COVID-19 Geçiren Türk Hematolojik Malignite Hastalarının Klinik Özellikleri ve Sonuçları

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Turkish Journal of Hematology

COVID-19 Geçiren Türk Hematolojik Malignite Hastalarının Klinik Özellikleri ve Sonuçları [Turk J Hematol]

Turk J Hematol. 2022; 39(1): 43-54 | DOI: 10.4274/tjh.galenos.2021.2021.0287

COVID-19 Geçiren Türk Hematolojik Malignite Hastalarının Klinik Özellikleri ve Sonuçları

Sinem Civriz Bozdağ¹, Güldane Cengiz Seval¹, İpek Yönal Hindilerden², Fehmi Hindilerden³, Neslihan Andıç⁴, Mustafa Baydar⁵, Lale Aydın Kaynar⁶, Selami Koçak Toprak¹, Hasan Sami Göksoy⁷, Berrin Balık Aydın⁸, Ufuk Demirci⁹, Ferda Can¹⁰, Vildan Özkocaman¹¹, Eren Gündüz⁴, Zeynep Tuğba Güven⁵, Zübeyde Nur Özkurt⁶, Sinan Demircioğlu¹², Meral Beksaç¹, İdris İnce¹³, Umut Yılmaz¹⁴, Hilal Eroğlu Küçükdiler¹⁵, Elgün Abishov¹⁷, Boran Yavuz¹⁶, Ünal Ataş¹⁷, Yaşa Gül Mutlu⁸, Volkan Baş⁹, Fahir Özkalemkaş¹¹, Hava Üsküdar Teke⁴, Vildan Gürsoy¹⁸, Serhat Çelik⁵, Rafiye Çiftçiler¹⁹, Münci Yağcı⁶, Pervin Topçuoğlu¹, Özcan Çeneli¹², Hamza Abbasov⁷, Cem Selim¹⁵, Muhlis Cem Ar¹⁴, Orhan Kemal Yücel¹⁷, Sevil Sadri⁸, Canan Albayrak²⁰, Ahmet Muzaffer Demir⁹, Nil Güler²¹, Muzaffer Keklik⁵, Hatice Terzi²², Ali Doğan²³, Zeynep Arzu Yegin⁶, Meltem Kurt Yüksel¹, Soğol Sadri⁷, İrfan Yavaşoğlu¹⁵, Hüseyin Saffet Beköz⁸, Tekin Aksu²⁴, Senem Maral²⁵, Veysel Erol²¹, Leylagül Kaynar⁵, Osman İlhan¹, Ali Zahit Bolaman¹⁵, Ömür Gökmen Sevindik⁸, Arzu Akyay²⁶, Muhit Özcan¹, Günhan Gürman¹, Şule Ünal²⁴, Yasemin Yavuz²⁷, Reyhan Diz Küçükkaya²⁸, Güner Hayri Özsan¹⁶
¹Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
²İstanbul University, İstanbul Faculty of Medicine, Department of Internal Medicine, İstanbul, Turkey
³İstanbul Bakırköy Sadi Konuk Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey
⁴Eskişehir Osmangazi University Faculty of Medicine, Department of Hematology, Eskişehir, Turkey
⁵Erciyes University Faculty of Medicine, Department of Internal Medicine, Kayseri, Turkey
⁶Gazi University Faculty of Medicine, Department of Hematology, Ankara, Turkey
⁷Yeni Yüzyıl University, Özel Gaziosmanpaşa Hospital, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
⁸Medipol University Faculty of Medicine, Department of Internal Medicine, İstanbul, Turkey
⁹Trakya University Faculty of Medicine, Department of Hematology, Edirne, Turkey
¹⁰Ankara City Hospital, Clinic of Internal Medicine, Department of Hematology, Ankara, Turkey
¹¹Bursa Uludağ University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Bursa, Turkey
¹²Necmettin Erbakan University, Meram Faculty of Medicine, Department of Hematology, Konya, Turkey
¹³Dr. Ersin Arslan Training and Research Hospital, Clinic of Hematology, Gaziantep, Turkey
¹⁴İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
¹⁵Adnan Menderes University Faculty of Medicine, Department of Hematology, Aydın, Turkey
¹⁶Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
¹⁷Akdeniz University Faculty of Medicine, Department of Hematology, Antalya, Turkey
¹⁸Bursa City Hospital, Clinic of Hematology, Bursa, Turkey
¹⁹Aksaray Training and Research Hospital, Clinic of Hematology, Aksaray, Turkey
²⁰Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Hematology, Samsun, Turkey
²¹Pamukkale University Faculty of Medicine, Department of Internal Medicine, Denizli, Turkey
²²Cumhuriyet University Faculty of Medicine, Department of Hematology, Sivas, Turkey
²³Van Yüzüncü Yıl University Faculty of Medicine, Department of Hematology, Van, Turkey
²⁴Hacettepe University Faculty of Medicine, Department of Pediatric Hematology, Ankara, Turkey
²⁵University of Health Sciences Turkey, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Department of Hematology, Ankara, Turkey
²⁶İnönü University Faculty of Medicine, Department of Pediatric Hematology and Oncology, Malatya, Turkey
²⁷Ankara University School of Medicine, Department of Biostatistics, Ankara, Turkey
²⁸İstanbul University Faculty of Science, Department of Molecular Biology and Genetic, İstanbul, Turkey

