The COVID-19 pandemic has had a tremendous impact globally on many aspects of society. One group that was especially affected was cancer patients, who are extremely dependent upon their treatments. In a recent multicenter study, the care for patients from the CONNECT Myeloid Disease Registry who had newly diagnosed acute myeloid leukemia (AML) was evaluated in periods before and during the pandemic. One participating researcher in this study was Bart L. Scott, MD, physician and Associate Professor in the Clinical Research Division at Fred Hutchinson Cancer Center.
"The goal of our study was to evaluate the effects that the COVID-19 pandemic had on the management and overall survival of patients with AML included in the CONNECT Myeloid registry," he noted.
CONNECT Registry
"The Connect Myeloid Disease Registry is a large, multicenter, U.S.-based prospective observational study consisting of patients with newly diagnosed AML, myelodysplastic syndromes, or idiopathic cytopenia of undetermined significance," Scott explained.
The study period for this analysis was divided into three distinct periods: Period 1-December 2013 to February 2020; Period 2-March 2020 to May 2021; and Period 3-June 2021 to January 2022 (NCT01688011). Period 1 corresponded to the pre-pandemic period to serve as a baseline for the standard of care in this population. Period 2 encompassed the period of maximum disruption of health care services, and in Period 3 the health care system was less stressed and had fewer service disruptions.
"In this analysis, enrollment of patients 55 years or older with newly diagnosed AML was initiated in December 2013," Scott explained. COVID-19 reference data were obtained monthly from the COVID Data Tracker of the Centers for Disease Control and Prevention.
Research Results
A total of 773 patients were included in this analysis: 650 in Period 1, 87 in Period 2, and 36 in Period 3. During this time frame, 529, 66, and 27 patients in Periods 1, 2, and 3, respectively, were considered for hematopoietic stem cell transplantation. Thus, in Period 1, Period 2, and Period 3, 74.8 percent, 54.6 percent, and 55.5 percent of patients considered for transplantation were actually assessed for that therapy.
Oral induction treatment was received by 49.4 percent, 50.6 percent, and 63.9 percent of the patients enrolled during Period 1, Period 2, and Period 3, respectively. The median overall survival values for Period 1, Period 2, and Period 3 were 14.6 months, 13.7 months, and 17.6 months, respectively. When comparing the overall survival for Period 1 and Period 2, a hazard ratio of 0.90 (95% CI: 0.67-1.21, p=0.47) was obtained, while for the Period 1 and Period 3 comparison, the hazard ratio was 0.74 (95% CI: 0.43-1.25, p=0.26).
"For the participants included within this analysis, there were no major differences in the demographics or clinical characteristics between the patients enrolled in the three distinct study periods prior to and including the COVID-19 pandemic," Scott noted. "Clearly, the pandemic did have an effect on the treatment of patients. There were fewer transfusions [and] fewer in-person visits to their doctors, as well as fewer patient assessments for hematopoietic stem cell transplants during the pandemic.
"Another aspect of treatment during the pandemic was that there was an increased use of oral therapies as part of induction regimens in the latter stages of the pandemic," he said. "Even though there were widespread disruptions to the health care systems, which did have an impact upon the treatment of patients, there did not appear to be an effect upon the overall survival of the patients included in this analysis."
The survival data for Period 2 and Period 3 were not considered to be mature at the time of the analysis. When asked about ongoing patient assessments in this study, Scott replied, "Survival data were still being collected, particularly for those patients enrolled during Period 2 and Period 3."
Richard Simoneaux is a contributing writer.
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