The FLARE score and circulating neutrophils in patients with cancer and COVID-19 disease

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• dc.contributor.author Seguí, Elia
• dc.contributor.author Casadevall Aguilar, David
• dc.contributor.author Mezquita, Laura
• dc.date.accessioned 2025-10-24T14:50:27Z
• dc.date.available 2025-10-24T14:50:27Z
• dc.date.issued 2024
• dc.date.updated 2025-10-24T14:50:27Z
• dc.description.abstract Purpose: Inflammation and neutrophils play a central role in both COVID-19 disease and cancer. We aimed to assess the impact of pre-existing tumor-related inflammation on COVID-19 outcomes in patients with cancer and to elucidate the role of circulating neutrophil subpopulations. Methods: We conducted a multicenter retrospective analysis of 524 patients with cancer and SARS-CoV-2 infection, assessing the relationship between clinical outcomes and circulating inflammatory biomarkers collected before and during COVID-19 infection. Additionally, a single-center prospective cohort study provided data for an exploratory analysis, assessing the immunophenotype of circulating neutrophils and inflammatory cytokines. The primary endpoints were 30-day mortality and the severity of COVID-19 disease. Results: Prior to COVID-19, 25% of patients with cancer exhibited elevated dNLR, which increased to 55% at the time of COVID-19 diagnosis. We developed the FLARE score, incorporating both tumor- and infection-induced inflammation, which categorized patients into four prognostic groups. The poor prognostic group had a 30-day mortality rate of 68%, significantly higher than the 23% in the favorable group (p < 0.0001). This score proved to be an independent predictor of early mortality. This prospective analysis revealed a shift towards immature forms of neutrophils and higher IL-6 levels in patients with cancer and severe COVID-19 infection. Conclusions: A pre-existing tumor-induced pro-inflammatory state significantly impacts COVID-19 outcomes in patients with cancer. The FLARE score, derived from circulating inflammatory markers, emerges as an easy-to-use, globally accessible, effective tool for clinicians to identify patients with cancer at heightened risk of severe COVID-19 complications and early mortality who might benefit most from immediate and intensive treatment strategies. Furthermore, our findings underscore the significance of immature neutrophils in the progression of COVID-19 in patients with cancer, advocating for further investigation into how these cells contribute to both cancer and COVID-19 disease.
• dc.description.sponsorship E.S. was supported by the Contracte Clínic Recerca “Emili Letang i Josep Font” 2022 and I Predoctoral Grant in Precision Oncology, 2022 (Cátedra UB IOP). L.M. received funding from the Beca SEOM retorno 2019; ESMO fellowship 2019–2021; Contrato Juan Rodes 2020 (ISCIII, Ministry of Health; JR20/00019); Ayuda Juan Rodés SEOM 2020; Ayuda de la Acción Estratégica en Salud—ISCIII FIS 2021 (PI21/01653); Beca SEOM para Proyectos de Investigación en Immunoncología 2021; Beca SEOM-ASTRAZENECA para Proyectos de Investigación para Grupo Emergente 2022; RADONORM, funded by the European Union’s Horizon 2020 Research and Innovation Programme under Grant Agreement No. 900009; Grupo Español de Tumores Huérfanos e infrecuentes (GETHI), Convocatoria Inés de Pablo Llorens 2023; and Becas Gilead a la Investigación Biomédica 2023. A.P. received funding from the Fundación CRIS contra el cáncer PR_EX_2021–14, Agència de Gestó d’Ajuts Universitaris i de Recerca 2021 SGR 01156, Fundación Fero BECA ONCOXXI21, Instituto de Salud Carlos III PI22/01017, Asociación Cáncer de Mama Metastásico IV Premios M. Chiara Giorgetti, Breast Cancer Research Foundation BCRF-23–198, and RESCUER, funded by the European Union’s Horizon 2020 Research and Innovation Programme under Grant Agreement No. 847912. Any views, opinions, findings, conclusions, or recommendations expressed in this material are those solely of the authors and do not necessarily reflect those of funding entities. The preliminary results of this study were presented at ESMO Congress 2020 [38] and ASCO 2022 [39] as poster communications. During the preparation of this work, the author(s) used ChatGPT4 in the writing process. After using this tool, the author(s) reviewed and edited the content as needed and take(s) full responsibility for the content of the publication.
• dc.format.mimetype application/pdf
• dc.identifier.citation Seguí E, Torres JM, Auclin E, et al. The FLARE score and circulating neutrophils in patients with cancer and COVID-19 disease. Cancers (Basel). 2024 Aug 26;16(17):2974. DOI: 10.3390/cancers16172974
• dc.identifier.doi http://dx.doi.org/10.3390/cancers16172974
• dc.identifier.issn 2072-6694
• dc.identifier.uri http://hdl.handle.net/10230/71650
• dc.language.iso eng
• dc.publisher MDPI
• dc.relation.ispartof Cancers. 2024;16(17):2974
• dc.relation.projectID info:eu-repo/grantAgreement/EC/H2020/900009
• dc.relation.projectID info:eu-repo/grantAgreement/EC/H2020/847912
• dc.rights © 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by/4.0/
• dc.subject.keyword COVID-19
• dc.subject.keyword IL-6
• dc.subject.keyword Cancer
• dc.subject.keyword dNLR
• dc.subject.keyword Neutrophils
• dc.title The FLARE score and circulating neutrophils in patients with cancer and COVID-19 disease
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion