LAUSR

We read with interest the article titled “COVID-19 in persons with haematological cancers” by Wenjuan He et al. published recently [1]. The authors conducted a retrospective cohort study of 13 hospitalized patients with hematological malignancies (PHM) from Wuhan, China, who developed coronavirus infectious disease 2019 (COVID-19) and compared their clinical characteristics and outcomes with eleven hospitalized health care providers (HCP). They showed that COVID-19 led to more severe disease and significantly higher case fatality rate (CFR) of 62% in PHM compared to zero in HCP (P= 0.002). We acknowledge these findings since data on COVID-19 infections in PHM have been scarce so far, but we see important limitations that were not explicitly addressed in the article. Furthermore, we present our own retrospective cohort data from Graz, Austria, which differs in terms of demographics and outcome. First, the cohort of PHM with COVID-19 exhibiting a median age of 35 years and selected by lung CT scan is likely not representative for most PHM whose median age reportedly is around 60 years [2, 3]. In Wuhan, PHM with COVID-19 were a median of 14 years younger compared with PHM without COVID-19 (P= 0.082). Moreover, 62% (8/13) of PHM with COVID-19 had already been in the intensive care unit (ICU) before the COVID-19 pandemic began. Depending on the reason for ICU admission, which is not specified in the article, mortality rates of up to 60% are to be expected [2]. Taken together, younger but obviously already critically ill patients prior to COVID-19 infection were reported by He et al. Second, predominantly female HCP with COVID-19 having a median age of 32 years are not an ideal comparator group since in these subjects CFR is expected to be below 2.5% [4]. Only 18% (2/11) of HCP were male compared with 54% (7/13) of PHM with COVID-19 and 57% (65/115) of PHM without COVID-19, respectively (Fisher’s exact test, P= 0.0492). It has been previously shown that male gender is strongly associated with worse outcome of COVID-19 [4]. In summary, the expectedly very low CFR in young female HCP and the high mortality in presumably preselected PHM likely overestimated the difference in CFR between these two groups. We similarly analyzed all consecutive patients infected with SARS-CoV-2 (N= 78; Supplementary Table 1) diagnosed at the University Hospital in Graz, Austria, until May 1, 2020. COVID-19 and acute respiratory distress syndrome (ARDS) were diagnosed as previously described [5]. Importantly, all SARS-CoV-2 infections were confirmed by nucleic acid test (NAT) and were not preselected by lung CT scan. There were eight PHM with a median age of 57 years showing equal sex distribution (Table 1). Surprisingly, there These authors contributed equally: Stefan Hatzl, Florian Eisner.