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      Outcomes of patients with hematologic malignancies and COVID-19: a systematic review and meta-analysis of 3377 patients

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          Abstract

          Outcomes for patients with hematologic malignancy infected with COVID-19 have not been aggregated. The objective of this study was to perform a systematic review and meta-analysis to estimate the risk of death and other important outcomes for these patients. We searched PubMed and EMBASE up to 20 August 2020 to identify reports of patients with hematologic malignancy and COVID-19. The primary outcome was a pooled mortality estimate, considering all patients and only hospitalized patients. Secondary outcomes included risk of intensive care unit admission and ventilation in hospitalized patients. Subgroup analyses included mortality stratified by age, treatment status, and malignancy subtype. Pooled prevalence, risk ratios (RRs), and 95% confidence intervals (CIs) were calculated using a random-effects model. Thirty-four adult and 5 pediatric studies (3377 patients) from Asia, Europe, and North America were included (14 of 34 adult studies included only hospitalized patients). Risk of death among adult patients was 34% (95% CI, 28-39; N = 3240) in this sample of predominantly hospitalized patients. Patients aged ≥60 years had a significantly higher risk of death than patients <60 years (RR, 1.82; 95% CI, 1.45-2.27; N = 1169). The risk of death in pediatric patients was 4% (95% CI, 1-9; N = 102). RR of death comparing patients with recent systemic anticancer therapy to no treatment was 1.17 (95% CI, 0.83-1.64; N = 736). Adult patients with hematologic malignancy and COVID-19, especially hospitalized patients, have a high risk of dying. Patients ≥60 years have significantly higher mortality; pediatric patients appear to be relatively spared. Recent cancer treatment does not appear to significantly increase the risk of death.

          Key Points

          • Adult patients with hematologic malignancy and COVID-19 found a 34% risk of death, whereas pediatric patients had a 4% risk of death.

          • Patients on systemic anticancer therapy had a similar risk of death to patients on no treatment (RR, 1.17; 95% CI, 0.83-1.64).

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          Most cited references86

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          Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area

          There is limited information describing the presenting characteristics and outcomes of US patients requiring hospitalization for coronavirus disease 2019 (COVID-19).
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            Cochrane Handbook for Systematic Reviews of Interventions

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              Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis

              Summary Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and is spread person-to-person through close contact. We aimed to investigate the effects of physical distance, face masks, and eye protection on virus transmission in health-care and non-health-care (eg, community) settings. Methods We did a systematic review and meta-analysis to investigate the optimum distance for avoiding person-to-person virus transmission and to assess the use of face masks and eye protection to prevent transmission of viruses. We obtained data for SARS-CoV-2 and the betacoronaviruses that cause severe acute respiratory syndrome, and Middle East respiratory syndrome from 21 standard WHO-specific and COVID-19-specific sources. We searched these data sources from database inception to May 3, 2020, with no restriction by language, for comparative studies and for contextual factors of acceptability, feasibility, resource use, and equity. We screened records, extracted data, and assessed risk of bias in duplicate. We did frequentist and Bayesian meta-analyses and random-effects meta-regressions. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. This study is registered with PROSPERO, CRD42020177047. Findings Our search identified 172 observational studies across 16 countries and six continents, with no randomised controlled trials and 44 relevant comparative studies in health-care and non-health-care settings (n=25 697 patients). Transmission of viruses was lower with physical distancing of 1 m or more, compared with a distance of less than 1 m (n=10 736, pooled adjusted odds ratio [aOR] 0·18, 95% CI 0·09 to 0·38; risk difference [RD] −10·2%, 95% CI −11·5 to −7·5; moderate certainty); protection was increased as distance was lengthened (change in relative risk [RR] 2·02 per m; p interaction=0·041; moderate certainty). Face mask use could result in a large reduction in risk of infection (n=2647; aOR 0·15, 95% CI 0·07 to 0·34, RD −14·3%, −15·9 to −10·7; low certainty), with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable 12–16-layer cotton masks; p interaction=0·090; posterior probability >95%, low certainty). Eye protection also was associated with less infection (n=3713; aOR 0·22, 95% CI 0·12 to 0·39, RD −10·6%, 95% CI −12·5 to −7·7; low certainty). Unadjusted studies and subgroup and sensitivity analyses showed similar findings. Interpretation The findings of this systematic review and meta-analysis support physical distancing of 1 m or more and provide quantitative estimates for models and contact tracing to inform policy. Optimum use of face masks, respirators, and eye protection in public and health-care settings should be informed by these findings and contextual factors. Robust randomised trials are needed to better inform the evidence for these interventions, but this systematic appraisal of currently best available evidence might inform interim guidance. Funding World Health Organization.
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                Author and article information

                Journal
                Blood
                Blood
                Blood
                American Society of Hematology. Published by Elsevier Inc.
                0006-4971
                1528-0020
                17 December 2020
                17 December 2020
                17 December 2020
                : 136
                : 25
                : 2881-2892
                Affiliations
                [1 ]Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
                [2 ]Department of Medicine, University of Toronto, Toronto, ON, Canada
                [3 ]Department of Haematology, University College London Hospital, London, United Kingdom
                [4 ]Department of Oncology, University of Oxford, Oxford, United Kingdom
                [5 ]Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
                [6 ]Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
                [7 ]Ca' Granda Ospedale Maggiore Policlinico, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
                [8 ]Department of Hematology, Ramón y Cajal University Hospital, Madrid, Spain
                [9 ]Department of Internal Medicine, Besançon University Hospital, Besançon, France
                [10 ]Centre for Hemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
                [11 ]Beth Israel Deaconess Medical Center, Boston, MA
                [12 ]Department of Hematology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
                [13 ]Strategic Research Program on CLL, Università Vita Salute and IRCCS Ospedale San Raffaele, Milan, Italy
                [14 ]HCT Unit, Hematology Department, G. Papanicolaou Hospital, Thessaloniki, Greece
                [15 ]Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
                [16 ]Department of Oncology, Montefiore Medical Center, Bronx, NY
                [17 ]Division of Hematology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; and
                [18 ]Division of Hematology/Oncology, St. Michael's Hospital, Toronto, ON, Canada
                Author notes
                [* ]Lisa K. Hicks, St. Michael's Hospital, Room 2-084 Donnelly Wing, 30 Bond St, Toronto, ON M5B 1W8, Canada;
                Article
                S0006-4971(20)77864-X
                10.1182/blood.2020008824
                7746126
                33113551
                e87120f2-163e-453d-8956-45b98224b1e1
                Copyright © 2020 American Society of Hematology. Published by Elsevier Inc. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 24 August 2020
                : 28 September 2020
                Categories
                Clinical Trials and Observations

                Hematology
                Hematology

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