Outcomes of COVID-19 in patients with CLL: a multicenter international experience

Research output: Contribution to journalArticlepeer-review

Authors

  • Anthony R. Mato
  • Lindsey E. Roeker
  • Nicole Lamanna
  • John N. Allan
  • Lori Leslie
  • John M. Pagel
  • Krish Patel
  • Anders Osterborg
  • Daniel Wojenski
  • Manali Kamdar
  • Scott F. Huntington
  • Matthew S. Davids
  • Jennifer R. Brown
  • Darko Antic
  • Ryan Jacobs
  • Inhye E. Ahn
  • Jeffrey Pu
  • Krista M. Isaac
  • Paul M. Barr
  • Chaitra S. Ujjani
  • Mark B. Geyer
  • Ellin Berman
  • Andrew D. Zelenetz
  • Nikita Malakhov
  • Richard R. Furman
  • Michael Koropsak
  • Neil Bailey
  • Lotta Hanson
  • Guilherme F. Perini
  • Shuo Ma
  • Christine E. Ryan
  • Adrian Wiestner
  • Craig A. Portell
  • Mazyar Shadman
  • Elise A. Chong
  • Danielle M. Brander
  • Suchitra Sundaram
  • Amanda N. Seddon
  • Erlene Seymour
  • Meera Patel
  • Nicolas Martinez-calle
  • Talha Munir
  • Renata Walewska
  • Angus Broom
  • Harriet Walter
  • Dima El-sharkawi
  • Piers E. M. Patten
  • José-ángel Hernández-rivas
  • Fatima Miras
  • Noemi Fernández Escalada
  • Paola Ghione
  • Chadi Nabhan
  • Sonia Lebowitz
  • Erica Bhavsar
  • Javier López-jiménez
  • Daniel Naya
  • Jose Antonio Garcia-marco
  • Sigrid S. Skånland
  • Raul Cordoba
  • Toby A. Eyre

External organisations

  • Memorial Sloan Kettering Cancer Center
  • Columbia University Irving Medical Center/New York-Presbyterian Hospital
  • Weill Cornell Medicine and The New York Presbyterian Hospital, New York, NY, United States.
  • John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ;
  • Swedish Cancer Institute, Seattle, WA;
  • Karolinska Institutet
  • Northwestern University
  • University of Colorado
  • Yale University
  • Dana-Farber Cancer Institute
  • University of Belgrade
  • Levine Cancer Institute
  • National Institutes of Health
  • Upstate Cancer Center
  • Emily Couric Clinical Cancer Center, Charlottesville, VA;
  • University of Rochester
  • Fred Hutchinson Cancer Research Center
  • Hospital Israelita Albert Einstein, São Paulo, Brazil;
  • University of Pennsylvania
  • Duke University
  • Roswell Park Comprehensive Cancer Center, Buffalo, NY;
  • Rush University Medical Center
  • Wayne State University
  • Nottingham University Hospitals NHS Trust
  • MRC Human Genetics Unit, IGMM, Western General Hospital, Edinburgh, United Kingdom.
  • University of Leicester
  • Royal Marsden NHS Foundation Trust
  • Beatson West Scotland Cancer Centre
  • King’s College London
  • Hospital Universitario Infanta Leonor, Madrid, Spain;
  • University Hospital Doce de Octubre, Madrid, Spain;
  • Marques de Valdecilla University Hospital, Santander, Spain;
  • Caris Life Sciences, Irving, TX;
  • Hospital Ramon y Cajal
  • University Hospital Infanta Elena, Valdemoro, Madrid, Spain;
  • Puerta de Hierra-Majadahonda University Hospital, Madrid, Spain;
  • Fundacion Jimenez Diaz University Hospital
  • Oxford University Hospitals NHS Foundation Trust
  • Leeds Teaching Hospitals NHS Trust
  • University of Oslo
  • Royal Bournemouth Hospital

Abstract

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.

Details

Original languageEnglish
Pages (from-to)1134-1143
JournalBlood
Volume136
Issue number10
Early online date20 Jul 2020
Publication statusPublished - 3 Sep 2020

Keywords

  • Adult, Agammaglobulinaemia Tyrosine Kinase/antagonists & inhibitors, Aged, Aged, 80 and over, Anti-Inflammatory Agents/therapeutic use, Antiviral Agents/therapeutic use, Betacoronavirus/isolation & purification, COVID-19, Coronavirus Infections/complications, Female, Humans, Immunization, Passive, Leukemia, Lymphocytic, Chronic, B-Cell/complications, Male, Middle Aged, Pandemics, Pneumonia, Viral/complications, Protein Kinase Inhibitors/therapeutic use, SARS-CoV-2, Survival Analysis, Treatment Outcome