Chronic Lymphocytic Leukemia Concomitant with COVID 19: A Case Report

Ali, Elrazi; Badawi, Mohamed; Abdelmahmuod, Elabbass; Kohla, Samah; Yassin, Mohamed A

doi:10.12659/ajcr.926062

Cited by 17 publications

(13 citation statements)

References 16 publications

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“…The authors postulate that COVID-19 co-infection with CLL can increase the clonality of B cells. As in a similar case report by Ali et al a possible scenario is that the patient had monoclonal B-cell lymphocytosis that accelerated into frank CLL by COVID-19 [ 2 ]. The other possibility is that indolent CLL became unmasked by COVID-19 producing hyperleukocytosis.…”

Section: Discussionmentioning

confidence: 99%

“…Chronic lymphocytic leukemia is usually an indolent disease where most patients will not require immediate treatment and can be monitored. However, in patients with concurrent COVID-19 and CLL, substantially elevated lymphocytes can occur in contrast to typical lymphopenia associated with COVID-19 [ 2 ]. Pseudohyperkalemia or artifactual hyperkalemia is seen secondary to red cell hemolysis occurring during or after a blood draw has occurred.…”

Section: Introductionmentioning

confidence: 99%

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Hyperleukocytosis and Pseudohyperkalemia in a Patient With Severe SARS-COVID 19 Unmasks Chronic Lymphocytic Leukemia

Menakuru¹,

Prişcu²,

Beirat³

et al. 2021

Cureus

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Coronavirus disease 2019 (COVID-19) has caused significant morbidity and mortality in a vast majority of the patient population, especially those with malignancies. Chronic lymphocytic leukemia (CLL) is the most common leukemia in adults and is often an indolent disease. High white blood cell counts greater than 120 k/cumm in chronic lymphocytic leukemia may be implicated in cases of COVID-19. Hyperleukocytosis leads to falsely elevated potassium levels due to cell fragility. Pseudohyperkalemia occurs when elevated potassium is present due to potassium movement out of cells during or after a blood sample is drawn. Pseudohyperkalemia may be suspected when elevated potassium is present in asymptomatic patients with no corresponding electrocardiogram findings. The authors present a case of hyperleukocytosis and pseudohyperkalemia in a patient whose COVID-19 infection unmasked CLL.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hyperleukocytosis and Pseudohyperkalemia in a Patient With Severe SARS-COVID 19 Unmasks Chronic Lymphocytic Leukemia

Menakuru¹,

Prişcu²,

Beirat³

et al. 2021

Cureus

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“…Leukocytosis accompanied by lymphocytosis is uncommon in patients who are diagnosed with SARS-CoV-2 infection. Flow cytometry analysis was performed in this case, and it was shown that the lymphocytosis was monoclonal, and this allowed the concomitant diagnosis of CLL with SARS-CoV-2 infection ( 21 ). Patients with CLL who have newly occurring but non-specific clinical manifestations of SARS-CoV-2 infection, have indications for virological testing using PCR, followed by chest X-ray examination if the test is negative ( 22 ).…”

Section: Distinct Characteristics Of Sars-cov-2 Infection In Patients With Cllmentioning

confidence: 97%

“…The reduced value or even lack of other populations of leukocytes (macrophages, granulocytes, and NK cells) may lead to an undesirable response from the immune system towards pathogens. The presence of CLL accompanied by impaired cellular and humoral immunity (mainly) ( 21 ) with secondary hypogammaglobulinemia explains the longer duration of SARS-CoV-2 infection in certain patients. Such a patient showed signs of infection for up to 70 days, and genomic and subgenomic viral shedding occurred for up to 105 days since diagnosis.…”

Section: Distinct Characteristics Of Sars-cov-2 Infection In Patients With Cllmentioning

confidence: 99%

Management of patients with chronic lymphocytic leukemia during the SARS‑CoV‑2 pandemic (Review)

