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This multicenter study was designed to report the outcomes of patients with chronic lymphocytic leukemia (CLL) and COVID-19 infection. Patients with CLL had high mortality rates, both those in the active treatment group and those treated with a "watch and wait” approach. The overall case-fatality rate was 33%. The use of a BTK inhibitor at diagnosis of COVID-19 infection did not influence the case fatality rate.
Patients with CLL and COVID-19 are at high risk of mortality, and further epidemiologic studies are needed to evaluate the risk of COVID-19 in this population.
– Neil Majithia, MD
This abstract is available on the publisher's site.
Given advanced age, comorbidities, and immune dysfunction, CLL patients may be at particularly high risk of infection and poor outcomes related to coronavirus disease-19 (COVID-19). Robust analysis of outcomes for CLL patients, particularly examining effects of baseline characteristics and CLL-directed therapy, is critical to optimally manage CLL patients through this evolving pandemic. CLL patients diagnosed with symptomatic COVID-19 across 43 international centers (n=198) were included. Hospital admission occurred in 90%. Median age at COVID-19 diagnosis was 70.5 years. Median CIRS score was 8 (range 4-32). Thirty-nine percent were treatment-naïve ("watch and wait") while 61% had received ≥1 CLL-directed therapy (median 2, range 1-8). Ninety patients (45%) were receiving active CLL therapy at COVID-19 diagnosis, most commonly BTK inhibitors (BTKi; n=68/90, 76%). At a median follow-up of 16 days, the overall case fatality rate (CFR) was 33%, though 25% remain admitted. "Watch and wait" and treated cohorts had similar rates of admission (89% vs. 90%), ICU admission (35% vs. 36%), intubation (33% vs. 25%), and mortality (37% vs. 32%). CLL-directed treatment with BTKi at COVID-19 diagnosis did not impact survival (CFR 34% vs. 35%), though BTKi was held during COVID-19 course for most patients. These data suggest that the subgroup of CLL patients admitted with COVID-19, regardless of disease phase or treatment status, are at high risk of death. Future epidemiologic studies are needed to assess SARS-CoV-2 infection risk, these data should be validated independently, and randomized studies of BTKi in COVID-19 are needed to provide definitive evidence of benefit.
Outcomes of COVID-19 in Patients With CLL: A Multicenter, International Experience
Blood 2020 Jul 20;[EPub Ahead of Print], AR Mato, LE Roeker, N Lamanna, J Allan, LA Leslie, JM Pagel, K Patel, A Osterborg, D Wojenski, M Kamdar, SF Huntington, MS Davids, JR Brown, D Antic, RW Jacobs, IE Ahn, JJ Pu, K Isaac, PM Barr, C Ujjani, MB Geyer, E Berman, AD Zelenetz, N Malakhov, RR Furman, M Koropsak, N Bailey, L Hansson, GF Perini, S Ma, CE Ryan, A Wiestner, CA Portell, M Shadman, EA Chong, DM Brander, S Sundaram, AN Seddon, E Seymour, M Patel, N Martinez-Calle, T Munir, R Walewska, A Broom, HS Walter, D El-Sharkawi, H Parry, MR Wilson, PE Patten, JÁ Hernández-Rivas, F Miras, N Fernández Escalada, P Ghione, C Nabhan, S Lebowitz, EB Bhavsar, J López-Jiménez, D Naya, JA Garcia-Marco, SS Skånland, R Cordoba, TA Eyre