TY - JOUR
T1 - Outcomes of COVID-19 in patients with CLL
T2 - a multicenter international experience
AU - Mato, Anthony R.
AU - Roeker, Lindsey E.
AU - Lamanna, Nicole
AU - Allan, John N.
AU - Leslie, Lori
AU - Pagel, John M.
AU - Patel, Krish
AU - Osterborg, Anders
AU - Wojenski, Daniel
AU - Kamdar, Manali
AU - Huntington, Scott F.
AU - Davids, Matthew S.
AU - Brown, Jennifer R.
AU - Antic, Darko
AU - Jacobs, Ryan
AU - Ahn, Inhye E.
AU - Pu, Jeffrey
AU - Isaac, Krista M.
AU - Barr, Paul M.
AU - Ujjani, Chaitra S.
AU - Geyer, Mark B.
AU - Berman, Ellin
AU - Zelenetz, Andrew D.
AU - Malakhov, Nikita
AU - Furman, Richard R.
AU - Koropsak, Michael
AU - Bailey, Neil
AU - Hanson, Lotta
AU - Perini, Guilherme F.
AU - Ma, Shuo
AU - Ryan, Christine E.
AU - Wiestner, Adrian
AU - Portell, Craig A.
AU - Shadman, Mazyar
AU - Chong, Elise A.
AU - Brander, Danielle M.
AU - Sundaram, Suchitra
AU - Seddon, Amanda N.
AU - Seymour, Erlene
AU - Patel, Meera
AU - Martinez-calle, Nicolas
AU - Munir, Talha
AU - Walewska, Renata
AU - Broom, Angus
AU - Walter, Harriet
AU - El-sharkawi, Dima
AU - Parry, Helen
AU - Wilson, Matthew R.
AU - Patten, Piers E. M.
AU - Hernández-rivas, José-ángel
AU - Miras, Fatima
AU - Fernández Escalada, Noemi
AU - Ghione, Paola
AU - Nabhan, Chadi
AU - Lebowitz, Sonia
AU - Bhavsar, Erica
AU - López-jiménez, Javier
AU - Naya, Daniel
AU - Garcia-marco, Jose Antonio
AU - Skånland, Sigrid S.
AU - Cordoba, Raul
AU - Eyre, Toby A.
PY - 2020/9/3
Y1 - 2020/9/3
N2 - Given advanced age, comorbidities, and immune dysfunction, chronic lymphocytic leukemia (CLL) patients may be at particularly high risk of infection and poor outcomes related to coronavirus disease 2019 (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 Cumulative Illness Rating Scale score was 8 (range, 4-32). Thirty-nine percent were treatment naive (“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 Bruton tyrosine kinase inhibitors (BTKi’s; n = 68/90 [76%]). At a median follow-up of 16 days, the overall case fatality rate was 33%, though 25% remain admitted. Watch-and-wait and treated cohorts had similar rates of admission (89% vs 90%), intensive care unit admission (35% vs 36%), intubation (33% vs 25%), and mortality (37% vs 32%). CLL-directed treatment with BTKi’s at COVID-19 diagnosis did not impact survival (case fatality rate, 34% vs 35%), though the BTKi was held during the 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 severe acute respiratory syndrome coronavirus 2 infection risk, these data should be validated independently, and randomized studies of BTKi’s in COVID-19 are needed to provide definitive evidence of benefit.
AB - Given advanced age, comorbidities, and immune dysfunction, chronic lymphocytic leukemia (CLL) patients may be at particularly high risk of infection and poor outcomes related to coronavirus disease 2019 (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 Cumulative Illness Rating Scale score was 8 (range, 4-32). Thirty-nine percent were treatment naive (“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 Bruton tyrosine kinase inhibitors (BTKi’s; n = 68/90 [76%]). At a median follow-up of 16 days, the overall case fatality rate was 33%, though 25% remain admitted. Watch-and-wait and treated cohorts had similar rates of admission (89% vs 90%), intensive care unit admission (35% vs 36%), intubation (33% vs 25%), and mortality (37% vs 32%). CLL-directed treatment with BTKi’s at COVID-19 diagnosis did not impact survival (case fatality rate, 34% vs 35%), though the BTKi was held during the 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 severe acute respiratory syndrome coronavirus 2 infection risk, these data should be validated independently, and randomized studies of BTKi’s in COVID-19 are needed to provide definitive evidence of benefit.
KW - Adult
KW - Agammaglobulinaemia Tyrosine Kinase/antagonists & inhibitors
KW - Aged
KW - Aged, 80 and over
KW - Anti-Inflammatory Agents/therapeutic use
KW - Antiviral Agents/therapeutic use
KW - Betacoronavirus/isolation & purification
KW - COVID-19
KW - Coronavirus Infections/complications
KW - Female
KW - Humans
KW - Immunization, Passive
KW - Leukemia, Lymphocytic, Chronic, B-Cell/complications
KW - Male
KW - Middle Aged
KW - Pandemics
KW - Pneumonia, Viral/complications
KW - Protein Kinase Inhibitors/therapeutic use
KW - SARS-CoV-2
KW - Survival Analysis
KW - Treatment Outcome
UR - http://www.scopus.com/inward/record.url?scp=85089864394&partnerID=8YFLogxK
UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7472711/
UR - https://europepmc.org/article/med/32688395
U2 - 10.1182/blood.2020006965
DO - 10.1182/blood.2020006965
M3 - Article
C2 - 32688395
SN - 0006-4971
VL - 136
SP - 1134
EP - 1143
JO - Blood
JF - Blood
IS - 10
ER -