Chemotherapy and COVID-19 Outcomes in Patients with Cancer

Justin Jee; Michael B. Foote; Melissa Lumish; Aaron J. Stonestrom; Beatriz Wills; Varun Narendra; Viswatej Avutu; Yonina R. Murciano-Goroff; Jason E. Chan; Andriy Derkach; John Philip; Rimma Belenkaya; Marina Kerpelev; Molly Maloy; Adam Watson; Chris Fong; Yelena Janjigian; Luis A. Diaz; Kelly L. Bolton; Melissa S. Pessin

doi:10.1200/JCO.20.01307

Chemotherapy and COVID-19 Outcomes in Patients with Cancer

Justin Jee, Michael B. Foote, Melissa Lumish, Aaron J. Stonestrom, Beatriz Wills, Varun Narendra, Viswatej Avutu, Yonina R. Murciano-Goroff, Jason E. Chan, Andriy Derkach, John Philip, Rimma Belenkaya, Marina Kerpelev, Molly Maloy, Adam Watson, Chris Fong, Yelena Janjigian, Luis A. Diaz, Kelly L. Bolton, Melissa S. Pessin

Research output: Contribution to journal › Article › peer-review

198 Scopus citations

Abstract

PURPOSE Coronavirus-2019 (COVID-19) mortality is higher in patients with cancer than in the general population, yet the cancer-associated risk factors for COVID-19 adverse outcomes are not fully characterized. PATIENTS AND METHODS We reviewed clinical characteristics and outcomes from patients with cancer and concurrent COVID-19 at Memorial Sloan Kettering Cancer Center until March 31, 2020 (n 5 309), and observed clinical end points until April 13, 2020. We hypothesized that cytotoxic chemotherapy administered within 35 days of a COVID-19 diagnosis is associated with an increased hazard ratio (HR) of severe or critical COVID-19. In secondary analyses, we estimated associations between specific clinical and laboratory variables and the incidence of a severe or critical COVID-19 event. RESULTS Cytotoxic chemotherapy administration was not significantly associated with a severe or critical COVID-19 event (HR, 1.10; 95% CI, 0.73 to 1.60). Hematologic malignancy was associated with increased COVID-19 severity (HR, 1.90; 95% CI, 1.30 to 2.80). Patients with lung cancer also demonstrated higher rates of severe or critical COVID-19 events (HR, 2.0; 95% CI, 1.20 to 3.30). Lymphopenia at COVID-19 diagnosis was associated with higher rates of severe or critical illness (HR, 2.10; 95% CI, 1.50 to 3.10). Patients with baseline neutropenia 14-90 days before COVID-19 diagnosis had worse outcomes (HR, 4.20; 95% CI, 1.70 to 11.00). Findings from these analyses remained consistent in a multivariable model and in multiple sensitivity analyses. The rate of adverse events was lower in a time-matched population of patients with cancer without COVID-19. CONCLUSION Recent cytotoxic chemotherapy treatment was not associated with adverse COVID-19 outcomes. Patients with active hematologic or lung malignancies, peri–COVID-19 lymphopenia, or baseline neutropenia had worse COVID-19 outcomes. Interactions among antineoplastic therapy, cancer type, and COVID-19 are complex and warrant further investigation.

Original language	English
Pages (from-to)	3538-3546
Number of pages	9
Journal	Journal of Clinical Oncology
Volume	38
Issue number	30
DOIs	https://doi.org/10.1200/JCO.20.01307
State	Published - 20 Oct 2020
Externally published	Yes

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10.1200/JCO.20.01307

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Jee, J., Foote, M. B., Lumish, M., Stonestrom, A. J., Wills, B., Narendra, V., Avutu, V., Murciano-Goroff, Y. R., Chan, J. E., Derkach, A., Philip, J., Belenkaya, R., Kerpelev, M., Maloy, M., Watson, A., Fong, C., Janjigian, Y., Diaz, L. A., Bolton, K. L., & Pessin, M. S. (2020). Chemotherapy and COVID-19 Outcomes in Patients with Cancer. Journal of Clinical Oncology, 38(30), 3538-3546. https://doi.org/10.1200/JCO.20.01307

