Top

International Journal of Clinical Oncology

Published in:

01-03-2021 | SARS-CoV-2 | Original Article

Characteristics and outcomes of coronavirus disease 2019 (COVID-19) patients with cancer: a single-center retrospective observational study in Tokyo, Japan

Authors: Shohei Nakamura, Yusuke Kanemasa, Yuya Atsuta, Sho Fujiwara, Masaru Tanaka, Kazuaki Fukushima, Taiichiro Kobayashi, Tatsu Shimoyama, Yasushi Omuro, Noritaka Sekiya, Akifumi Imamura

Published in: International Journal of Clinical Oncology | Issue 3/2021

Abstract

Background

Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused an international outbreak of coronavirus disease 2019 (COVID-19), data on the clinical characteristics of COVID-19 patients with cancer are limited. This study aimed to evaluate the clinical characteristics and outcomes including mortality and viral shedding period in COVID-19 patients with cancer in Japan.

Methods

We retrospectively analyzed 32 patients with a history of cancer who were referred to our hospital between January 31, 2020 and May 25, 2020. We evaluated the association between clinical outcomes and potential prognostic factors using univariate analyses.

Results

The median age was 74.5 (range 24–90) years and 22 patients (69%) were men. A total of 11 patients (34%) died. Our analyses demonstrated that the mortality was significantly associated with lymphocyte count, albumin, lactate dehydrogenase, serum ferritin, and C-reactive protein on admission. The median period between illness onset and the first effective negative SARS-CoV-2 PCR result was 22 days (interquartile range 18–25) in survivors. Of four patients with hematological malignancy who developed COVID-19 within the rest period of chemotherapy, three died and the other patient, who received bendamustine plus rituximab therapy, had the longest duration of viral shedding (56 days).

Conclusion

Our study suggested that the risk factors for mortality previously reported in general COVID-19 patients, including lymphocytopenia, were also effective in cancer patients. Patients who received cytotoxic chemotherapy recently or were treated with chemotherapy, which can lead to lymphocyte reduction, had poor prognosis and prolonged periods of viral shedding.

Available only for authorised users

Zhu N, Zhang D, Wang W et al (2019) A novel coronavirus from patients with pneumonia in China. N Eng J Med 382(8):727–733. https://doi.org/10.1056/NEJMoa2001017CrossRef

Organization WH (2020) Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). 16–24 February 2020

Organization WH (2020) Novel Coronavirus (2019-nCoV): Situation Report-1. 21 January 2020

Liang W, Guan W, Chen R et al (2020) Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol 21(3):335–337. https://doi.org/10.1016/s1470-2045(20)30096-6CrossRefPubMedPubMedCentral

Zhang L, Zhu F, Xie L et al (2020) Clinical characteristics of COVID-19-infected cancer patients: a retrospective case study in three hospitals within Wuhan, China. Ann Oncol Off J Eur Soc Med Oncol 31(7):894–901. https://doi.org/10.1016/j.annonc.2020.03.296CrossRef

Zhang H-Y, Wang L-W, Chen Y-Y et al (2020) A multicentre study of 2019 novel coronavirus disease outcomes of cancer patients in Wuhan, China. medRxiv 41:145. https://doi.org/10.1101/2020.03.21.20037127CrossRef

He W, Chen L, Chen L et al (2020) COVID-19 in persons with haematological cancers. Leukemia 34(6):1637–1645. https://doi.org/10.1038/s41375-020-0836-7CrossRefPubMed

Martín-Moro F, Marquet J, Piris M et al (2020) Survival study of hospitalised patients with concurrent COVID-19 and haematological malignancies. Br J Haematol. https://doi.org/10.1111/bjh.16801CrossRefPubMedPubMedCentral

Mehta V, Goel S, Kabarriti R et al (2020) Case fatality rate of cancer patients with COVID-19 in a New York Hospital System. Cancer Discov. https://doi.org/10.1158/2159-8290.cd-20-0516CrossRefPubMedPubMedCentral

10.

