ASH: Covid-19 and Blood Cancer

This year's ASH conference takes place in just a few weeks, from Wednesday, December 2 to Friday the 11th. 

If you're new to all of this, ASH is the American Society of Hematology, the largest group of doctors who study blood disorders (including blood cancers) in the U.S. Their big conference happens every December, and its one of two cancer conferences that I get most excited about every year, because there are usually some interesting about Follicular Lymphoma every year. 

This year's ASCO conference (that's the other big one that I like) was great because patient advocates were allowed to attend for free, since it was online anyway so they wouldn't have to give us any free swag that doctors get. No such luck with the ASH conference -- if I want to attend, I need to pay a few hundred dollars. Not going to happen. But I can still look at the abstracts online, since they are free for anyone to look at. I won't get the in-depth look at the research that I got when I "attended" ASCO, but that's OK. I can learn plenty from the abstracts, and of course, share it with you. 

To be honest, I haven't even looked at the abstracts yet, even though they've been available for almost two weeks. I've just been too busy. 

But I did see a small discussion of one abstract on Twitter, and it's an important one, so I want to share it with you.

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 The paper is called "Severity of Sars-Cov-2 Infection in Patients with Hematologic Malignancies: A COVID-19 and Cancer Consortium (CCC19) Registry Analysis." It's basically about how Covid-19 has affected blood cancer patients. I've been waiting months for information like this.

And before I get into it, I want to remind you: statistics don't tell you anything about your own individual situation. We need to learn what we can from them, but always keep in mind that statistics measure what happened in the past to a small number of people. Other peoples' numbers do not determine your destiny.

That said, it's probably no surprise to anyone reading this that Covid-19 outcomes for blood cancer patients are, overall, worse than for the general population. I've been hearing since the spring that people with blood and lung cancers would probably have the most difficulty with Covid-19, given the virus's focus on the respiratory and immune systems. 

The paper looks at data from the Covid-19 and Cancer Consortium, or CCC19, a group of about 100 institution that have been collecting data about cancer patients who have contracted Covid. The way it works is, doctors whose cancer patients have contracted Covid can upload information about the patient (age, sex, treatments, etc.) to the database, and every few weeks, the consortium releases an analysis about how certain groups of cancer patients have been affected by Covid.

The primary endpoint for the research -- the main thing they wanted to find out -- was how many blood cancer patients has "severe COVID-19 illness, " which they measured as meaning the patient needed mechanical ventilation, was hospitalized, was in an intensive care unit (ICU) requirement, or died. They broke the data down into types of blood cancer, as well as things like treatment type and stage, comorbidities, etc. 

To make things a little bit easier, I'm going to include the entire table from the abstract. But I want you to remember what I said about statistics.

I'm going to focus on just one line here: "Low-grade Non-Hodgkin lymphoma," which would include Follicular Lymphoma (as well as some others). 

Of the 757 patients in the study, 95 of them had low-grade NHL. 36% of these patients who were diagnosed with Covid ended up with severe disease, as the researchers define it. 24% ended up in the ICU, 19% on a ventilator, and 16% died. All much higher than the general population. Not a surprise. 

Other numbers are not broken down by specific disease, so it's harder to say how Follicular Lymphoma patients are especially affected. But the trends are easy to see:

Patients in active treatment are more vulnerable, and have worse outcomes. Patients who have progressive disease, rather than stable disease or in remission, have worse outcomes. Patients who are over 60, or who have certain other conditions, have worse outcomes. 

Again, none of this is a surprise, it's just been conformed by research.

And I will say again -- trends in numbers of other do not necessarily indicate something about you personally.

The lesson from all this is, to me, the same lessons that I heard back in March:

We are more vulnerable, so we need to be extra careful. We need to ask our oncologists questions, and follow their advice. We should follow the same public health advice as everyone else -- stay away from crowds, keep 6 feet/2 meters from others, wear a mask, and wash your hands.  

Remember, having blood cancer means we have a better chance at worse outcomes if we get the disease. But it doesn't mean we are more likely to get it than other people are. We can and should take the same precautions as everyone else, with maybe some extra care thrown in.

(And I'm going to assume that anyone reading this believes strongly in what science tells us, and values it, so there isn't going to be an argument about public health guidelines. Maybe about how they are carried out by individual governments, but not the basic science. I saw a couple of people posting on an online NHL group about Covid, who said they don't wear masks because it's a "personal choice." Goodness gracious, people, wear a freakin' mask. Make the choice to stay alive, for cryin' out loud.)

(Those last few sentences were heavily edited for language. I hope the translator works on them, and conveys my passion.)

And all of this is coming out as cases are increasing, especially in the U.S.

It's all scary, but there's still plenty of reason for hope. 

This research should have all of the usual cautions that any research has -- it looks at a fairly small number of patients (757), and an even smaller number of indolent NHL patients (95). Larger numbers of patients might tell a different story. (Perhaps better, perhaps worse.)

The research does not look at changes over time. That is, in the general population, there has been a decrease in severe cases and deaths over time, as doctors have learned how to treat Covid. It's certainly possible that these numbers are better now than they were in March, if we were able to break them down that way. (And who knows, maybe they will be broken down that way at the actual ASH conference.)

And most hopefully, there has been good news about a possible vaccine, with potentially more good news coming in the weeks ahead about other vaccines in development. 

And when the vaccine has been deemed truly safe and effective, the most vulnerable people should be the ones who are at the front of the line, including health care workers, certainly, but also patients in active cancer treatment not too far behind. 

But whatever you do, don't let a new set of numbers make you more anxious. Nothing has changed, really; you're no more vulnerable than you were yesterday. Don't let anxiety about the disease change the way you've been living -- carefully and smartly. Look at those numbers and take them as a sign that you've been doing the right thing all this time, that it's been worth it because your behavior has kept you safe, and that there really is a light at the end of the tunnel.

Stay well. And look for more ASH commentary in the weeks to come.