Clinical Characteristics and Outcomes of COVID-19 in Turkish Patients with Hematological Malignancies

Clinical Characteristics and Outcomes of COVID-19 in Turkish Patients with Hematological Malignancies [Turk J Hematol]

Turk J Hematol. 2022; 39(1): 43-54 | DOI: 10.4274/tjh.galenos.2021.2021.0287

Clinical Characteristics and Outcomes of COVID-19 in Turkish Patients with Hematological Malignancies

Sinem Civriz Bozda�¹, G�ldane Cengiz Seval¹, �pek Y�nal Hindilerden², Fehmi Hindilerden³, Neslihan And��⁴, Mustafa Baydar⁵, Lale Ayd�n Kaynar⁶, Selami Ko�ak Toprak¹, Hasan Sami G�ksoy⁷, Berrin Bal�k Ayd�n⁸, Ufuk Demirci⁹, Ferda Can¹⁰, Vildan �zkocaman¹¹, Eren G�nd�z⁴, Zeynep Tu�ba G�ven⁵, Z�beyde Nur �zkurt⁶, Sinan Demircio�lu¹², Meral Beksa�¹, �dris �nce¹³, Umut Y�lmaz¹⁴, Hilal Ero�lu K��kdiler¹⁵, Elg�n Abishov¹⁷, Boran Yavuz¹⁶, �nal Ata�¹⁷, Ya�a G�l Mutlu⁸, Volkan Ba�⁹, Fahir �zkalemka�¹¹, Hava �sk�dar Teke⁴, Vildan G�rsoy¹⁸, Serhat �elik⁵, Rafiye �ift�iler¹⁹, M�nci Ya�c�⁶, Pervin Top�uo�lu¹, �zcan �eneli¹², Hamza Abbasov⁷, Cem Selim¹⁵, Muhlis Cem Ar¹⁴, Orhan Kemal Y�cel¹⁷, Sevil Sadri⁸, Canan Albayrak²⁰, Ahmet Muzaffer Demir⁹, Nil G�ler²¹, Muzaffer Keklik⁵, Hatice Terzi²², Ali Do�an²³, Zeynep Arzu Yegin⁶, Meltem Kurt Y�ksel¹, So�ol Sadri⁷, �rfan Yava�o�lu¹⁵, H�seyin Saffet Bek�z⁸, Tekin Aksu²⁴, Senem Maral²⁵, Veysel Erol²¹, Leylag�l Kaynar⁵, Osman �lhan¹, Ali Zahit Bolaman¹⁵, �m�r G�kmen Sevindik⁸, Arzu Akyay²⁶, Muhit �zcan¹, G�nhan G�rman¹, �ule �nal²⁴, Yasemin Yavuz²⁷, Reyhan Diz K��kkaya²⁸, G�ner Hayri �zsan¹⁶
¹Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
²�stanbul University, �stanbul Faculty of Medicine, Department of Internal Medicine, �stanbul, Turkey
³�stanbul Bak�rk�y Sadi Konuk Training and Research Hospital, Clinic of Hematology, �stanbul, Turkey
⁴Eski�ehir Osmangazi University Faculty of Medicine, Department of Hematology, Eski�ehir, Turkey
⁵Erciyes University Faculty of Medicine, Department of Internal Medicine, Kayseri, Turkey
⁶Gazi University Faculty of Medicine, Department of Hematology, Ankara, Turkey
⁷Yeni Y�zy�l University, �zel Gaziosmanpa�a Hospital, Department of Internal Medicine, Division of Hematology, �stanbul, Turkey
⁸Medipol University Faculty of Medicine, Department of Internal Medicine, �stanbul, Turkey
⁹Trakya University Faculty of Medicine, Department of Hematology, Edirne, Turkey
¹⁰Ankara City Hospital, Clinic of Internal Medicine, Department of Hematology, Ankara, Turkey
¹¹Bursa Uluda� University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Bursa, Turkey
¹²Necmettin Erbakan University, Meram Faculty of Medicine, Department of Hematology, Konya, Turkey
¹³Dr. Ersin Arslan Training and Research Hospital, Clinic of Hematology, Gaziantep, Turkey
¹⁴�stanbul University-Cerrahpa�a, Cerrahpa�a Faculty of Medicine, Department of Internal Medicine, Division of Hematology, �stanbul, Turkey
¹⁵Adnan Menderes University Faculty of Medicine, Department of Hematology, Ayd�n, Turkey
¹⁶Dokuz Eyl�l University Faculty of Medicine, Department of Hematology, �zmir, Turkey
¹⁷Akdeniz University Faculty of Medicine, Department of Hematology, Antalya, Turkey
¹⁸Bursa City Hospital, Clinic of Hematology, Bursa, Turkey
¹⁹Aksaray Training and Research Hospital, Clinic of Hematology, Aksaray, Turkey
²⁰Ondokuz May�s University Faculty of Medicine, Department of Pediatric Hematology, Samsun, Turkey
²¹Pamukkale University Faculty of Medicine, Department of Internal Medicine, Denizli, Turkey
²²Cumhuriyet University Faculty of Medicine, Department of Hematology, Sivas, Turkey
²³Van Y�z�nc� Y�l University Faculty of Medicine, Department of Hematology, Van, Turkey
²⁴Hacettepe University Faculty of Medicine, Department of Pediatric Hematology, Ankara, Turkey
²⁵University of Health Sciences Turkey, D��kap� Y�ld�r�m Beyaz�t Training and Research Hospital, Department of Hematology, Ankara, Turkey
²⁶�n�n� University Faculty of Medicine, Department of Pediatric Hematology and Oncology, Malatya, Turkey
²⁷Ankara University School of Medicine, Department of Biostatistics, Ankara, Turkey
²⁸�stanbul University Faculty of Science, Department of Molecular Biology and Genetic, �stanbul, Turkey