Amaç: Solid malignite hastalarının şiddetli akut solunum yolu enfeksiyonu-koronavirüs-2 (SARS-CoV-2) enfeksiyonuna sağlıklı bireylerden daha yatkın oldukları gösterilmiştir. Bu verilerin ardından oldukça yoğun immünosupresif olan hematolojik malignite hastalarında SARS-CoV-2 infeksiyonu sonuçları ilgi konusu olmuştur. Biz de bu makalede Türkiye’de hematolojik malignite tanısı ile takip ve tedavi edilirken SARS-CoV-2 enfeksiyonu saptanan hastaların semptom, komplikasyon, yoğun bakım ünitesine yatış ve mortalite oranlarını değerlendirmeyi amaçladık.
Gereç ve Yöntem: Çok merkezli çalışmamıza Mart-Kasım 2020 tarihleri arasında SARS-CoV-2 enfeksiyonu tanısı alan erişkin ve pediatrik 340 hastayı dahil ettik. Hastaların hematolojik malignite tanıları, hastalık statusları, tedavileri, son tedaviden enfeksiyona kadar geçen süre, komorbiditeleri, yaşam beklentileri değerlendirildi. Semptomları, oluşan komplikasyonlar ve sonuçlar analiz edildi.
Bulgular: Kırk-dört hasta semptomsuz olarak enfeksiyonu geçirirken, semptomatik hastaların ateş, öksürük, ve dispne oranları sırasıyla %62,6, %48,8 ve %41,8 idi. Altmış altı hasta (%20) hastalığı hafif geçirirken, orta, ciddi ve kritik hastalık tanısı alanların oranı sırasıyla %29, %20 ve %16 idi. Tüm kohortta ölüm oranı %26,6 idi; ölüm hafif hastalığı olanlarda %4,4, orta derece hastalık geçirenlerde %12 ve ciddi/kritik hastalık geçirenlerde ise %83 olarak saptandı. Aktif hematolojik hastalık olması, primer hematolojik hastalığa bağlı düşük hayat beklentisi, SARS-CoV-2 tanısı aldığında nötropenik olmak, yoğun bakıma alınmış olmak ve ilk sıra koronavirüs hastalığı-2019 tedavisi yüksek ölüm riski ile ilişkilendirilen faktörlerdendi. Tek başına veya azitromisin ile kombine olarak hidroksiklorokin kullanan hastaların sadece favipiravir kullananlara göre ölüm riskleri daha yüksek saptandı.
Sonuç: SARS-CoV-2 infeksiyonu geçiren hematolojik malignite hastalarında daha yüksek oranda ciddi hastalık ve ölüm riski gözlenmektedir.

