MDS, AML Early Predictors of COVID-19 Treatment Failure

By Leah Sherwood - Last Updated: March 6, 2023

Patients with hematological malignancies treated for mild or moderate COVID-19 during the Omicron period would be more likely to experience treatment failure if they were diagnosed with myelodysplastic syndromes (MDS) or acute myeloid leukemia (AML), according to a retrospective study.

The study analyzed outcomes of patients with hematologic malignancies who were treated with an antiviral or monoclonal antibody (MAB) in two university hospitals in Italy. The main composite endpoint was treatment failure (severe COVID-19 or COVID-19-related death).

The authors, led by Malgorzata Mikulska, of the University of Genova, noted that patients with hematologic malignancies “have a worse prognosis and an early case fatality rate of approximately 14%.” The purpose of the study was to investigate early treatment outcomes of mild or moderate COVID-19 in this group of patients, and to identify the predictors of poor outcomes.

The study analyzed 328 patients who received antiviral or MAB treatment over a median of two days after symptoms started between March 2021 and July 2022 (see TABLE 1). Patients were excluded if they received early treatment with both antivirals and MABs. The focus was on patients who were tested for the presence of new onset SARS-CoV-2 symptoms, either respiratory or systemic. Patients who tested positive during screening after close exposure or prior to chemotherapy or HSCT were also evaluated for the presence of any signs or symptoms of SARS-CoV-2 infection.

TABLE 1. Specific Treatment of Patients with COVID-19

Treatment Number of Patients Percentage  Specific medication (if applicable)
MABs 120 37% Sotrovimab (n=73)
Antiviral 208 63% Nirmatrelvir/Ritonavir (n=116)

*Percentage calculated out of total number of patients (n=308)

Most infections (n=304/328; 94%) occurred during the Omicron period. Treatment failure, defined as severe COVID-19 or COVID-19-related death, was observed in 9.5% of patients.

The rate of failure was significantly higher during the pre-Omicron than in the Omicron period (n=7/19 [36.8%] vs n=24/309 [7.8%]; P<.001). When the analyses were restricted to the Omicron period, the rate of failure was 5.8% (12/208) for antivirals and 11.8% (12/101) for MABs (P=.06).

Mortality in those who developed severe COVID-19 after early treatment was 26% during the Omicron period. Multivariate analysis showed that the independent predictors of failure were older age, fewer vaccine doses, treatment with MABs, and a diagnosis of AML/MDS. Of the 328 patients in the study, 111 (33.8%) had AML and nine (2.7%) had MDS.

“The negative outcome in AML/MDS patients might be related to the aggressiveness of their underlying disease and high intensity chemotherapy and was present also in initial studies in patients with [hematologic malignancies] as a risk factor for higher mortality,” the authors wrote.


Mikulska M, Testi D, Russo C, et al. Outcome of early treatment of SARS-CoV-2 infection in patients with haematological disorders. Br J Haematol. 2023;10.1111/bjh.18690. doi:10.1111/bjh.18690


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