Longitudinal characterisation of haematological and biochemical parameters in cancer patients prior to and during COVID-19 reveals features associated with outcome
Longitudinal characterisation of haematological and biochemical parameters in cancer patients prior to and during COVID-19 reveals features associated with outcome
Background: 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.
Patients and methods: 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.
Results: 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 (O 2) 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.
Conclusion: 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.
COVID-19, SARS-CoV-2, cancer
100005
Lee, R J
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Tivey, A
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Aung, T
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Banfill, K
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Baxter, M
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Boyce, H
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Brearton, G
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Copson, E
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Dickens, E
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Eastlake, L
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Gomes, F
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Hague, C
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Harrison, M
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Horsley, L
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Huddar, P
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Hudson, Z
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Khan, S
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Khan, U T
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Maynard, A
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McKenzie, H
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Palmer, D
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Robinson, T
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Rowe, M
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Thomas, A
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Tweedy, J
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Sheehan, R
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Stockdale, A
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Weaver, J
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Williams, S
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Wilson, C
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Zhou, C
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Dive, C
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Cooksley, T
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Palmieri, C
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Freitas, A
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Armstrong, A C
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February 2021
Lee, R J
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Wysocki, O
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Bhogal, T
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Shotton, R
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Tivey, A
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Angelakas, A
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Aung, T
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Banfill, K
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Baxter, M
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Boyce, H
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Brearton, G
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Copson, E
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Dickens, E
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Eastlake, L
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Gomes, F
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Hague, C
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Khan, S
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Maynard, A
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McKenzie, H
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Palmer, D
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Robinson, T
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Rowe, M
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Thomas, A
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Tweedy, J
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Sheehan, R
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Stockdale, A
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Weaver, J
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Williams, S
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Wilson, C
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Zhou, C
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Dive, C
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Cooksley, T
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Palmieri, C
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Freitas, A
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Armstrong, A C
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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 and Armstrong, A C
(2021)
Longitudinal characterisation of haematological and biochemical parameters in cancer patients prior to and during COVID-19 reveals features associated with outcome.
ESMO open, 6 (1), , [100005].
(doi:10.1016/j.esmoop.2020.100005).
Abstract
Background: 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.
Patients and methods: 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.
Results: 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 (O 2) 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.
Conclusion: 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.
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e-pub ahead of print date: 4 January 2021
Published date: February 2021
Additional Information:
Funding Information:
RJL speaker fees BMS and Astrazeneca, MR honoraria from Astellas Pharma, speaker fees MSD and Servier. CW consultancy and speaker fees Pfizer, Amgen, Novartis, AA conference fee Merck, spouse shares in Astrazeneca. TR financial support to attend educational workshops from Amgen and Daiichi-Sankyo. JT is now working at Astra Zeneca. CD , outside of this scope of work, has received research funding from AstraZeneca, Astex Pharmaceuticals, Bioven, Amgen, Carrick Therapeutics, Merck AG, Taiho Oncology, Clearbridge Biomedics, Angle PLC, Menarini Diagnostics, GSK, Bayer, Boehringer Ingelheim, Roche, BMS, Novartis, Celgene, Thermofisher. CD is on advisory boards for, and has received consultancy fees/honoraria from, AstraZeneca, Biocartis and Merck KGaA. The remaining authors have no conflicts of interest to declare.
Funding Information:
RJL is supported by the National Institute for Health Research as a Clinical Lecturer. TB is supported by the National Institute for Health Research as an academic clinical fellow. UTK is an MRC Clinical Training Fellow based at the University of Liverpool supported by the North West England Medical Research Council Fellowship Scheme in Clinical Pharmacology and Therapeutics, which is funded by the Medical Research Council [grant number MR/N025989/1]. Funding for COVID-19 work has been provided by The Christie Charitable fund [grant number 1049751 ].
Funding Information:
The authors thank Clare Griffin for administrative support, Digital ECMT team for insights into data analysis and Manchester and Liverpool ECMC. RJL is supported by the National Institute for Health Research as a Clinical Lecturer. TB is supported by the National Institute for Health Research as an academic clinical fellow. UTK is an MRC Clinical Training Fellow based at the University of Liverpool supported by the North West England Medical Research Council Fellowship Scheme in Clinical Pharmacology and Therapeutics, which is funded by the Medical Research Council [grant number MR/N025989/1]. Funding for COVID-19 work has been provided by The Christie Charitable fund [grant number 1049751]. RJL speaker fees BMS and Astrazeneca, MR honoraria from Astellas Pharma, speaker fees MSD and Servier. CW consultancy and speaker fees Pfizer, Amgen, Novartis, AA conference fee Merck, spouse shares in Astrazeneca. TR financial support to attend educational workshops from Amgen and Daiichi-Sankyo. JT is now working at Astra Zeneca. CD, outside of this scope of work, has received research funding from AstraZeneca, Astex Pharmaceuticals, Bioven, Amgen, Carrick Therapeutics, Merck AG, Taiho Oncology, Clearbridge Biomedics, Angle PLC, Menarini Diagnostics, GSK, Bayer, Boehringer Ingelheim, Roche, BMS, Novartis, Celgene, Thermofisher. CD is on advisory boards for, and has received consultancy fees/honoraria from, AstraZeneca, Biocartis and Merck KGaA. The remaining authors have no conflicts of interest to declare.
Publisher Copyright:
© 2020 The Authors
A correction has been attached to this output located at:
https://doi.org/10.1016/j.esmoop.2021.100056
Keywords:
COVID-19, SARS-CoV-2, cancer
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Local EPrints ID: 448575
URI: http://eprints.soton.ac.uk/id/eprint/448575
ISSN: 2059-7029
PURE UUID: c7188d15-6aab-47b4-9d4a-0d9b1ade0d8a
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Date deposited: 27 Apr 2021 16:40
Last modified: 16 Mar 2024 11:55
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Author:
R J Lee
Author:
O Wysocki
Author:
T Bhogal
Author:
R Shotton
Author:
A Tivey
Author:
A Angelakas
Author:
T Aung
Author:
K Banfill
Author:
M Baxter
Author:
H Boyce
Author:
G Brearton
Author:
E Dickens
Author:
L Eastlake
Author:
F Gomes
Author:
C Hague
Author:
M Harrison
Author:
L Horsley
Author:
P Huddar
Author:
Z Hudson
Author:
S Khan
Author:
U T Khan
Author:
A Maynard
Author:
H McKenzie
Author:
T Robinson
Author:
M Rowe
Author:
A Thomas
Author:
J Tweedy
Author:
R Sheehan
Author:
A Stockdale
Author:
J Weaver
Author:
S Williams
Author:
C Wilson
Author:
C Zhou
Author:
C Dive
Author:
T Cooksley
Author:
C Palmieri
Author:
A Freitas
Author:
A C Armstrong
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