Anahtar Kelimeler: COVID-19, SARS-CoV-2 infection, Hematological malignancy

Clinical Characteristics and Outcomes of COVID-19 in Turkish Patients with Hematological Malignancies

Sinem Civriz Bozdağ¹, Güldane Cengiz Seval¹, İpek Yönal Hindilerden², Fehmi Hindilerden³, Neslihan Andıç⁴, Mustafa Baydar⁵, Lale Aydın Kaynar⁶, Selami Koçak Toprak¹, Hasan Sami Göksoy⁷, Berrin Balık Aydın⁸, Ufuk Demirci⁹, Ferda Can¹⁰, Vildan Özkocaman¹¹, Eren Gündüz⁴, Zeynep Tuğba Güven⁵, Zübeyde Nur Özkurt⁶, Sinan Demircioğlu¹², Meral Beksaç¹, İdris İnce¹³, Umut Yılmaz¹⁴, Hilal Eroğlu Küçükdiler¹⁵, Elgün Abishov¹⁷, Boran Yavuz¹⁶, Ünal Ataş¹⁷, Yaşa Gül Mutlu⁸, Volkan Baş⁹, Fahir Özkalemkaş¹¹, Hava Üsküdar Teke⁴, Vildan Gürsoy¹⁸, Serhat Çelik⁵, Rafiye Çiftçiler¹⁹, Münci Yağcı⁶, Pervin Topçuoğlu¹, Özcan Çeneli¹², Hamza Abbasov⁷, Cem Selim¹⁵, Muhlis Cem Ar¹⁴, Orhan Kemal Yücel¹⁷, Sevil Sadri⁸, Canan Albayrak²⁰, Ahmet Muzaffer Demir⁹, Nil Güler²¹, Muzaffer Keklik⁵, Hatice Terzi²², Ali Doğan²³, Zeynep Arzu Yegin⁶, Meltem Kurt Yüksel¹, Soğol Sadri⁷, İrfan Yavaşoğlu¹⁵, Hüseyin Saffet Beköz⁸, Tekin Aksu²⁴, Senem Maral²⁵, Veysel Erol²¹, Leylagül Kaynar⁵, Osman İlhan¹, Ali Zahit Bolaman¹⁵, Ömür Gökmen Sevindik⁸, Arzu Akyay²⁶, Muhit Özcan¹, Günhan Gürman¹, Şule Ünal²⁴, Yasemin Yavuz²⁷, Reyhan Diz Küçükkaya²⁸, Güner Hayri Özsan¹⁶
¹Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
²İstanbul University, İstanbul Faculty of Medicine, Department of Internal Medicine, İstanbul, Turkey
³İstanbul Bakırköy Sadi Konuk Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey
⁴Eskişehir Osmangazi University Faculty of Medicine, Department of Hematology, Eskişehir, Turkey
⁵Erciyes University Faculty of Medicine, Department of Internal Medicine, Kayseri, Turkey
⁶Gazi University Faculty of Medicine, Department of Hematology, Ankara, Turkey
⁷Yeni Yüzyıl University, Özel Gaziosmanpaşa Hospital, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
⁸Medipol University Faculty of Medicine, Department of Internal Medicine, İstanbul, Turkey
⁹Trakya University Faculty of Medicine, Department of Hematology, Edirne, Turkey
¹⁰Ankara City Hospital, Clinic of Internal Medicine, Department of Hematology, Ankara, Turkey
¹¹Bursa Uludağ University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Bursa, Turkey
¹²Necmettin Erbakan University, Meram Faculty of Medicine, Department of Hematology, Konya, Turkey
¹³Dr. Ersin Arslan Training and Research Hospital, Clinic of Hematology, Gaziantep, Turkey
¹⁴İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
¹⁵Adnan Menderes University Faculty of Medicine, Department of Hematology, Aydın, Turkey
¹⁶Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
¹⁷Akdeniz University Faculty of Medicine, Department of Hematology, Antalya, Turkey
¹⁸Bursa City Hospital, Clinic of Hematology, Bursa, Turkey
¹⁹Aksaray Training and Research Hospital, Clinic of Hematology, Aksaray, Turkey
²⁰Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Hematology, Samsun, Turkey
²¹Pamukkale University Faculty of Medicine, Department of Internal Medicine, Denizli, Turkey
²²Cumhuriyet University Faculty of Medicine, Department of Hematology, Sivas, Turkey
²³Van Yüzüncü Yıl University Faculty of Medicine, Department of Hematology, Van, Turkey
²⁴Hacettepe University Faculty of Medicine, Department of Pediatric Hematology, Ankara, Turkey
²⁵University of Health Sciences Turkey, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Department of Hematology, Ankara, Turkey
²⁶İnönü University Faculty of Medicine, Department of Pediatric Hematology and Oncology, Malatya, Turkey
²⁷Ankara University School of Medicine, Department of Biostatistics, Ankara, Turkey
²⁸İstanbul University Faculty of Science, Department of Molecular Biology and Genetic, İstanbul, Turkey

