SARS‐CoV‐2 infection in patients with chronic lymphocytic leukemia: The Italian Hematology Alliance on COVID‐19 cohort

Abstract

COVID‐19, the disease caused by SARS‐CoV‐2, is still afflicting thousands of people across the globe. Few studies on COVID‐19 in chronic lymphocytic leukemia (CLL) are available. Here, we analyzed data from the CLL cohort of the Italian Hematology Alliance on COVID‐19 (NCT04352556), which included 256 CLL patients enrolled between 25 February 2020 and 1 February 2021. Median age was 70 years (range 38–94) with male preponderance (60.1%). Approximately half of patients ( n = 127) had received at least one line of therapy for CLL, including 108 (83.7%) who were on active treatment at the time of COVID‐19 or received their last therapy within 12 months. Most patients (230/256, 89.9%) were symptomatic at COVID‐19 diagnosis and the majority required hospitalization ( n = 176). Overall, after a median follow‐up of 42 days (IQR 24–96), case fatality rate was 30.1%, and it was 37.5% and 24.4% in the first (25 February 2020–22 June 2020) and second wave (23 June 2020–1 February 2021), respectively ( p = 0.03). At multivariate analysis, male sex (HR 1.82, 95% CI 1.03–3.24, p = 0.04), age over than 70 years (HR 2.23, 95% CI 1.23–4.05, p = 0.01), any treatment for CLL given in the last 12 months (HR 1.72, 95% CI 1.04–2.84, p = 0.04) and COVID‐19 severity (severe: HR 5.66, 95% CI 2.62–12.33, p < 0.0001; critical: HR 15.99, 95% CI 6.93–36.90, p < 0.0001) were independently associated with poor survival. In summary, we report a dismal COVID‐related outcome in a significant fraction of CLL patients, that can be nicely predicted by clinical parameters.

Repeated COVID‐19 vaccination to maximum antibody response yields very low mortality and hospitalisation rates in patients with CLL and MBL

“…First, the rates of COVID‐19 infection are significantly lower than the general Australian community (>90%) 12 suggesting that patients continue to practice COVID‐19 vigilance. Second, the rates of hospitalisation and death are dramatically lower than in early waves prior to vaccine availability, and remain lower following vaccine availability than rates reported in North America and Europe in late 2022, 2,3,13 with many vulnerable CLL patients succumbing to COVID‐19. These outcomes are also lower than those reported recently in the Omicron wave from Danish 4 and Israeli 14 data, and for the latter, comparable to the subgroup that received nirmatrelvir+ritonavir.…”

COVID-19 in patients with acute leukemia: 3 years' experience of pandemic

“…Среди пациентов с гемобластозами наиболее вы сокий риск тяжелого течения коронавирусной инфек ции и смерти от COVID19 наблюдается у пациентов с острыми лейкозами, хроническим лимфолейкозом, множественной миеломой и неходжкинскими лимфо мами [9][10][11][12][13][14][15][16][17]. Также одной из наиболее уязвимых групп пациентов с онкогематологическими заболеваниями показали себя больные, получавшие CARTтерапию (Chimeric Antigen Receptor Tcell), и пациенты после аллогенной трансплантации гематопоэтических ство ловых клеток, особенно в 1й год после транспланта ции [18,19].…”

Mortality associated to hematological malignancies across pandemic waves in 2020: A nationwide analysis of multiple causes of death in Italy

“…CLL patients are affected by suppression of both the B and T-adaptive immune response, which is further exacerbated by CLL-directed drugs, possibly justifying the peculiar survival disadvantage compared to other hematological neoplasms. Notably, in large multicentric studies, patients with advanced age and CLL-directed treatment were at increased risk of death following COVID-19 11,12. Study findings are limited by the unavailability of data from 2021 to 2022.…”