Mihăilă

2021

Oncol Lett

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Oncohematological patients are prone to develop infections due to immunosuppression caused by the disease and chemo-immunotherapy. The aim of this review was to outline the details of the management of patients with chronic lymphocytic leukemia (CLL) during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Patients with CLL often exhibit inadequate humoral and cellular immune responses to various infections and vaccinations. Patients under the 'watch and wait' strategy have a lower risk of infections, including with SARS-CoV-2, compared with those undergoing therapeutic interventions, but they still have a higher risk than age-matched controls. Patients with CLL have a high risk of developing severe forms of coronavirus disease-2019 (COVID-19), particularly if they are undergoing chemo-immunotherapy. The total anti-SARS-CoV-2 antibody titer demonstrates a slower increase in patients with CLL infected with the virus, and the antibody levels tend to decrease after reaching a maximum level sooner than in healthy individuals. This leads to a late negativation of the PCR tests and a longer duration of hospitalization. In total, ~1/3 of patients with CLL do not develop a persistent titer of antiviral antibodies, and this is associated with the presence of hypogammaglobulinemia. It appears that patients with CLL have the worst outcomes amongst patients with malignant hemopathies and SARS-CoV-2 infection. Bruton tyrosine kinase inhibitors reduce the hyperinflammatory status of patients with CLL with COVID-19, which is accompanied by decreased levels of serum inflammatory markers, ferritin and D-dimer, and serum levels of pro-inflammatory cytokines, but they increase the risk of infections and impaired humoral immunity. An abrupt discontinuation of these may promote the rapid decompensation of CLL, which may even mimic the clinical manifestations of COVID-I9, including a significant increase in cytokine release. In conclusion, therapeutic decisions must be personalized to each patient with CLL and each at risk patient must be quarantined during the SARS-CoV-2 pandemic to reduce their risk of contraction. Contents

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“…The effect of SARS-CoV-2 on patients with chronic leukemia is variable. In patients with chronic lymphocytic leukemia, mortality is related to age, and the COVID infection is usually associated with increased white cell count [ 7 , 8 ]. Previous studies showed that chronic myeloid leukemia (CML) with SARS-CoV-2 infection had increased mortality.…”

Section: Introductionmentioning

confidence: 99%

SARS-CoV-2 Omicron Variant in Patients With Chronic Myeloid Leukemia: A Retrospective Study

Ali

Khamees

Abu-Tineh

et al. 2022

Cureus

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Background and aims Coronavirus disease 2019 (COVID-19) is caused by a virus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since the first pandemic wave, SARS-CoV-2 had developed significant changes and mutations that resulted in the emergence of different strains. Each strain varies in its virulence and disease severity. Most reports have shown that the Omicron variant causes mild illness. Little is known about the impact of Omicron in patients with chronic myeloid leukemia. We present patients with chronic myeloid leukemia who had infection with the Omicron variant of the SARS-CoV-2 and their outcomes. Materials and methods Retrospective data from the records of the National Center for Cancer Care and Research from December 20, 2021, to January 30, 2022. Participants were adults over the age of 18 years with Omicron infection who had been diagnosed with chronic myeloid leukemia according to World Health Organization classifications from 2008 and 2016. Results Eleven patients with chronic myeloid leukemia had Omicron infection. All patients had a mild disease according to the World Health Organization classification of COVID-19 severity. The majority of patients were young males. Conclusions In patients with chronic myeloid leukemia, infection with the Omicron variant of the SARS-CoV-2 usually results in mild disease not requiring hospitalization.

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Chronic Lymphocytic Leukemia Concomitant with COVID 19: A Case Report

Cited by 17 publications

References 16 publications

Hyperleukocytosis and Pseudohyperkalemia in a Patient With Severe SARS-COVID 19 Unmasks Chronic Lymphocytic Leukemia

Hyperleukocytosis and Pseudohyperkalemia in a Patient With Severe SARS-COVID 19 Unmasks Chronic Lymphocytic Leukemia

Management of patients with chronic lymphocytic leukemia during the SARS‑CoV‑2 pandemic (Review)

SARS-CoV-2 Omicron Variant in Patients With Chronic Myeloid Leukemia: A Retrospective Study

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