Management and mortality of acute leukemia during covid-19 pandemic: 8-month follow-up at a single institution in Peru

Background: The COVID-19 pandemic is a global public health crisis. Most patients were affected on their active treatment, patients with acute leukemia are particularly vulnerable to any change in their curative therapy. It has been almost a year since the first reported case of COVID-19 in Peru. Our country had the highest mortality rates per one million population during the first wave. Since January 2021 we are on the second wave with the total excess deaths higher than the first wave. Aims: The aim of this study was to report the management and mortality of acute leukemias during the COVID-19 pandemic and its impact in relapse or survival of leukemia patients. Methods: We included prospectively patients aged 14 years or older with the diagnosis of acute leukemia on active treatment and treated at the National Cancer Institute (NCI) in Peru since March 8th, 2020 to June 20th, 2020. The first result was reported as part of a multicenter study in the ASH 2020 annual meeting, now we are reporting a follow-up after 8 months of the last recorded case. We compared the leukemia status between the first cohort and the last cohort using chi-square test. Results: 126 patients were evaluated during the first 100 days of started the COVID-19 pandemic in Peru (cut point June 20th 2020), the median age was 32 (range 15-70). 52% were male. 65% of patients had highrisk factors. 53% of patients were Ph negative Acute lymphoblastic leukemia (Ph- ALL), both Ph + ALL and Acute myeloid leukemia (AML) were 18.2% each one of them. Acute promyelocytic leukemia (APL) were 10.3% (n=13). 83.3% were on complete response. 45% of patients were on consolidation, 33% on maintenance, 12.6% on reinduction and 8.7% on induction. Modification of treatment due to COVID-19 was made in 34.9%. The reasons for modification were mainly due to logistic issues (54.5%) followed by medical decision (45.5%). 3.9% of patients had COVID-19 infection, 80% of them were mild-moderate cases. Only 1 patient (25%) died from COVID-19 disease. On June 2020, 61% of patients were alive in CR and 20.6% were alive with leukemia, (total 103 patients alive). 23 patients (18.2%) died during the study period, 14.3% had leukemia-related death, 3.2% treatment- related death (on CR), and 0.8% COVID-related death. Up to February 28th, 2021 of the 103 patients alive in the first cohort 63 (61.1%) patients are alive in CR (previous 77 patients) being that 18% of patients relapsed. Of the 26 patients alive with leukemia (1 received intensive treatment and achieved CR). During this second cohort 9 (8.8%) patients died, 8 from leukemia-related death (7.8%) and 1 (0.9%) patient from treatment-related death. It is important to note of the 8 patients with leukemia-related death 6 (75%) were on CR. In the second cohort no COVID-19 infection was reported. From the initial 126 patients only 94 (74.5%) patients are alive. For the total cohort leukemia related death accounts for 20.6% (n=26), treatment-related death in 3.9 (n=5) and COVID-19 in one case. The difference between the leukemia status in both cohorts were compared with a statistically significant difference p<0.001. Summary/Conclusion: The modification on the treatment due to COVID-19 was mainly because logistic issues followed by medical decision. The mortality of patients with acute leukemia has increased in a short period of time, being that a quarter of them have died mainly due to leukemia-related death, followed by treatment-related death. Both COVID-19 infection and COVID-19 death were rare in our cohort. The difference in deaths and relapsed between both cohorts was statistically significant.