@article{d7abf1a7ba1c4816979a1f82daefa2c3,

title = "Chemotherapy and COVID-19 Outcomes in Patients with Cancer",

abstract = "PURPOSE Coronavirus-2019 (COVID-19) mortality is higher in patients with cancer than in the general population, yet the cancer-associated risk factors for COVID-19 adverse outcomes are not fully characterized. PATIENTS AND METHODS We reviewed clinical characteristics and outcomes from patients with cancer and concurrent COVID-19 at Memorial Sloan Kettering Cancer Center until March 31, 2020 (n 5 309), and observed clinical end points until April 13, 2020. We hypothesized that cytotoxic chemotherapy administered within 35 days of a COVID-19 diagnosis is associated with an increased hazard ratio (HR) of severe or critical COVID-19. In secondary analyses, we estimated associations between specific clinical and laboratory variables and the incidence of a severe or critical COVID-19 event. RESULTS Cytotoxic chemotherapy administration was not significantly associated with a severe or critical COVID-19 event (HR, 1.10; 95% CI, 0.73 to 1.60). Hematologic malignancy was associated with increased COVID-19 severity (HR, 1.90; 95% CI, 1.30 to 2.80). Patients with lung cancer also demonstrated higher rates of severe or critical COVID-19 events (HR, 2.0; 95% CI, 1.20 to 3.30). Lymphopenia at COVID-19 diagnosis was associated with higher rates of severe or critical illness (HR, 2.10; 95% CI, 1.50 to 3.10). Patients with baseline neutropenia 14-90 days before COVID-19 diagnosis had worse outcomes (HR, 4.20; 95% CI, 1.70 to 11.00). Findings from these analyses remained consistent in a multivariable model and in multiple sensitivity analyses. The rate of adverse events was lower in a time-matched population of patients with cancer without COVID-19. CONCLUSION Recent cytotoxic chemotherapy treatment was not associated with adverse COVID-19 outcomes. Patients with active hematologic or lung malignancies, peri–COVID-19 lymphopenia, or baseline neutropenia had worse COVID-19 outcomes. Interactions among antineoplastic therapy, cancer type, and COVID-19 are complex and warrant further investigation.",

author = "Justin Jee and Foote, {Michael B.} and Melissa Lumish and Stonestrom, {Aaron J.} and Beatriz Wills and Varun Narendra and Viswatej Avutu and Murciano-Goroff, {Yonina R.} and Chan, {Jason E.} and Andriy Derkach and John Philip and Rimma Belenkaya and Marina Kerpelev and Molly Maloy and Adam Watson and Chris Fong and Yelena Janjigian and Diaz, {Luis A.} and Bolton, {Kelly L.} and Pessin, {Melissa S.}",

year = "2020",

month = oct,

day = "20",

doi = "10.1200/JCO.20.01307",

language = "English",

volume = "38",

pages = "3538--3546",

journal = "Journal of Clinical Oncology",

issn = "0732-183X",

publisher = "Lippincott Williams and Wilkins",

number = "30",

}

Jee, J, Foote, MB, Lumish, M, Stonestrom, AJ, Wills, B, Narendra, V, Avutu, V, Murciano-Goroff, YR, Chan, JE, Derkach, A, Philip, J, Belenkaya, R, Kerpelev, M, Maloy, M, Watson, A, Fong, C, Janjigian, Y, Diaz, LA, Bolton, KL & Pessin, MS 2020, 'Chemotherapy and COVID-19 Outcomes in Patients with Cancer', Journal of Clinical Oncology, vol. 38, no. 30, pp. 3538-3546. https://doi.org/10.1200/JCO.20.01307

TY - JOUR

T1 - Chemotherapy and COVID-19 Outcomes in Patients with Cancer

AU - Jee, Justin

AU - Foote, Michael B.

AU - Lumish, Melissa

AU - Stonestrom, Aaron J.

AU - Wills, Beatriz

AU - Narendra, Varun

AU - Avutu, Viswatej

AU - Murciano-Goroff, Yonina R.

AU - Chan, Jason E.

AU - Derkach, Andriy

AU - Philip, John

AU - Belenkaya, Rimma

AU - Kerpelev, Marina

AU - Maloy, Molly

AU - Watson, Adam

AU - Fong, Chris

AU - Janjigian, Yelena

AU - Diaz, Luis A.

AU - Bolton, Kelly L.

AU - Pessin, Melissa S.

