# Factors Associated With Mortality in Leukemia and Lymphoma With COVID-19: A National Inpatient Sample Analysis (2020–2021)

## TL;DR

This study finds that leukemia and lymphoma patients with COVID-19 face high mortality risks, especially during certain pandemic periods, and identifies factors like organ dysfunction that increase the risk.

## Contribution

The study provides new insights into mortality trends and risk factors for leukemia and lymphoma patients with COVID-19 using U.S. national inpatient data.

## Key findings

- Leukemia and lymphoma patients with COVID-19 had mortality rates of 14.7% and 19.7%, respectively.
- Mortality was strongly associated with pulmonary, renal, and cardiac dysfunction, as well as bone marrow dysfunction.
- Mortality surges occurred during specific pandemic periods, such as October-December 2020 and January-March 2021.

## Abstract

Background

Patients with hematological malignancies face a substantially increased mortality from COVID-19. Although the peak of the COVID-19 pandemic has passed, the virus remains common, and understanding its impact on vulnerable groups such as those with hematologic malignancies remains crucial. Limited research exists on mortality patterns in leukemia and lymphoma patients during the pandemic. Studying these outcomes provides important insights into how different waves of COVID-19 affected immunocompromised individuals and supports the development of strategies for prevention, patient care, and risk reduction, which are essential both for managing emerging variants and preventing future pandemics. We aimed to identify the mortality risk of COVID-19 in leukemia (LekCov-19) and lymphoma (LymCov-19) in the United States and the mortality trends between each quartile from 2020 to 2021.

Methods

We analyzed the National Inpatient Sample database (2020-2021) to include adults (≥18 years) having leukemia and lymphoma admitted for COVID-19. Descriptive analysis, propensity matching, and multivariate regression were performed, with the p-value at ≤0.05 considered statistically significant. The risk of mortality was compared between each outcome.

Results

Among 8,191 LekCov-19 patients, 1,200 (14.7%) experienced mortality, whereas 507 out of 2,578 LymCov-19 patients (19.7%) experienced mortality. Multivariate regression showed a two-fold increase in mortality among LekCOV-19 and LymCOV-19 (p < 0.001). In both cohorts, several organ dysfunctions, including pulmonary, renal, and cardiac dysfunctions, were associated with increased mortality (p ≤ 0.0001). Similarly, in both cohorts, signs of bone marrow dysfunction, such as pancytopenia and thrombocytopenia, showed increased odds of mortality (p < 0.01). Both cohorts exhibited varying mortality trends, peaking during October-December 2020, January-March, July-September, and October-December 2021 (p ≤ 0.01). Hematopoietic stem cell transplantation recipients had lower odds of mortality in both cohorts, but did not attain statistical significance (p > 0.05).

Conclusion

COVID-19 was associated with increased mortality in leukemia and lymphoma patients. Surges in COVID-19-related mortality were identified from October 2020 to March 2021, and these trends could be pivotal in forecasting future mortality risks in cancer patients. Clinicians should refine treatment regimens and prioritize advancing clinical trials to address the effects of COVID-19 and the multiple comorbidities associated with hematological malignancies.