A greater understanding of clinical trends in COVID-19 outcomes among patients with hematologic malignancies (HM) over the course of the pandemic, particularly the Omicron era, is needed. This ongoing, observational, and registry-based study with prospective data collection evaluated COVID-19 clinical severity and mortality in 1818 adult HM patients diagnosed with COVID-19 between 27 February 2020 and 1 October 2022, at 31 centers in the Madrid region of Spain. Of these, 1281 (70.5%) and 537 (29.5%) were reported in the pre-Omicron and Omicron periods, respectively. Overall, patients aged ≥70 years (odds ratio 2.16, 95% CI 1.64–2.87), with >1 comorbidity (2.44, 1.85–3.21), or with an underlying HM of chronic lymphocytic leukemia (1.64, 1.19–2.27), had greater odds of severe/critical COVID-19; odds were lower during the Omicron BA.1/BA.2 (0.28, 0.2–0.37) or BA.4/BA.5 (0.13, 0.08–0.19) periods and among patients vaccinated with one or two (0.51, 0.34–0.75) or three or four (0.22, 0.16–0.29) doses. The hospitalization rate (75.3% [963/1279], 35.7% [191/535]), rate of intensive care admission (30.0% [289/963], 14.7% [28/191]), and mortality rate overall (31.9% [409/1281], 9.9% [53/536]) and in hospitalized patients (41.3% [398/963], 22.0% [42/191]) decreased from the pre-Omicron to Omicron period. Age ≥70 years was the only factor associated with higher mortality risk in both the pre-Omicron (hazard ratio 2.57, 95% CI 2.03–3.25) and Omicron (3.19, 95% CI 1.59–6.42) periods. Receipt of prior stem cell transplantation, COVID-19 vaccination(s), and treatment with nirmatrelvir/ritonavir or remdesivir were associated with greater survival rates. In conclusion, COVID-19 mortality in HM patients has decreased considerably in the Omicron period; however, mortality in hospitalized HM patients remains high. Specific studies should be undertaken to test new treatments and preventive interventions in HM patients.
随着疫情发展，特别是奥密克戎时期，我们需要更深入地了解血液系统恶性肿瘤（HM）患者COVID-19临床结局的变化趋势。这项基于前瞻性数据收集的持续性观察性注册研究，评估了2020年2月27日至2022年10月1日期间，在西班牙马德里地区31个中心确诊的1818例成年HM患者COVID-19的临床严重程度和死亡率。其中，1281例（70.5%）和537例（29.5%）分别发生在奥密克戎变异株流行前和流行期间。总体而言，年龄≥70岁（比值比2.16，95% CI 1.64–2.87）、合并症超过1种（2.44，1.85–3.21）或基础HM为慢性淋巴细胞白血病（1.64，1.19–2.27）的患者，其COVID-19发展为重症/危重症的几率更高；而在奥密克戎BA.1/BA.2（0.28，0.2–0.37）或BA.4/BA.5（0.13，0.08–0.19）流行期，以及接种过一或两剂（0.51，0.34–0.75）或三至四剂（0.22，0.16–0.29）疫苗的患者中，该几率较低。从奥密克戎流行前到流行期间，住院率（75.3% [963/1279] 降至 35.7% [191/535]）、重症监护室入住率（30.0% [289/963] 降至 14.7% [28/191]）、总死亡率（31.9% [409/1281] 降至 9.9% [53/536]）以及住院患者死亡率（41.3% [398/963] 降至 22.0% [42/191]）均有所下降。年龄≥70岁是奥密克戎流行前（风险比2.57，95% CI 2.03–3.25）和流行期间（3.19，95% CI 1.59–6.42）均与更高死亡风险相关的唯一因素。既往接受过干细胞移植、接种过COVID-19疫苗以及接受奈玛特韦/利托那韦或瑞德西韦治疗与更高的生存率相关。总之，在奥密克戎流行期间，HM患者的COVID-19死亡率已显著下降；然而，住院HM患者的死亡率仍然很高。应开展专门研究，以测试针对HM患者的新疗法和预防性干预措施。
肿瘤(癌症)患者之家