Association of COVID-19 with Features of the Peripheral Hemogram Among Cancer Patients Undergoing Chemotherapy

Jia-Yong Su^1#, Zhen-Jie Guo^2#, Yao-Hong Liu¹, Qiong-Mei Li³, Yan-Jun Li¹, Bing-Hua Chen¹, Yu-Ling Zhao¹, Bin-Yuan Mo¹, De-Shen Chen¹, Yu-Ni Li¹, Yu-Tong Cai¹, Qing-Qing Chen⁴, Jian-Hong Zhong^1,5

Show Less

¹ Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, China

² Medical Records Room, Guangxi Medical University Cancer Hospital, Nanning, China

³ Nursing College of Guangxi Medical University, Nanning, China

⁴ Guangxi Crucial Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University, Nanning, China

⁵ Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumors (Guangxi Medical University), Ministry of Education, Nanning, China

EJMO 2023, 7(3), 255–264; https://doi.org/10.14744/ejmo.2023.18762

Submitted: 22 July 2023 | Accepted: 17 August 2023 | Published: 6 October 2023

© 2023 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )

Download PDF

Cite

XML

Abstract

Objectives: Future pandemics involving COVID-19 or other respiratory disorders may pose risks to treatment outcomes among cancer patients on chemotherapy. Here we explored whether diagnosis with COVID-19 might influence how chemotherapy alters the peripheral hemogram of cancer patients. To examine changes in the peripheral hemogram before and after chemotherapy depending on whether patients were unexposed to the SARS-CoV-2 virus, had COVID-19, or were recovering from COVID-19.

Methods: We retrospectively reviewed the records of 8,900 patients with solid cancers who underwent chemotherapy between October 10, 2022 and March 1, 2023. We compared hemograms before and after chemotherapy within and across the following three groups: 3,215 patients previously unexposed to SARS-CoV-2, 2,771 patients with COVID-19, and 2,817 patients recovering from COVID-19. We compared counts of white blood cells, red blood cells, and platelets as well as percentages of neutrophils between the first blood sampling after admission and the first sampling after conclusion of chemotherapy.

Results: Of the various parameters examined, only the changes in counts of white blood cells and platelets differed significantly across the three patient groups. White blood cell count before chemotherapy was lower in patients with COVID-19 than in those unexposed to the virus or those recovering from COVID-19. Platelet count after chemotherapy was lower in patients with COVID-19 than in those recovering from COVID-19. Chemotherapy reduced the red blood cell count and increased the neutrophil percentage in all three patient groups, with the largest changes occurring in patients with COVID-19; however, these changes did not achieve statistical significance.

Conclusion: These studies suggest that COVID-19 does not significantly alter the peripheral hemogram of cancer patients who receive effective chemotherapy.

Keywords

COVID-19

tumor chemotherapy

peripheral hemogram

Conflict of interest

None declared.

