Assessment of clinical evolution of COVID-19 and neoplastic malignancies patients

Introduction: Coronavirus disease 2019 (COVID-19) is a highly infectious disease The pathogenic mechanism of COVID-19 pneumonia involved excessive immune reaction in the host - a “cytokine storm”, that determined extensive tissue damage The clinical-therapeutic staging was proposed for COVID-19 in order to evaluate patients at the onset: stage1-mild stage patients without pneumonia;stage 2-moderate stage patients with pneumonia without/with hypoxia and stage 3 - severe form that included patients with pneumonia and systemic hyperinflammation Materials and Methods: In this study, we evaluate particularities of clinical picture and evolution of COVID-19 in haematological malignancies patients We performed a prospective study that included all COVID-19 patients with hematological malignancies admitted in Hematology Department at Colentina Clinical Hospital Bucharest Romania during April - July 2020 The study group included 27 patients that were split into chronic myeloproliferative patients (MPN)- 6 patients, chronic lymphoproliferative neoplasms (chronic lymphatic leukemia - CLL and lymphoma) - 9 patients, multiple myeloma (MM) - 5 patients, myelodysplastic syndromes (MDS) 3 patients and acute myeloblastic leukemia - 4 patients All patients were SARSCoV- 2-positive by molecular test Results: Hematologic malignancies associated COVID-19 seems to be important because patients with CLL, MM or MDS have severe evolution with moderate/severe pneumonia;4 patients belonging these groups were admitted in intensive care unit (ICU), mechanical ventilation were needed The clinical-therapeutical stage of COVID-19 at the hospital admission was done: 4 patients in stage 1- (mild), 18 patients was included in stage 2 (moderate), 5 patients in stage 3 (severe) All patients with severe form of COVID-19 were admitted in ICU department, 3 with fatal evolution The type of hematologic malignancies of the patients included in all 3 stages of COVID-19 was represented in Fig 1 Patients with myeloproliferative neoplasia seems to have mild/moderate stage compared with patients diagnosed with lymphoproliferative neoplasms especially monoclonal gamapathy who have moderate/severe evolution Patients with fatal evolution was included in stage3 with severe pneumonia (more than 50% in CT scan evaluation) The neutrophil/lymphocytes ratio (NLR) have a statistical difference between stage3 of disease and stages 1 and 2: 19 11 (min 3 57, max 9 35) vs stage 1: 1 06 (min 0 22, max 6 07) or stage 2: 2 5 (min 0 28 max 31 56), p< 0 04 This indicator have a high correlation with IL-6 level (r=0 73, p< 0 001);high level corresponding to cytokine storm phase of the disease NLR in association with IL-6, CRP and ferritin level are important factors in severe evolution of COVID-19, coefficient of determination-R2 =0 69, R2 - adjusted 0 67, p< 0 0001 Conclusions: We conclude that patients with lymphoproliferative neoplasms (CLL, lymphoma, multiple myeloma) and MDS could have severe evolution compared with acute/chronic myeloproliferative neoplasms;severe pneumonia and ICU admission could be present during evolution of COVID-19 in these type of patients NLR is important to be evaluated in COVID-19 patients, especially in patients with pneumonia, in order to identify severe evolution of COVID-19