On behalf of Grupo Oncoclínicas.

COVID-19 has become one of the worst pandemics in history and patients with acute myeloid leukemia (AML) seems to have high risk for severe events and death by the SARS-COV-2. Our aim is to report a survey conducted with Brazilian hematologists who attended AML patients with COVID-19 to evaluate the mortality rate and any potential risk factor for death.

From May 5th to May 19th, 2021 we conducted a survey with 178 hematologists and collected data about adult patients with AML who had the COVID-19 diagnosis confirmed by RT-PCR: age, gender, possible source of contamination by SARS-COV-2 previous vaccination, moment of the AML treatment, status of AML when COVID was diagnosed and the outcomes related to COVID-19.

33 patients (22 females) were recorded and the median age at the COVID-19 diagnosis was 60 years (19 to 79y). Only one had been previously vaccinated. In 21 cases (63%) in-hospital transmission was presumed to be the source of infection. In 20 patients (60,6%) COVID-19 was diagnosed when the patient had active AML, while in 13 patients (39,3%) AML was in remission. Twelve patients had diagnosis before starting AML treatment, 6 during intensive chemo induction remission, 3 during intensive chemo consolidation, 9 while in low-intensity therapy and 2 during treatment of relapse. There were 18 deaths attributed to COVID-19 (54,5%), of which 15 (83%) had active AML and 3 (17%) were in AML remission (p = 0.0052). We did not identify any other factors that could be associated to death. Among the 15 patients who survived 8 (53%) had some delay in their AML treatment.

Despite its limitations, this exploratory report addressing specifically AML and COVID-19 brings up some points to consider: 1) Most patients were presumed to be infected in the hospital, which reinforces the need for taking measures to control the dissemination of COVID-19 in the hospital enviroment.2) Our data suggests that patients with active AML possibly have a higher risk of death from COVID-19 and that patients on treatment did not have better outcomes. Beside this, 5 of 12 patients who had COVID-19 diagnosis before beginning AML treatment were alive. These findings lead us to speculate that the best strategy could be postponing the beginning of AML treatment as long as it is safe. 3) Our survey seems to confirm the high risk of death due to COVID-19 in patients with AML. 4) More than 50% of patients who survived COVID-19 had a delay in their treatment; the impact of this delay on AML survival remains uncertain and should be evaluated in future studies.

AML patients seem to have a very high risk of death when infected by SARS-COV-2. Furthermore, even when recovered from COVID-19 those patients may suffer a delay in their treatment. Further reports are need to formulate evidence-based recommendations.