Objective: Patients with solid malignancies are more vulnerable to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection than the healthy population. The outcome of SARS-CoV-2 infection in highly immunosuppressed populations, such as in patients with hematological malignancies, is a point of interest. We aimed to analyze the symptoms, complications, intensive care unit admissions, and mortality rates of patients with hematological malignancies infected with SARS-CoV-2 in Turkey.
Materials and Methods: In this multicenter study, we included 340 adult and pediatric patients diagnosed with SARS-CoV-2 from March to November 2020. Diagnosis and status of primary disease, treatment schedules for hematological malignancies, time from last treatment, life expectancy related to the hematological disease, and comorbidities were recorded, together with data regarding symptoms, treatment, and outcome of SARS-CoV-2 infection.
Results: Forty four patients were asymptomatic at diagnosis of SARSCoV- 2 infection. Among symptomatic patients, fever, cough, and dyspnea were observed in 62.6%, 48.8%, and 41.8%, respectively. Sixtynine (20%) patients had mild SARS-CoV-2 disease, whereas moderate, severe, and critical disease was reported in 101 (29%), 71 (20%), and 55 (16%) patients, respectively. Of the entire cohort, 251 (73.8%) patients were hospitalized for SARS-CoV-2. Mortality related to SARS-CoV-2 infection was 26.5% in the entire cohort; this comprised 4.4% of those patients with mild disease, 12.4% of those with moderate disease, and 83% of those with severe or critical disease. Active hematological disease, lower life expectancy related to primary hematological disease, neutropenia at diagnosis of SARS-CoV-2, ICU admission, and first-line therapy used for coronavirus disease-2019 treatment were found to be related to higher mortality rates. Treatments with hydroxychloroquine alone or in combination with azithromycin were associated with a higher rate of mortality in comparison to favipiravir use.
Conclusion: Patients with hematological malignancy infected with SARS-CoV-2 have an increased risk of severe disease and mortality.

Keywords: COVID-19, SARS-CoV-2 enfeksiyon, Hematolojik malignite

Sinem Civriz Bozdağ, Güldane Cengiz Seval, İpek Yönal Hindilerden, Fehmi Hindilerden, Neslihan Andıç, Mustafa Baydar, Lale Aydın Kaynar, Selami Koçak Toprak, Hasan Sami Göksoy, Berrin Balık Aydın, Ufuk Demirci, Ferda Can, Vildan Özkocaman, Eren Gündüz, Zeynep Tuğba Güven, Zübeyde Nur Özkurt, Sinan Demircioğlu, Meral Beksaç, İdris İnce, Umut Yılmaz, Hilal Eroğlu Küçükdiler, Elgün Abishov, Boran Yavuz, Ünal Ataş, Yaşa Gül Mutlu, Volkan Baş, Fahir Özkalemkaş, Hava Üsküdar Teke, Vildan Gürsoy, Serhat Çelik, Rafiye Çiftçiler, Münci Yağcı, Pervin Topçuoğlu, Özcan Çeneli, Hamza Abbasov, Cem Selim, Muhlis Cem Ar, Orhan Kemal Yücel, Sevil Sadri, Canan Albayrak, Ahmet Muzaffer Demir, Nil Güler, Muzaffer Keklik, Hatice Terzi, Ali Doğan, Zeynep Arzu Yegin, Meltem Kurt Yüksel, Soğol Sadri, İrfan Yavaşoğlu, Hüseyin Saffet Beköz, Tekin Aksu, Senem Maral, Veysel Erol, Leylagül Kaynar, Osman İlhan, Ali Zahit Bolaman, Ömür Gökmen Sevindik, Arzu Akyay, Muhit Özcan, Günhan Gürman, Şule Ünal, Yasemin Yavuz, Reyhan Diz Küçükkaya, Güner Hayri Özsan. Clinical Characteristics and Outcomes of COVID-19 in Turkish Patients with Hematological Malignancies. Turk J Hematol. 2022; 39(1): 43-54

Sorumlu Yazar: Sinem Çivriz Bozdağ, Türkiye

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