Longitudinal characterisation of haematological and biochemical parameters in cancer patients prior to and during COVID-19 reveals features associated with outcome

• Published in: ESMO open Vol. 6; no. 1; p. 100005
• Main Authors: Lee, R.J., Wysocki, O., Bhogal, T., Shotton, R., Tivey, A., Angelakas, A., Aung, T., Banfill, K., Baxter, M., Boyce, H., Brearton, G., Copson, E., Dickens, E., Eastlake, L., Gomes, F., Hague, C., Harrison, M., Horsley, L., Huddar, P., Hudson, Z., Khan, S., Khan, U.T., Maynard, A., McKenzie, H., Palmer, D., Robinson, T., Rowe, M., Thomas, A., Tweedy, J., Sheehan, R., Stockdale, A., Weaver, J., Williams, S., Wilson, C., Zhou, C., Dive, C., Cooksley, T., Palmieri, C., Freitas, A., Armstrong, A.C.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.02.2021; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; C-Reactive Protein - analysis; cancer; COVID-19; COVID-19 - prevention & control; COVID-19 - virology; Female; Humans; L-Lactate Dehydrogenase - metabolism; Logistic Models; Longitudinal Studies; Lymphocyte Count; Lymphocytes - metabolism; Male; Middle Aged; Neoplasms - blood; Neoplasms - metabolism; Neoplasms - therapy; Neutrophils - metabolism; Original Research; Outcome Assessment, Health Care - methods; Outcome Assessment, Health Care - statistics & numerical data; Platelet Count; SARS-CoV-2; SARS-CoV-2 - isolation & purification; SARS-CoV-2 - physiology; United Kingdom; Young Adult; United Kingdom; COVID-19; SARS-CoV-2; cancer
• ISSN: 2059-7029; 2059-7029
• DOI: 10.1016/j.esmoop.2020.100005

Cancer patients are at increased risk of death from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Cancer and its treatment affect many haematological and biochemical parameters, therefore we analysed these prior to and during coronavirus disease 2019 (COVID-19) and correlated them with outcome. Consecutive patients with cancer testing positive for SARS-CoV-2 in centres throughout the United Kingdom were identified and entered into a database following local governance approval. Clinical and longitudinal laboratory data were extracted from patient records. Data were analysed using Mann–Whitney U test, Fisher's exact test, Wilcoxon signed rank test, logistic regression, or linear regression for outcomes. Hierarchical clustering of heatmaps was performed using Ward's method. In total, 302 patients were included in three cohorts: Manchester (n = 67), Liverpool (n = 62), and UK (n = 173). In the entire cohort (N = 302), median age was 69 (range 19-93 years), including 163 males and 139 females; of these, 216 were diagnosed with a solid tumour and 86 with a haematological cancer. Preinfection lymphopaenia, neutropaenia and lactate dehydrogenase (LDH) were not associated with oxygen requirement (O2) or death. Lymphocyte count (P < 0.001), platelet count (P = 0.03), LDH (P < 0.0001) and albumin (P < 0.0001) significantly changed from preinfection to during infection. High rather than low neutrophils at day 0 (P = 0.007), higher maximal neutrophils during COVID-19 (P = 0.026) and higher neutrophil-to-lymphocyte ratio (NLR; P = 0.01) were associated with death. In multivariable analysis, age (P = 0.002), haematological cancer (P = 0.034), C-reactive protein (P = 0.004), NLR (P = 0.036) and albumin (P = 0.02) at day 0 were significant predictors of death. In the Manchester/Liverpool cohort 30 patients have restarted therapy following COVID-19, with no additional complications requiring readmission. Preinfection biochemical/haematological parameters were not associated with worse outcome in cancer patients. Restarting treatment following COVID-19 was not associated with additional complications. Neutropaenia due to cancer/treatment is not associated with COVID-19 mortality. Cancer therapy, particularly in patients with solid tumours, need not be delayed or omitted due to concerns that treatment itself increases COVID-19 severity. •Pre-infection haematological/biochemical characteristics are not associated with COVID-19 severity.•Significant haematological/biochemical changes occur upon infection with heterogeneity in response observed.•High not low neutrophils were associated with oxygen requirement and COVID-19 mortality – GCSF should be used with caution.•Age, haematological cancer, high neutrophil:lymphocyte ratio, CRP and low albumin were significant predictors of death in multivariable analysis.•No significant complications requiring readmission were seen upon restart of cancer therapy following diagnosis of COVID-19.