Robilotti EV, Babady NE, Mead PA et al (2020) Determinants of severity in cancer patients with COVID-19 illness. medRxiv. https://doi.org/10.1101/2020.05.04.20086322CrossRefPubMedPubMedCentral

11.

Lee LYW, Cazier JB, Starkey T et al (2020) COVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments: a prospective cohort study. Lancet (London, England). https://doi.org/10.1016/s0140-6736(20)31173-9CrossRef

12.

Kuderer NM, Choueiri TK, Shah DP et al (2020) Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study. Lancet (London, England). https://doi.org/10.1016/s0140-6736(20)31187-9CrossRef

13.

Wynants L, Van Calster B, Collins GS et al (2020) Prediction models for diagnosis and prognosis of covid-19 infection: systematic review and critical appraisal. BMJ (Clin Res Ed) 369:m1328. https://doi.org/10.1136/bmj.m1328CrossRef

14.

Kanda Y (2013) Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 48(3):452–458. https://doi.org/10.1038/bmt.2012.244CrossRefPubMed

15.

Huang C, Wang Y, Li X et al (2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet (London, England) 395(10223):497–506. https://doi.org/10.1016/s0140-6736(20)30183-5CrossRef

16.

Chen N, Zhou M, Dong X et al (2020) Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet (London, England) 395(10223):507–513. https://doi.org/10.1016/s0140-6736(20)30211-7CrossRef

17.

Yang X, Yu Y, Xu J et al (2020) Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 8(5):475–481. https://doi.org/10.1016/s2213-2600(20)30079-5CrossRefPubMedPubMedCentral

18.

Diao B, Wang C, Tan Y et al (2020) Reduction and functional exhaustion of T cells in patients with coronavirus disease 2019 (COVID-19). Front Immunol 11:827. https://doi.org/10.3389/fimmu.2020.00827CrossRefPubMedPubMedCentral

19.

Jiang M, Guo Y, Luo Q et al (2020) T cell subset counts in peripheral blood can be used as discriminatory biomarkers for diagnosis and severity prediction of COVID-19. J Infect Dis. https://doi.org/10.1093/infdis/jiaa252CrossRefPubMedPubMedCentral

20.

Liu J, Li S, Liu J et al (2020) Longitudinal characteristics of lymphocyte responses and cytokine profiles in the peripheral blood of SARS-CoV-2 infected patients. EBioMedicine 55:102763. https://doi.org/10.1016/j.ebiom.2020.102763CrossRefPubMedPubMedCentral

21.

Wan S, Yi Q, Fan S et al (2020) Characteristics of lymphocyte subsets and cytokines in peripheral blood of 123 hospitalized patients with 2019 novel coronavirus pneumonia (NCP). medRxiv. https://doi.org/10.1101/2020.02.10.20021832CrossRefPubMedPubMedCentral

22.

Zhou F, Yu T, Du R et al (2020) Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet (London, England) 395(10229):1054–1062. https://doi.org/10.1016/s0140-6736(20)30566-3CrossRef

23.

Xiao AT, Tong YX, Gao C et al (2020) Dynamic profile of RT-PCR findings from 301 COVID-19 patients in Wuhan, China: a descriptive study. J Clin Virol Off Publ Pan Am Soc Clin Virol 127:104346. https://doi.org/10.1016/j.jcv.2020.104346CrossRef

24.

Rummel MJ, Niederle N, Maschmeyer G et al (2013) Bendamustine plus rituximab versus CHOP plus rituximab as first-line treatment for patients with indolent and mantle-cell lymphomas: an open-label, multicentre, randomised, phase 3 non-inferiority trial. Lancet (London, England) 381(9873):1203–1210. https://doi.org/10.1016/s0140-6736(12)61763-2CrossRef

25.

Flinn IW, van der Jagt R, Kahl BS et al (2014) Randomized trial of bendamustine-rituximab or R-CHOP/R-CVP in first-line treatment of indolent NHL or MCL: the BRIGHT study. Blood 123(19):2944–2952. https://doi.org/10.1182/blood-2013-11-531327CrossRefPubMedPubMedCentral

26.