PY - 2020/10/20

Y1 - 2020/10/20

N2 - PURPOSE Coronavirus-2019 (COVID-19) mortality is higher in patients with cancer than in the general population, yet the cancer-associated risk factors for COVID-19 adverse outcomes are not fully characterized. PATIENTS AND METHODS We reviewed clinical characteristics and outcomes from patients with cancer and concurrent COVID-19 at Memorial Sloan Kettering Cancer Center until March 31, 2020 (n 5 309), and observed clinical end points until April 13, 2020. We hypothesized that cytotoxic chemotherapy administered within 35 days of a COVID-19 diagnosis is associated with an increased hazard ratio (HR) of severe or critical COVID-19. In secondary analyses, we estimated associations between specific clinical and laboratory variables and the incidence of a severe or critical COVID-19 event. RESULTS Cytotoxic chemotherapy administration was not significantly associated with a severe or critical COVID-19 event (HR, 1.10; 95% CI, 0.73 to 1.60). Hematologic malignancy was associated with increased COVID-19 severity (HR, 1.90; 95% CI, 1.30 to 2.80). Patients with lung cancer also demonstrated higher rates of severe or critical COVID-19 events (HR, 2.0; 95% CI, 1.20 to 3.30). Lymphopenia at COVID-19 diagnosis was associated with higher rates of severe or critical illness (HR, 2.10; 95% CI, 1.50 to 3.10). Patients with baseline neutropenia 14-90 days before COVID-19 diagnosis had worse outcomes (HR, 4.20; 95% CI, 1.70 to 11.00). Findings from these analyses remained consistent in a multivariable model and in multiple sensitivity analyses. The rate of adverse events was lower in a time-matched population of patients with cancer without COVID-19. CONCLUSION Recent cytotoxic chemotherapy treatment was not associated with adverse COVID-19 outcomes. Patients with active hematologic or lung malignancies, peri–COVID-19 lymphopenia, or baseline neutropenia had worse COVID-19 outcomes. Interactions among antineoplastic therapy, cancer type, and COVID-19 are complex and warrant further investigation.

AB - PURPOSE Coronavirus-2019 (COVID-19) mortality is higher in patients with cancer than in the general population, yet the cancer-associated risk factors for COVID-19 adverse outcomes are not fully characterized. PATIENTS AND METHODS We reviewed clinical characteristics and outcomes from patients with cancer and concurrent COVID-19 at Memorial Sloan Kettering Cancer Center until March 31, 2020 (n 5 309), and observed clinical end points until April 13, 2020. We hypothesized that cytotoxic chemotherapy administered within 35 days of a COVID-19 diagnosis is associated with an increased hazard ratio (HR) of severe or critical COVID-19. In secondary analyses, we estimated associations between specific clinical and laboratory variables and the incidence of a severe or critical COVID-19 event. RESULTS Cytotoxic chemotherapy administration was not significantly associated with a severe or critical COVID-19 event (HR, 1.10; 95% CI, 0.73 to 1.60). Hematologic malignancy was associated with increased COVID-19 severity (HR, 1.90; 95% CI, 1.30 to 2.80). Patients with lung cancer also demonstrated higher rates of severe or critical COVID-19 events (HR, 2.0; 95% CI, 1.20 to 3.30). Lymphopenia at COVID-19 diagnosis was associated with higher rates of severe or critical illness (HR, 2.10; 95% CI, 1.50 to 3.10). Patients with baseline neutropenia 14-90 days before COVID-19 diagnosis had worse outcomes (HR, 4.20; 95% CI, 1.70 to 11.00). Findings from these analyses remained consistent in a multivariable model and in multiple sensitivity analyses. The rate of adverse events was lower in a time-matched population of patients with cancer without COVID-19. CONCLUSION Recent cytotoxic chemotherapy treatment was not associated with adverse COVID-19 outcomes. Patients with active hematologic or lung malignancies, peri–COVID-19 lymphopenia, or baseline neutropenia had worse COVID-19 outcomes. Interactions among antineoplastic therapy, cancer type, and COVID-19 are complex and warrant further investigation.

UR - http://www.scopus.com/inward/record.url?scp=85091839894&partnerID=8YFLogxK

U2 - 10.1200/JCO.20.01307

DO - 10.1200/JCO.20.01307

M3 - Article

C2 - 32795225

AN - SCOPUS:85091839894

SN - 0732-183X

VL - 38

SP - 3538

EP - 3546

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

IS - 30

ER -

Chemotherapy and COVID-19 Outcomes in Patients with Cancer

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