COVID-19 severity and mortality in patients with chronic lymphocytic leukemia: a joint study by ERIC, the European Research Initiative on CLL, and CLL Campus

Abstract

Chronic lymphocytic leukemia (CLL) is a disease of the elderly, characterized by immunodeficiency. Hence, patients with CLL might be considered more susceptible to severe complications from COVID-19. We undertook this retrospective international multicenter study to characterize the course of COVID-19 in patients with CLL and identify potential predictors of outcome. Of 190 patients with CLL and confirmed COVID-19 diagnosed between 28/03/2020 and 22/05/2020, 151 (79%) presented with severe COVID-19 (need of oxygen and/or intensive care admission). Severe COVID-19 was associated with more advanced age (≥65 years) (odds ratio 3.72 [95% CI 1.79-7.71]). Only 60 patients (39.7%) with severe COVID-19 were receiving or had recent (≤12 months) treatment for CLL at the time of COVID-19 versus 30/39 (76.9%) patients with mild disease. Hospitalization rate for severe COVID-19 was lower (p < 0.05) for patients on ibrutinib versus those on other regimens or off treatment. Of 151 patients with severe disease, 55 (36.4%) succumbed versus only 1/38 (2.6%) with mild disease; age and comorbidities did not impact on mortality. In CLL, (1) COVID-19 severity increases with age; (2) antileukemic treatment (particularly BTK inhibitors) appears to exert a protective effect; (3) age and comorbidities did not impact on mortality, alluding to a relevant role of CLL and immunodeficiency.

Risk factors and outcome of COVID-19 in patients with hematological malignancies

“…The day 45 overall and COVID-19-related mortality in this series (29% and 27%, respectively) was comparable to other series of hematological patients [10][11][12], apparently higher than patients with solid tumors (13%) [37] and much higher than in the general population (2.3%) [38]. Somewhat surprising, however, was the lower mortality observed in SCT recipients, a patient group usually linked to the highest risk of death from opportunistic infections, including those caused by other CARV.…”

“…The outcomes of COVID-19 in patients with hematological disorders such as leukemia, lymphoma, myeloma and recipients of autologous (ASCT) or allogeneic hematopoietic stem cell transplantation (allo-SCT) are of utmost interest due to their high degree of humoral and cellular immunosuppression status. Recent studies have reported an overall COVID-19 related mortality of 32 to 40% in hematological patients [10][11][12][13][14]. Future challenges include the identification of prognostic factors that could help in risk assessment and decision-making for effective supportive care and antiviral therapy or in cases of limited access to ICU.…”

Chronic Lymphocytic Leukemia Concomitant with COVID 19: A Case Report

“…Another reason for the benign course can be the age of the patient. A recent study of CLL patients with COVID-19 infection showed increased mortality due to COVID-19 infection among participants with advanced age (median 75 years), which is much more compared to our patient’s 49 years [ 17 ].…”

Ibrutinib for chronic lymphocytic leukemia in the setting of respiratory failure from severe COVID‐19 infection: Case report and literature review

“…Most of the discontinuation decisions were due to concerns of the increased infections risks with BTK inhibitor use. On the other hand, hospitalization rate for severe COVID‐19 infections was significantly lower for CLL patients who were on ibrutinib prior to diagnosis compared with those on other CLL‐directed therapies or off therapy [9].…”