International Multicenter Study Comparing COVID-19 in Patients With Cancer to Patients Without Cancer: Impact of Risk Factors and Treatment Modalities on Survivorship

Background: In this international multicenter study we aimed to determine the independent risk factors associated with increased 30-day mortality and the impact of cancer and novel treatment modalities in a large group of patients with and without cancer with COVID-19 from multiple countries. Methods: We retrospectively collected de-identified data on a cohort of patients with and without cancer diagnosed with COVID-19 between January and November 2020, from 16 international centers. Results: We analyzed 3966 COVID-19 confirmed patients, 1115 with cancer and 2851 nwithout cancer patients. Patients with cancer were more likely to be pancytopenic, and have a smoking history, pulmonary disorders, hypertension, diabetes mellitus, and corticosteroid use in the preceding two weeks (p≤0.01). In addition, they were more likely to present with higher inflammatory biomarkers (D-dimer, ferritin and procalcitonin), but were less likely to present with clinical symptoms (p≤0.01). By country-adjusted multivariable logistic regression analyses, cancer was not found to be an independent risk factor for 30-day mortality (p=0.18) whereas lymphopenia was independently associated with increased mortality in all patients, and in patients with cancer. Older age (≥65 years) was the strongest predictor of 30-day mortality in all patients(OR=4.47, p<0.0001). Remdesivir was the only therapeutic agent independently associated with decreased 30-day mortality ()(OR=0.64, p=0.036). Among patients on low-flow oxygen at admission, patients who received remdesivir had a lower 30-day mortality rate than those who did not (5.9% vs 17.6%; p=0.03). Conclusions: Increased 30-day all-cause mortality from COVID-19 was not independently associated with cancer but was independently associated with lymphopenia often observed in hematolgic malignancy. Remdesivir, particularly in patients with cancer receiving low-flow oxygen, can reduce 30-day all-cause mortality. Funding: National Cancer Institute, National Institutes of Health Condensed Abstract In this large multicenter worldwide study of 4015 patients with COVID-19 that included 1115 patients with cancer, we found that cancer is an independent risk factor for increased 30-day allcause mortality. Remdesivir is a promising treatment modality to reduce 30-day all-cause mortality.