COVID-19 Risk Remains High for Patients With Hematologic Malignancies

Even as the COVID-19 health crisis transitioned from a pandemic to an endemic disease, people with hematologic malignancies continued to be at a high risk of serious illness and death from the infection.

Those are the key findings of a new report, which was published in Cancer Medicine.¹ The single-center study found that critical illness with SARS-CoV-2 infection was common even among patients who were vaccinated against COVID-19.

The study adds important data about how people with hematologic malignancies are affected by COVID-19 infection. | Image credit: Tyler Olson -stock.adobe.com

From the very start of the pandemic in late 2019 and early 2020, public health experts warned that people with hematological malignancies were at a heightened risk of critical illness from COVID-19 due to their compromised immune systems. Soon, however, additional evidence emerged suggesting that people with hematologic cancers were even more vulnerable to COVID-19 than people with solid tumors. A June 2021 study found that the case fatality rate among people with hematological malignancies who were diagnosed with COVID-19 was 14.9%, compared to 4.8% among people with solid tumors.²

The successful development of vaccines against SARS-CoV-2 helped shift the pandemic into an endemic phase, though it also sparked active—and ongoing—debate about the safety and efficacy of the vaccine in immunocompromised patients.³

Most of the research into COVID-19 among patients with hematologic malignancies took place within the first 2 years of the pandemic.¹ However, they said it is important to also analyze later phases of the pandemic because the virus continues to evolve, and long-term outcomes in this patient population largely remain unknown.

The investigators constructed a single-center observational study in the medical unit of the University Hospital Renato Dulbecco, in Catanzaro. Adult patients with active hematological malignancies in the 5 years prior to their COVID-19 diagnosis were eligible for inclusion in the study. All patients had laboratory-confirmed diagnoses of COVID-19, and all of the COVID-19 cases were diagnosed between January 1, 2022, and December 31, 2023.

A total of 85 cases were identified and included in the study. Among those patients, multiple myeloma and non-Hodgkin lymphoma were the most common malignancy types (33 and 30 patients, respectively). Nine patients had chronic lymphocytic leukemia. About two-thirds of patients (58) had controlled disease prior to COVID-19 diagnosis. A majority of patients (48) were male, and the median age was 69 years. Most patients had 0 or 1 comorbidity, but 29 patients had 2 or more comorbidities. The most common comorbidities were chronic heart disease (63 patients) and a history of smoking (50 patients).

All but 2 patients (97.6%) had received the COVID-19 vaccine. Still, 23.5% of patients experienced severe or critical illness once infected, and the overall COVID-19-related mortality rate was 22.4%. The 30-day mortality rate was 11.8%, the investigators reported. The authors explained there were multiple reasons for the significant death rate.

“Our analysis identified several factors that negatively influenced mortality, such as increasing age, active disease, and ICU admission,” they wrote.

The investigators did note, however, that the mortality rate declined significantly over the course of the study period, from 27.7% to 16.7%. Yet, the mortality rate among patients who were critically ill persisted, they said, ranging from 75% to 100%

COVID-19 can delay treatment for a patient’s malignancy, which can allow for disease progression and negatively impact patient survival, the authors noted.

“Indeed, our analysis shows that in 47.4% of cases, progressing hematologic malignancy strongly influenced COVID-19 mortality,” they wrote.

The investigators said their study adds important data about how people with hematologic malignancies are affected by COVID-19 infection.

“As the COVID-19 landscape continues to evolve and new variants emerge, sustained effort in research, clinical adaptation, and patient advocacy will be essential to improving outcomes for this high-risk population,” they concluded.

References

1. Caracciolo D, D'Aquino G, Froio C, et al. Impact of COVID-19 on hematologic cancer patients: insights from the late pandemic phase. Cancer Med. 2025;14(15):e71112. doi:10.1002/cam4.71112

2. Başcı S, Ata N, Altuntaş F, et al. Patients with hematologic cancers are more vulnerable to COVID-19 compared to patients with solid cancers. Intern Emerg Med. 2022;17(1):135-139. doi:10.1007/s11739-021-02784-y

3. Rinaldi I, Pratama S, Wiyono L, Tandaju JR, Wardhana IL, Winston K. Efficacy and safety profile of COVID-19 mRNA vaccine in patients with hematological malignancies: Systematic review and meta-analysis. Front Oncol. 2022;12:951215. doi:10.3389/fonc.2022.951215