References

1. World health statistics 2023: monitoring health for the SDGs, Sustainable Development Goals. Geneva: World Health Organization; 2023. Licence: CC BY-NC-SA 3.0 IGO.
2. Jordan RE, Adab P, Cheng KK. Covid-19: risk factors for severe disease and death. BMJ. 2020;368:m1198.
3. Westblade LF, Brar G, Pinheiro LC, Paidoussis D, Rajan M, Martin P, et al. SARS-CoV-2 Viral Load Predicts Mortality in Patients with and without Cancer Who Are Hospitalized with COVID-19. Cancer Cell. 2020;38(5):661-71 e2.
4. Kuderer NM, Choueiri TK, Shah DP, Shyr Y, Rubinstein SM, Rivera DR, et al. Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study. Lancet. 2020;395(10241):1907-18.
5. Belsky JA, Tullius BP, Lamb MG, Sayegh R, Stanek JR, Auletta JJ. COVID-19 in immunocompromised patients: A systematic review of cancer, hematopoietic cell and solid organ transplant patients. J Infect. 2021;82(3):329-38.
6. Sun L, Surya S, Le AN, Desai H, Doucette A, Gabriel P, et al. Rates of COVID-19-Related Outcomes in Cancer Compared With Noncancer Patients. JNCI Cancer Spectr. 2021;5(1):Pkaa120.
7. Liang W, Guan W, Chen R, Wang W, Li J, Xu K, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020;21(3):335-7.
8. Li LQ, Huang T, Wang YQ, Wang ZP, Liang Y, Huang TB, et al. COVID-19 patients' clinical characteristics, discharge rate, and fatality rate of meta-analysis. J Med Virol. 2020;92(6):577-83.
9. Kamboj M, Sepkowitz KA. Nosocomial infections in patients with cancer. Lancet Oncol. 2009;10(6):589-97.
10. Zhang L, Zhu F, Xie L, Wang C, Wang J, Chen R, et al. Clinical characteristics of COVID-19-infected cancer patients: a retrospective case study in three hospitals within Wuhan, China. Ann Oncol. 2020;31(7):894-901.
11. Key NS, Khorana AA, Kuderer NM, Bohlke K, Lee AYY, Arcelus JI, et al. Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update. J Clin Oncol. 2020;38(5):496-520.
12. Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. 2023;73(1):17-48.
13. Fujii K, Chihara Y, Mishima C, Yamamoto M. [Concurrent COVID-19 and Pneumocystis Jirovecii Pneumonia in a Patient with Breast Cancer Receiving Adjuvant Dose-Dense Chemotherapy]. Gan To Kagaku Ryoho. 2022;49(13):1941-3.
14. Mechal H, Benmalek R, Choukrallah H, Maaroufi A, Habbal R, Benouna EGM, et al. Cardiac involvement in cancer patients under chemotherapy and diagnosed with COVID-19: case report and literature review. Pan Afr Med J. 2022;41:45.
15. Chen LP, Lin SJ, Yu MS. Prognostic value of platelet count in diffuse large B-cell lymphoma. Clin Lymphoma Myeloma Leuk. 2012;12(1):32-7.
16. Nagashima K, Tanaka H, Nagai Y, Sugita Y. Immune pancytopenia after chemotherapy in a patient with diffuse large B-cell lymphoma. BMJ Case Rep. 2016;2016.
17. Zhou J, Sun H, Wang Z, Cong W, Wang J, Zeng M, et al. Guidelines for the Diagnosis and Treatment of Hepatocellular Carcinoma (2019 Edition). Liver Cancer. 2020;9(6):682-720.
18. Curran MP, Robinson DM. Aprepitant: a review of its use in the prevention of nausea and vomiting. Drugs. 2009;69(13):1853- 78.
19. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708-20.
20. European Association for the Study of the Liver. Electronic address eee, European Association for the Study of the L. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182-236.
21. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
22. Lievre A, Turpin A, Ray-Coquard I, Le Malicot K, Thariat J, Ahle G, et al. Risk factors for Coronavirus Disease 2019 (COVID-19) severity and mortality among solid cancer patients and impact of the disease on anticancer treatment: A French nationwide cohort study (GCO-002 CACOVID-19). Eur J Cancer. 2020;141:62-81.
23. Grivas P, Khaki AR, Wise-Draper TM, French B, Hennessy C, Hsu CY, et al. Association of clinical factors and recent anticancer therapy with COVID-19 severity among patients with cancer: a report from the COVID-19 and Cancer Consortium. Ann Oncol. 2021;32(6):787-800.
