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COVID-19 severity and mortality in patients with CLL: an update of the international ERIC and Campus CLL study
Thomas Chatzikonstantinou1,2, Anargyros Kapetanakis2, Lydia Scarfò3
1Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece.
Insights
Patients with chronic lymphocytic leukemia (CLL) face higher risks from COVID-19. Untreated patients showed better survival outcomes compared to those receiving treatment, highlighting treatment impacts on COVID-19 prognosis.
Area of Science:
- Hematology
- Infectious Diseases
- Oncology
Background:
- Patients with chronic lymphocytic leukemia (CLL) exhibit increased vulnerability to infections, including Coronavirus disease 2019 (COVID-19), due to factors like age, the disease itself, and immunosuppression from treatments.
- Understanding the specific risks and outcomes associated with COVID-19 in CLL patients is crucial for managing this vulnerable population.
Purpose of the Study:
- To assess the risk factors influencing the outcomes of COVID-19 in patients with chronic lymphocytic leukemia.
- To determine the impact of treatments directed at CLL on the course and prognosis of COVID-19.
Main Methods:
- A retrospective, international study was conducted, gathering data from 91 centers worldwide.
- Data included 941 patients diagnosed with chronic lymphocytic leukemia and confirmed COVID-19, collected from the pandemic's start until March 16, 2021.
- Investigated risk factors for case fatality rate (CFR), disease severity, and overall survival (OS), with OS analysis focused on patients experiencing severe COVID-19.
Main Results:
- The case fatality rate (CFR) among patients with severe COVID-19 (requiring oxygen or ICU admission) was 38.4%.
- Overall survival (OS) was significantly poorer for patients undergoing CLL-directed treatments compared to untreated patients (p < 0.001).
- Untreated patients demonstrated a lower risk of death (HR=0.54), while older age and cardiac failure were identified as significant risk factors for mortality.
Conclusions:
- Age, undergoing CLL-directed treatment, and the presence of cardiac failure are significant risk factors impacting overall survival in CLL patients with COVID-19.
- Patients with chronic lymphocytic leukemia who were not receiving treatment for their condition had a better chance of survival following COVID-19 infection compared to those on active or recent treatment.
Abstract:
Patients with chronic lymphocytic leukemia (CLL) may be more susceptible to Coronavirus disease 2019 (COVID-19) due to age, disease, and treatment-related immunosuppression. We aimed to assess risk factors of outcome and elucidate the impact of CLL-directed treatments on the course of COVID-19. We conducted a retrospective, international study, collectively including 941 patients with CLL and confirmed COVID-19. Data from the beginning of the pandemic until March 16, 2021, were collected from 91 centers. The risk factors of case fatality rate (CFR), disease severity, and overall survival (OS) were investigated. OS analysis was restricted to patients with severe COVID-19 (definition: hospitalization with need of oxygen or admission into an intensive care unit). CFR in patients with severe COVID-19 was 38.4%. OS was inferior for patients in all treatment categories compared to untreated (p < 0.001). Untreated patients had a lower risk of death (HR = 0.54, 95% CI:0.41-0.72). The risk of death was higher for older patients and those suffering from cardiac failure (HR = 1.03, 95% CI:1.02-1.04; HR = 1.79, 95% CI:1.04-3.07, respectively). Age, CLL-directed treatment, and cardiac failure were significant risk factors of OS. Untreated patients had a better chance of survival than those on treatment or recently treated.
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