Lee LYW, Cazier J-B, Starkey T et al (2020) COVID-19 prevalence and mortality in patients with cancer and the effect of primary tumour subtype and patient demographics: a prospective cohort study. Lancet Oncol 21(10):1309–1316. https://doi.org/10.1016/S1470-2045(20)30442-3CrossRefPubMedPubMedCentral

27.

Mehta P, McAuley DF, Brown M et al (2020) COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet (London, England) 395(10229):1033–1034. https://doi.org/10.1016/s0140-6736(20)30628-0CrossRef

28.

Moore JB, June CH (2020) Cytokine release syndrome in severe COVID-19. Science (New York, NY) 368(6490):473–474. https://doi.org/10.1126/science.abb8925CrossRef

29.

Rotz SJ, Leino D, Szabo S et al. (2017) Severe cytokine release syndrome in a patient receiving PD-1-directed therapy. Pediatric Blood Cancer 64(12). https://doi.org/10.1002/pbc.26642

30.

McGonagle D, O’Donnell JS, Sharif K et al (2020) Immune mechanisms of pulmonary intravascular coagulopathy in COVID-19 pneumonia. Lancet Rheumatol. https://doi.org/10.1016/S2665-9913(20)30121-1CrossRefPubMedPubMedCentral

31.

Wu C, Chen X, Cai Y et al (2020) Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. https://doi.org/10.1001/jamainternmed.2020.0994CrossRefPubMedPubMedCentral

32.

Zhang L, Yan X, Fan Q et al (2020) d-dimer levels on admission to predict in-hospital mortality in patients with Covid-19. J Thromb Haemost JTH 18(6):1324–1329. https://doi.org/10.1111/jth.14859CrossRefPubMed

33.

Walker AJ, Card TR, West J et al (2013) Incidence of venous thromboembolism in patients with cancer - a cohort study using linked United Kingdom databases. Eur J Cancer (Oxford, England 1990) 49(6):1404–1413. https://doi.org/10.1016/j.ejca.2012.10.021CrossRef

34.

Khorana AA, Kuderer NM, Culakova E et al (2008) Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood 111(10):4902–4907. https://doi.org/10.1182/blood-2007-10-116327CrossRefPubMedPubMedCentral

35.

Guo L, Wei D, Zhang X et al. (2019) Clinical features predicting mortality risk in patients with viral pneumonia: the MuLBSTA score. Front Microbiol 10(2752). https://doi.org/10.3389/fmicb.2019.02752

Title: Characteristics and outcomes of coronavirus disease 2019 (COVID-19) patients with cancer: a single-center retrospective observational study in Tokyo, Japan
Authors: Shohei Nakamura
Yusuke Kanemasa
Yuya Atsuta
Sho Fujiwara
Masaru Tanaka
Kazuaki Fukushima
Taiichiro Kobayashi
Tatsu Shimoyama
Yasushi Omuro
Noritaka Sekiya
Akifumi Imamura
Publication date: 01-03-2021
Publisher: Springer Singapore
Keywords: SARS-CoV-2
Lymphopenia
COVID-19
Cytostatic Therapy
Published in: International Journal of Clinical Oncology / Issue 3/2021
Print ISSN: 1341-9625
Electronic ISSN: 1437-7772
DOI: https://doi.org/10.1007/s10147-020-01837-0

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2021

TRIM37 overexpression is associated with chemoresistance in hepatocellular carcinoma via activating the AKT signaling pathway

Phase II study of the combination of S-1 with bevacizumab for patients with previously treated advanced non-squamous non-small-cell lung cancer

Randomized phase II trial of carboplatin + nab-paclitaxel versus cisplatin + gemcitabine for chemotherapy-naïve squamous cell carcinoma: North Japan lung cancer study group 1302

Risk factors for gemcitabine plus nab-paclitaxel-induced interstitial lung disease in pancreatic cancer patients

Diagnostic accuracies of intraoperative frozen section and permanent section examinations for histological grades during open biopsy of bone tumors

Oncologic outcomes and safety of percutaneous cryoablation for biopsy-proven renal cell carcinoma up to 4 cm in diameter: a prospective observational study

Keynote webinar | Spotlight on antibody–drug conjugates in cancer