Objective: Patients with solid malignancies are more vulnerable to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection than the healthy population. The outcome of SARS-CoV-2 infection in highly immunosuppressed populations, such as in patients with hematological malignancies, is a point of interest. We aimed to analyze the symptoms, complications, intensive care unit admissions, and mortality rates of patients with hematological malignancies infected with SARS-CoV-2 in Turkey.
Materials and Methods: In this multicenter study, we included 340 adult and pediatric patients diagnosed with SARS-CoV-2 from March to November 2020. Diagnosis and status of primary disease, treatment schedules for hematological malignancies, time from last treatment, life expectancy related to the hematological disease, and comorbidities were recorded, together with data regarding symptoms, treatment, and outcome of SARS-CoV-2 infection.
Results: Forty four patients were asymptomatic at diagnosis of SARSCoV- 2 infection. Among symptomatic patients, fever, cough, and dyspnea were observed in 62.6%, 48.8%, and 41.8%, respectively. Sixtynine (20%) patients had mild SARS-CoV-2 disease, whereas moderate, severe, and critical disease was reported in 101 (29%), 71 (20%), and 55 (16%) patients, respectively. Of the entire cohort, 251 (73.8%) patients were hospitalized for SARS-CoV-2. Mortality related to SARS-CoV-2 infection was 26.5% in the entire cohort; this comprised 4.4% of those patients with mild disease, 12.4% of those with moderate disease, and 83% of those with severe or critical disease. Active hematological disease, lower life expectancy related to primary hematological disease, neutropenia at diagnosis of SARS-CoV-2, ICU admission, and first-line therapy used for coronavirus disease-2019 treatment were found to be related to higher mortality rates. Treatments with hydroxychloroquine alone or in combination with azithromycin were associated with a higher rate of mortality in comparison to favipiravir use.
Conclusion: Patients with hematological malignancy infected with SARS-CoV-2 have an increased risk of severe disease and mortality.

Keywords: COVID-19, SARS-CoV-2 enfeksiyon, Hematolojik malignite

COVID-19 Ge�iren T�rk Hematolojik Malignite Hastalar�n�n Klinik �zellikleri ve Sonu�lar�

