Severe acute respiratory syndrome coronavirus 2 infection in patients with hematological malignancies in the Omicron era: Respiratory failure, need for mechanical ventilation and mortality in seronegative and seropositive patients

Erica Franceschini; Valentina Menozzi; Vera Todisco; Mariachiara Pellegrino; Samuele Cantergiani; Andrea Dessilani; Anna Spadoni; Federico Romani; Alice Mazzocchi; Antonella Santoro; Marianna Meschiari; Adriana Cervo; Andrea Gilioli; Francesca Bettelli; Giulia Fregni-Serpini; Antonella Grottola; Anna Candoni; Giovanni Guaraldi; Mario Sarti; Mario Luppi; Cristina Mussini

doi:10.1002/jha2.867

Severe acute respiratory syndrome coronavirus 2 infection in patients with hematological malignancies in the Omicron era: Respiratory failure, need for mechanical ventilation and mortality in seronegative and seropositive patients

EJHaem. 2024 Apr 9;5(3):505-515. doi: 10.1002/jha2.867. eCollection 2024 Jun.

Authors

Erica Franceschini¹, Valentina Menozzi¹, Vera Todisco¹, Mariachiara Pellegrino¹, Samuele Cantergiani¹, Andrea Dessilani¹, Anna Spadoni¹, Federico Romani¹, Alice Mazzocchi¹, Antonella Santoro¹, Marianna Meschiari¹, Adriana Cervo¹, Andrea Gilioli², Francesca Bettelli¹, Giulia Fregni-Serpini³, Antonella Grottola³, Anna Candoni², Giovanni Guaraldi¹, Mario Sarti⁴, Mario Luppi¹, Cristina Mussini¹

Affiliations

¹ Department of Surgical, Medical, Dental, and Morphological Sciences, University of Modena and Reggio Emilia, Infectious Disease Clinic University of Modena and Reggio Emilia AOU Policlinico di Modena Modena Italy.
² Department of Medical and Surgical Sciences Section of Hematology University of Modena and Reggio Emilia AOU Policlinico di Modena Modena Italy.
³ Department of Laboratory Medicine Molecular Virology and Microbiology Unit AOU Policlinico di Modena Modena Italy.
⁴ Department of Laboratory Medicine Clinical Microbiology Laboratory Modena Italy.

Abstract

Background: Patients with hematological malignancies (HM) have a high risk of severe coronavirus disease 2019 (COVID-19), also in the Omicron period.

Material and methods: Retrospective single-center study including HM patients with severe acute respiratory syndrome Coronavirus 2 (SARS-CoV2) infection from January 2022 to March 2023. Study outcomes were respiratory failure (RF), mechanical ventilation (MV), and COVID-related mortality, comparing patients according to SARS-CoV2 serology.

Results: Note that, 112 patients were included: 39% had negative SARS-CoV2 serology. Seronegative were older (71.5 vs. 65.0 years, p = 0.04), had more often a lymphoid neoplasm (88.6% vs. 69.1%, p = 0.02), underwent anti-CD20 therapy (50.0% vs. 30.9% p = 0.04) and had more frequently a severe disease (23.0% vs. 3.0%, p = 0.02) than seropositive.Kaplan-Meier showed a higher risk for seronegative patients for RF (p = 0.014), MV (p = 0.044), and COVID-related mortality (p = 0.021). Negative SARS-CoV2 serostatus resulted in a risk factor for RF (hazards ratio [HR] 2.19, 95% confidence interval [CI] 1.03-4.67, p = 0.04), MV (HR 3.37, 95% CI 1.06-10.68, p = 0.04), and COVID-related mortality (HR 4.26, 95% CI 1.09-16.71, p = 0.04).

Conclusions: : HM patients with negative SARS-CoV2 serology, despite vaccinations and previous infections, have worse clinical outcomes compared to seropositive patients in the Omicron era. The use of serology for SARS-CoV2 diagnosis could be an easy tool to identify patients prone to developing complications.

Keywords: COVID‐19; hematological malignancies; serostatus.