Clinical characteristics and outcome of SARS-CoV-2 infection in admitted patients with chronic lymphocytic leukemia from a single European country

Muntañola, A.; Villacampa, Guillermo; Hernández‐Rivas, José Ángel; Alonso, Rosalía; Mirás, Fatima; Osorio, Sonia; Baile, Mónica; Baltasar, Patricia; Jiménez, Javier López; Hernández‐Rodríguez, Inés; Valenciano, Susana; Alfayate, A.; Gimeno, Eva; Bárez, Abelardo; Oliveira, Ana Carla; Riaza, Rosalía; Romero, Pilar; Delgado, Julio; Yáñez, Lucrecia; Zabalza, Amaya; Torres, Ana; Gómez-Roncero, Ma Isabel; Crespo, Marta; Mateos-Mazón, Juan J.; Pérez, Sonia Trobajo; Andreu, Rafael; Labrador, Jorge; Ruiz, M.; Velasquez, César A; Terol, Ma José; Santiago, Raquel; Vidal, M J; García, Fiz Campoy; Villalón, Lucı́a; Muiña, Begoña; Soler, Josep Pubill; Serí, Cristina; Sánchez, Mónica; Cuesta, Amalia; Ramos, Rafael; Sánchez-Montalvà, Adrián; Ruiz‐Camps, Isabel; González, Marcos; Bosch, Francesc

doi:10.1186/s40164-020-00195-x

Cited by 11 publications

(13 citation statements)

References 9 publications

(19 reference statements)

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“…The COVID-19 pandemic complicates the current clinical practice for CLL patients, making it more challenging. CLL patients are a population particularly susceptible to SARS-CoV-2 infection, with a high fatality rate (~32–34%) [ 258 , 259 , 260 ]. This is not surprisingly, as many of these patients harbor high-risk factors for developing severe COVID-19 (age, comorbidities and immunodeficiency) [ 261 ].…”

Section: Treatmentmentioning

confidence: 99%

The Evolving Landscape of Chronic Lymphocytic Leukemia on Diagnosis, Prognosis and Treatment

et al. 2021

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The knowledge of chronic lymphocytic leukemia (CLL) has progressively deepened during the last forty years. Research activities and clinical studies have been remarkably fruitful in novel findings elucidating multiple aspects of the pathogenesis of the disease, improving CLL diagnosis, prognosis and treatment. Whereas the diagnostic criteria for CLL have not substantially changed over time, prognostication has experienced an expansion with the identification of new biological and genetic biomarkers. Thanks to next-generation sequencing (NGS), an unprecedented number of gene mutations were identified with potential prognostic and predictive value in the 2010s, although significant work on their validation is still required before they can be used in a routine clinical setting. In terms of treatment, there has been an impressive explosion of new approaches based on targeted therapies for CLL patients during the last decade. In this current chemotherapy-free era, BCR and BCL2 inhibitors have changed the management of CLL patients and clearly improved their prognosis and quality of life. In this review, we provide an overview of these novel advances, as well as point out questions that should be further addressed to continue improving the outcomes of patients.

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Section: Treatmentmentioning

confidence: 99%

The Evolving Landscape of Chronic Lymphocytic Leukemia on Diagnosis, Prognosis and Treatment

et al. 2021

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“…Out of 165 Spanish patients with CLL, 27% died during acute infection with and due to SARS-CoV-2 infection. Certain patients with CLL who died were under 60 years of age and had no associated conditions ( 31 ). The mortality of Spanish patients with CLL during SARS-CoV-2 infection was higher than that of patients without neoplasms or immunosuppression hospitalized at Vall d'Hebron University Hospital.…”

Section: Clinical Experience Of Patients With Cll During the Sars-cov-2 Pandemicmentioning

confidence: 99%

“…Age, lymphocytosis, and D-dimers were associated with overall survival in patients with CLL infected with SARS-CoV-2 ( 24 ). Therefore, a more active CLL disease, which manifests as a higher number of lymphocytes, may contribute to a greater vulnerability in these patients during this infection ( 31 ).…”

Section: Clinical Experience Of Patients With Cll During the Sars-cov-2 Pandemicmentioning

confidence: 99%

“…Amongst the inflammatory markers, ferritin and D-dimer were present at lower levels in patients with CLL during treatment with BTKi at the time of SARS-CoV-2 infection compared with patients who received other treatments, and this may be explained by the immunomodulatory effect of BTKi ( 31 ). Overall survival was the same in patients with CLL, regardless of whether they received treatment during the SARS-CoV-2 infection period.…”

Section: Treatment Of Patients With Cll During the Sars-cov-2 Pandemicmentioning

confidence: 99%

“…Overall survival was the same in patients with CLL, regardless of whether they received treatment during the SARS-CoV-2 infection period. This observation also includes the patients treated with BTKi, whose mortality rate did not differ from that of those to whom the ‘watch and wait’ strategy was applied ( 31 ).…”

Section: Treatment Of Patients With Cll During the Sars-cov-2 Pandemicmentioning

confidence: 99%

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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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SARS‐CoV‐2‐reactive antibody detection after SARS‐CoV‐2 vaccination in hematopoietic stem cell transplant recipients: Prospective survey from the Spanish Hematopoietic Stem Cell Transplantation and Cell Therapy Group

et al. 2021

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This is a multicenter prospective observational study that included a large cohort ( n = 397) of allogeneic (allo‐HSCT; ( n = 311) and autologous (ASCT) hematopoietic stem cell transplant ( n = 86) recipients who were monitored for antibody detection within 3–6 weeks after complete severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) vaccination from February 1, 2021, to July 20, 2021. Most patients ( n = 387, 97.4%) received mRNA‐based vaccines. Most of the recipients (93%) were vaccinated more than 1 year after transplant. Detectable SARS‐CoV‐2‐reactive antibodies were observed in 242 (78%) of allo‐HSCT and in 73 (85%) of ASCT recipients. Multivariate analysis in allo‐HSCT recipients identified lymphopenia < 1 × 10 9 /ml (odds ratio [OR] 0.33, 95% confidence interval [95% CI] 0.16–0.69, p = .003), active graft versus host disease (GvHD; OR 0.51, 95% CI 0.27–0.98, p = .04) and vaccination within the first year of transplant (OR 0.3, 95% CI 0.15–0.9, p = .04) associated with lower antibody detection whereas. In ASCT, non‐Hodgkin's lymphoma (NHL; OR 0.09, 95% CI 0.02–0.44, p = .003) and active corticosteroid therapy (OR 0.2, 95% CI 0.02–0.87, p = .03) were associated with lower detection rate. We report an encouraging rate of SARS‐CoV‐2‐reactive antibodies detection in these severe immunocompromised patients. Lymphopenia, GvHD, the timing of vaccine, and NHL and corticosteroids therapy should be considered in allo‐HSCT and ASCT, respectively, to identify candidates for SARS‐CoV‐2 antibodies monitoring.

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Clinical characteristics and outcome of SARS-CoV-2 infection in admitted patients with chronic lymphocytic leukemia from a single European country

Cited by 11 publications

References 9 publications

The Evolving Landscape of Chronic Lymphocytic Leukemia on Diagnosis, Prognosis and Treatment

The Evolving Landscape of Chronic Lymphocytic Leukemia on Diagnosis, Prognosis and Treatment

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

SARS‐CoV‐2‐reactive antibody detection after SARS‐CoV‐2 vaccination in hematopoietic stem cell transplant recipients: Prospective survey from the Spanish Hematopoietic Stem Cell Transplantation and Cell Therapy Group

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