Ama�: Solid malignite hastalar�n�n �iddetli akut solunum yolu enfeksiyonu-koronavir�s-2 (SARS-CoV-2) enfeksiyonuna sa�l�kl� bireylerden daha yatk�n olduklar� g�sterilmi�tir. Bu verilerin ard�ndan olduk�a yo�un imm�nosupresif olan hematolojik malignite hastalar�nda SARS-CoV-2 infeksiyonu sonu�lar� ilgi konusu olmu�tur. Biz de bu makalede T�rkiye�de hematolojik malignite tan�s� ile takip ve tedavi edilirken SARS-CoV-2 enfeksiyonu saptanan hastalar�n semptom, komplikasyon, yo�un bak�m �nitesine yat�� ve mortalite oranlar�n� de�erlendirmeyi ama�lad�k.
Gere� ve Y�ntem: �ok merkezli �al��mam�za Mart-Kas�m 2020 tarihleri aras�nda SARS-CoV-2 enfeksiyonu tan�s� alan eri�kin ve pediatrik 340 hastay� dahil ettik. Hastalar�n hematolojik malignite tan�lar�, hastal�k statuslar�, tedavileri, son tedaviden enfeksiyona kadar ge�en s�re, komorbiditeleri, ya�am beklentileri de�erlendirildi. Semptomlar�, olu�an komplikasyonlar ve sonu�lar analiz edildi.
Bulgular: K�rk-d�rt hasta semptomsuz olarak enfeksiyonu ge�irirken, semptomatik hastalar�n ate�, �ks�r�k, ve dispne oranlar� s�ras�yla %62,6, %48,8 ve %41,8 idi. Altm�� alt� hasta (%20) hastal�� hafif ge�irirken, orta, ciddi ve kritik hastal�k tan�s� alanlar�n oran� s�ras�yla %29, %20 ve %16 idi. T�m kohortta �l�m oran� %26,6 idi; �l�m hafif hastal�� olanlarda %4,4, orta derece hastal�k ge�irenlerde %12 ve ciddi/kritik hastal�k ge�irenlerde ise %83 olarak saptand�. Aktif hematolojik hastal�k olmas�, primer hematolojik hastal��a ba�l� d��k hayat beklentisi, SARS-CoV-2 tan�s� ald��nda n�tropenik olmak, yo�un bak�ma al�nm�� olmak ve ilk s�ra koronavir�s hastal��-2019 tedavisi y�ksek �l�m riski ile ili�kilendirilen fakt�rlerdendi. Tek ba��na veya azitromisin ile kombine olarak hidroksiklorokin kullanan hastalar�n sadece favipiravir kullananlara g�re �l�m riskleri daha y�ksek saptand�.
Sonu�: SARS-CoV-2 infeksiyonu ge�iren hematolojik malignite hastalar�nda daha y�ksek oranda ciddi hastal�k ve �l�m riski g�zlenmektedir.

Anahtar Kelimeler: COVID-19, SARS-CoV-2 infection, Hematological malignancy

Sinem Civriz Bozda�, G�ldane Cengiz Seval, �pek Y�nal Hindilerden, Fehmi Hindilerden, Neslihan And��, Mustafa Baydar, Lale Ayd�n Kaynar, Selami Ko�ak Toprak, Hasan Sami G�ksoy, Berrin Bal�k Ayd�n, Ufuk Demirci, Ferda Can, Vildan �zkocaman, Eren G�nd�z, Zeynep Tu�ba G�ven, Z�beyde Nur �zkurt, Sinan Demircio�lu, Meral Beksa�, �dris �nce, Umut Y�lmaz, Hilal Ero�lu K��kdiler, Elg�n Abishov, Boran Yavuz, �nal Ata�, Ya�a G�l Mutlu, Volkan Ba�, Fahir �zkalemka�, Hava �sk�dar Teke, Vildan G�rsoy, Serhat �elik, Rafiye �ift�iler, M�nci Ya�c�, Pervin Top�uo�lu, �zcan �eneli, Hamza Abbasov, Cem Selim, Muhlis Cem Ar, Orhan Kemal Y�cel, Sevil Sadri, Canan Albayrak, Ahmet Muzaffer Demir, Nil G�ler, Muzaffer Keklik, Hatice Terzi, Ali Do�an, Zeynep Arzu Yegin, Meltem Kurt Y�ksel, So�ol Sadri, �rfan Yava�o�lu, H�seyin Saffet Bek�z, Tekin Aksu, Senem Maral, Veysel Erol, Leylag�l Kaynar, Osman �lhan, Ali Zahit Bolaman, �m�r G�kmen Sevindik, Arzu Akyay, Muhit �zcan, G�nhan G�rman, �ule �nal, Yasemin Yavuz, Reyhan Diz K��kkaya, G�ner Hayri �zsan. Clinical Characteristics and Outcomes of COVID-19 in Turkish Patients with Hematological Malignancies. Turk J Hematol. 2022; 39(1): 43-54

Corresponding Author: Sinem �ivriz Bozda�, T�rkiye

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