late stage of COVID-19, hematologic malignancies, progression-free survival, overall survival