COVID-19 and fortuitous discovery of chronic lymphocytic leukemia: biological findings and therapeutic challenges

Чарра, Б.; Ellouadghiri, A.; Magramane, Abdellah; Kebbou, Touda; Damaan, Kenza; Maghfour, Abdeljabbar; Seddiki, K. Brahmi; Ezzouine, Hanane

doi:10.11604/pamj.2020.36.286.24361

Cited by 5 publications

(9 citation statements)

References 10 publications

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“…As the cases described by Charra et al. [16] in Morocco and Jin et al. [21] in China, it was concluded that the occurrence of lymphopenia, as a common finding of COVID-19, is in stark contrast to the occurrence of lymphocytosis in the context of CLL; therefore, the simultaneous occurrence of two diseases continues to challenge physicians in interpreting these changes.…”

Section: Resultsmentioning

confidence: 98%

Concurrent chronic lymphocytic leukemia and COVID-19: A comprehensive review of epidemiological, diagnostic, and therapeutic challenges

Roosta¹,

Behzadi²,

Askari³

et al. 2021

Leukemia Research Reports

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A comprehensive review of the literature on chronic lymphocytic leukemia (CLL) patients and recommendations regarding the evaluation and treatment of these patients was conducted. The overall prevalence of CLL and COVID-19 concurrence was found to be 0.6% (95%CI: 0.5% to 0.7%). Diagnostic interaction between CLL and COVID-19 remains a major challenge. Also, CLL patients have a lower rate of anti-SARS-CoV-2 IgG development. Evidences show the unacceptable therapeutic outcome in these patients. Although the CLL-COVID-19 occurrence is associated with adverse clinical consequences, no general and standard agreement has yet been presented for the management and treatment of this disease.

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Section: Resultsmentioning

confidence: 98%

Concurrent chronic lymphocytic leukemia and COVID-19: A comprehensive review of epidemiological, diagnostic, and therapeutic challenges

Roosta¹,

Behzadi²,

Askari³

et al. 2021

Leukemia Research Reports

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“…It is estimated that ~80% of patients with CLL are asymptomatic at the time of diagnosis and that 30% of them should never be treated (8,20). Some patients are diagnosed simultaneously with COVID-19 and CLL.…”

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

confidence: 99%

“…Untreated patients with CLL are considered to have a lower risk of infection than those who have undergone therapeutic interventions, but a higher risk compared with age-matched controls ( 5 ). Indeed, patients with CLL have a high risk of developing a severe form of COVID-19 ( 3 , 4 ), particularly if they are undergoing chemotherapy, due to the immunosuppressive effects of these regimens ( 4 , 8 ) and a result of hematological malignancy. Immunomodulatory agents also increase the risk of this viral infection and alter the response to treatment ( 9 ).…”

Section: Introductionmentioning

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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“…DISCUSSION CLL is the most common leukaemia in adults in the Western world and is categorized by the presence of the proliferation of mature clonal B cells in the bloodstream, bone marrow, lymph nodes and spleen, which is confirmed by flow cytometry. A majority (80%) of patients are asymptomatic at the time of diagnosis [5] . The SARS-CoV-2 pandemic has led to profound morbidity and mortality around the globe.…”

Section: Case Descriptionmentioning

confidence: 99%

“…Finally, the decision to continue, or discontinue, antileukaemic therapy should be made on an individual basis. FDA-approved therapy for CLL includes the use of Bruton tyrosine kinase inhibitors (BTKis) such as ibrutinib; purine analogues such as fludarabine and pentostatin; the anti-CD20 monoclonal antibodies obinutuzumab, ofatumumab and rituximab and alkylating agents such as bendamustine, chlorambucil and cyclophosphamide [5] . The BTK pathway is crucial for the development of several pro-inflammatory cytokines; thus, inhibiting this process leads to decreased release of cytokines and results in an anti-inflammatory effect.…”

Section: Case Descriptionmentioning

confidence: 99%

COVID-19-Induced Hyperleucocytosis in Chronic Lymphocytic Leukaemia

Singh

Ayad

Kaur

et al. 2021

European Journal of Case Reports in Internal Medicine

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus responsible for the current global pandemic, coronavirus disease 2019 (COVID-19). COVID-19 usually presents with respiratory symptoms but can affect multiple organ systems. A wide spectrum of complications can occur depending upon the comorbidities of patients. There is limited literature available regarding the presentation and outcome of COVID-19 in chronic lymphocytic leukaemia (CLL) patients. We report 2 cases of COVID-19-induced hyperleucocytosis (WBC count >100,000/?l) in CLL patients.

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COVID-19 and fortuitous discovery of chronic lymphocytic leukemia: biological findings and therapeutic challenges

Cited by 5 publications

References 10 publications

Concurrent chronic lymphocytic leukemia and COVID-19: A comprehensive review of epidemiological, diagnostic, and therapeutic challenges

Concurrent chronic lymphocytic leukemia and COVID-19: A comprehensive review of epidemiological, diagnostic, and therapeutic challenges

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

COVID-19-Induced Hyperleucocytosis in Chronic Lymphocytic Leukaemia

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