24. Wang X, Lu XJ, Sun B. The pros and cons of dying tumour cells in adaptive immune responses. Nat Rev Immunol. 2017;17(9):591.
25. Mortezaee K, Majidpoor J. CD8(+) T Cells in SARS-CoV-2 Induced Disease and Cancer-Clinical Perspectives. Front Immunol. 2022;13:864298.
26. McKinney EF, Smith KG. T cell exhaustion and immune-mediated disease-the potential for therapeutic exhaustion. Curr Opin Immunol. 2016;43:74-80.
27. Wu MY, Li CJ, Yiang GT, Cheng YL, Tsai AP, Hou YT, et al. Molecular Regulation of Bone Metastasis Pathogenesis. Cell Physiol Biochem. 2018;46(4):1423-38.
28. Kang DH, Weaver MT, Park NJ, Smith B, McArdle T, Carpenter J. Significant impairment in immune recovery after cancer treatment. Nurs Res. 2009;58(2):105-14.
29. Marfella R, Sardu C, D'Onofrio N, Prattichizzo F, Scisciola L, Messina V, et al. Glycaemic control is associated with SARSCoV-2 breakthrough infections in vaccinated patients with type 2 diabetes. Nat Commun. 2022;13(1):2318.
30. Napoli C, Tritto I, Mansueto G, Coscioni E, Ambrosio G. Immunosenescence exacerbates the COVID-19. Arch Gerontol Geriatr. 2020;90:104174.
31. Grimaldi V, Benincasa G, Moccia G, Sansone A, Signoriello G, Napoli C. Evaluation of circulating leucocyte populations both in subjects with previous SARS-COV-2 infection and in healthy subjects after vaccination. J Immunol Methods. 2022;502:113230.
32. Corbeau A, Kuipers SC, de Boer SM, Horeweg N, Hoogeman MS, Godart J, et al. Correlations between bone marrow radiation dose and hematologic toxicity in locally advanced cervical cancer patients receiving chemoradiation with cisplatin: a systematic review. Radiother Oncol. 2021;164:128-37.
33. Newman NB, Sidhu MK, Baby R, Moss RA, Nissenblatt MJ, Chen T, et al. Long-Term Bone Marrow Suppression During Postoperative Chemotherapy in Rectal Cancer Patients After Preoperative Chemoradiation Therapy. Int J Radiat Oncol Biol Phys. 2016;94(5):1052-60.
34. Yuan Y, Jiao B, Qu L, Yang D, Liu R. The development of COVID-19 treatment. Front Immunol. 2023;14:1125246.
35. Harris E. FDA Grants Full Approval to Paxlovid, COVID-19 Antiviral Treatment. JAMA. 2023;329(24):2118.
36. Tomazini BM, Maia IS, Cavalcanti AB, Berwanger O, Rosa RG, Veiga VC, et al. Effect of Dexamethasone on Days Alive and Ventilator-Free in Patients With Moderate or Severe Acute Respiratory Distress Syndrome and COVID-19: The CoDEX Randomized Clinical Trial. JAMA. 2020;324(13):1307-16.
37. Group WHOREAfC-TW, Sterne JAC, Murthy S, Diaz JV, Slutsky AS, Villar J, et al. Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19: A Meta-analysis. JAMA. 2020;324(13):1330-41.
38. O'Brien SF, Lieshout-Krikke RW, Lewin A, Erikstrup C, Steele WR, Uzicanin S, et al. Research initiatives of blood services worldwide in response to the covid-19 pandemic. Vox Sang. 2021;116(3):296-304.
39. Piechotta V, Chai KL, Valk SJ, Doree C, Monsef I, Wood EM, et al. Convalescent plasma or hyperimmune immunoglobulin for people with COVID-19: a living systematic review. Cochrane Database Syst Rev. 2020;7(7):CD013600.
40. Huang L, Li X, Gu X, Zhang H, Ren L, Guo L, et al. Health outcomes in people 2 years after surviving hospitalisation with COVID-19: a longitudinal cohort study. Lancet Respir Med. 2022;10(9):863-76.
41. Global Burden of Disease Long CC, Wulf Hanson S, Abbafati C, Aerts JG, Al-Aly Z, Ashbaugh C, et al. Estimated Global Proportions of Individuals With Persistent Fatigue, Cognitive, and Respiratory Symptom Clusters Following Symptomatic COVID-19 in 2020 and 2021. JAMA. 2022;328(16):1604-15.
42. Chen AK, Wang X, McCluskey LP, Morgan JC, Switzer JA, Mehta R, et al. Neuropsychiatric sequelae of long COVID-19: Pilot results from the COVID-19 neurological and molecular prospective cohort study in Georgia, USA. Brain Behav Immun Health. 2022;24:100491.

Previous article in this issue

Next article in this issue

Eurasian Journal of Medicine and Oncology, Electronic ISSN: 2587-196X Print ISSN: 2587-2400, Published by AccScience Publishing