Background

The novel coronavirus has been responsible for significant morbidity and mortality since its discovery in December 2019 in Wuhan, China. In response to the UK lockdown, Kings College Hospital (KCH) separated suspected and confirmed cases of novel coronavirus in haemato-oncology patients. The aim of this review was to audit the clinical outcomes of patients with an underlying haematological or oncological diagnosis in order to ascertain clinical parameters or demographic data which may help differentiated higher risk patients. Specific to haematology KCH is a level three BCSH facility undertaking stem cell transplantation.

Method

Haemato-oncology patients admitted with COVID symptoms and positive nasopharyngeal aspirate between March and June 2020 were retrospectively evaluated. Cases where clinical suspicion were also included. Patients were stratified by demographic data such as age, blood type, locality and ethnicity.

Results

Of the cohort studied, 21 patients (72%) were admitted with symptoms of COVID-19 infection at the time of admission, the remaining patients having acquired it during their hospital stay. Eight patients (27%) required level 2+ care on HDU or ITU. Of these, four patients survived to successful discharge from hospital with a median inpatient stay of 53 days.
Four patients (13%) were for ward-based ceiling of care and died during inpatient stay. Of those patients who died (n=8), three patients had undergone allogeneic stem cell transplantation for myeloid malignancies, seven patients had two or more comorbidities and one patient had suspected relapse of ALL. 
Hyperferritinaemia (median level 3181) and high CRP (median 288) were associated with adverse outcomes.
Patients with active haematological malignancies undergoing chemotherapy or awaiting treatment showed a trend toward the development of respiratory failure earlier in the course of their illness.

Conclusion

Patients with underlying haematological or oncological malignancy and/or undergoing chemotherapeutic treatment have increased morbidity and mortality from COVID-19 infection compared with the general population. Certain clinical predictors (Ferritin, CRP and troponin) may help in the differentiation of patients at increased risk in this cohort of patients.

Impact statement

With this review we aim to differentiate patients who are at a higher risk of morbidity and mortality associated with infection with SARS-COV-2 and underlying haematological and oncological diagnoses.