CLL-393 Outcomes of COVID-19 Infections in Patients With Hematological Malignancies in Republic of North Macedonia

Context: Patients with hematological malignancies are at increased risk of complications and adverse outcomes associated with COVID-19, according to current available studies. These patients are particularly vulnerable due to impaired or compromised immune responses caused by treatment or the disease itself. Objective: Our aim was to examine the severity and outcomes of COVID-19 infections among patients with hematological malignancies in Republic of North Macedonia. Design: This is the first retrospective descriptive study on patients with COVID-19 and underlying hematological malignancies in Republic of North Macedonia. We focused on clinical characteristics and COVID-19 infection outcomes in different malignancy settings. Patients: We collected data on clinical characteristics, diagnosis, treatment, and outcomes in adult patients with hematologic malignancies and confirmed COVID-19 infections between June 2020 and April 2022. Parametric data were compared using Fisher's exact test. Results: Of 206 patients, 153 (74%) had lymphoid, and 53 (26%) had myeloid malignancies. Median age was 61 years (IQR 47–70 years), 118 (57%) patients were male, and 86 (74%) patients were older than 60 years and had ≥2 comorbidities, with only 16 (17%) patients younger than 60 years. Severe/critical clinical severity was identified in 77 (37%). Overall, 42 patients (20%) died, including 33 patients (78%) older than 60 years. Patients older than 60 years had significantly higher mortality (p=0.0015) than younger patients. The majority of patients (58%) became COVID-19–positive while on active treatment. Significantly worse outcomes were observed among patients who were on active treatment compared with patients who were in hematological remission (p=0.0028). Among lethal cases, the majority of patients were diagnosed with CLL and NHL. We found no significant differences in mortality between treated and untreated CLL and NHL patients. Among 37 patients treated with a cocktail of monoclonal antibodies (casirivimab/imdevimab), no significant difference in outcome was observed, although 86% of them survived. Conclusions: Patients with hematological malignancies and COVID-19 infection were associated with higher mortality associated with older age, more comorbidities, and active disease. Patients with B-cell malignancy were the most affected, but no significant difference in mortality rate was observed across different subgroups, which may suggest that B-cell impairment is a key factor leading to severe infection.