How COVID-19 Lockdown Affected Outcomes of Acute Myeloid Leukemia Patients

A study of patients with acute myeloid leukemia (AML) in India showed that patients who received induction during COVID-19 lockdown had a higher mortality rate than patients treated after lockdown lifted.¹

The study was presented at the Annual Meeting of the Society of Hematologic Oncology (SOHO) by Asif Iqbal, MD, of Dr B. Borooah Cancer Institute in Guwahati, a unit of the Tata Memorial Centre in Mumbai, India, and colleagues.

Dr Iqbal explained that induction outcomes of AML patients in India are mostly on par with outcomes for patients in Western countries. He cited 2019 data from the Hematology Cancer Consortium showing an induction mortality rate of 16.9% and a complete remission (CR) rate of 52.8%.²

For the current study, Dr Iqbal and colleagues set out to determine whether travel restrictions imposed due to the COVID-19 pandemic had an impact on induction outcomes among AML patients.

Patient and Treatment Characteristics

The retrospective, observational study included data from 53 patients with AML who received 2 cycles of induction with intensive chemotherapy (ICT) or low-intensity chemotherapy (LCT).

Patients were divided into 2 groups:

• Those treated during the lockdown phase, from May 1, 2020, through August 31, 2020 (22 patients)
• Those treated after the lockdown was lifted, from September 1, 2020, through December 31, 2020 (31 patients).

The mean age was 36.23 ± 19.1 years in the lockdown group and 29 ± 22.22 years in the lockdown-lifted group. The sex distribution and other baseline characteristics were generally comparable between the 2 groups.

However, the percentage of patients with the B-positive blood group was higher in the lockdown group than in the lockdown-lifted group (31.8% vs 3.2%), and the percentage of patients with the AB-positive blood group was higher in the lockdown-lifted group (22.6% vs 9.1%).

Dr Iqbal noted that, during the study period, there was an acute shortage of blood in blood banks across all states in India. As blood transfusions are the backbone of leukemia treatment, the care of patients with AML was compromised, he said.

However, the median numbers of transfusions were similar between the lockdown and lockdown-lifted groups. The median number of red blood cell, random donor plasma, and single donor platelet transfusions was 3, 11, and 0, respectively, in the lockdown group and 3, 12, and 0, respectively, in the lockdown-lifted group.

During the lockdown phase, 45.5% of patients received ICT as induction, and 54.5% received LCT. In the lockdown-lifted phase, 45.2% received ICT induction, and 51.6% received LCT. 

Response and Survival

Response to the first induction cycle was significantly better during the lockdown phase. The CR rate was 40.9% in the lockdown phase and 25.8% in the lockdown-lifted phase (P =.034).

However, response to the second induction cycle was not significantly different between the groups. The CR rate was 35.7% in the lockdown phase and 17.6% in the lockdown-lifted phase (P =.558).

The mortality rate was significantly higher in the lockdown phase than in the lockdown-lifted phase — 36.4% and 45.2%, respectively (P =.034). Dr Iqbal noted that both of these mortality rates were significantly higher than the 16.9% mortality rate reported by the Hematology Cancer Consortium in 2019.²

There was no significant difference in mean survival time between the lockdown and lockdown-lifted groups —149.77 ± 19.74 days and 137.23 ± 13.19 days, respectively (P =.6509).

The most common cause of death was septicemia, which was observed in 9 patients (40.9%) in the lockdown group and 7 (22.6%) in the lockdown-lifted group. Two patients in each group died of bleeding.

Two patients in the lockdown-lifted group died of COVID-19, compared with none of the patients in the lockdown group.

Disclosures: This study was not funded, and the authors declared no conflicts of interest.

References

1. Iqbal A, Daniel N, Reddy R, Hazarika M. Outcomes of induction therapy in patients with acute myeloid leukemia during Covid-19 pandemic: A retrospective study from a tertiary care cancer centre. Paper presented at: Annual Meeting of the Society of Hematologic Oncology (SOHO); September 8-11, 2021.
2. Kayal S, Sengar M, Jain H, et al. Induction related mortality in AML: Multivariate model of predictive score from the IndianAcute Leukemia Research Database ( INwARD ) of the Hematology Cancer Consortium (HCC). Blood. 2019;134(1):2615. https://doi.org/10.1182/blood-2019-127623

This article originally appeared on Cancer Therapy Advisor