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

Blood. 2020 Sep 3;136(10):1134-1143. doi: 10.1182/blood.2020006965.

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.

Publication types

  • Clinical Trial
  • Multicenter Study

MeSH terms

  • 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*
  • Coronavirus Infections / therapy
  • Female
  • Humans
  • Immunization, Passive
  • Leukemia, Lymphocytic, Chronic, B-Cell / complications*
  • Leukemia, Lymphocytic, Chronic, B-Cell / therapy
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / therapy
  • Protein Kinase Inhibitors / therapeutic use
  • SARS-CoV-2
  • Survival Analysis
  • Treatment Outcome

Substances

  • Anti-Inflammatory Agents
  • Antiviral Agents
  • Protein Kinase Inhibitors
  • Agammaglobulinaemia Tyrosine Kinase
  • BTK protein, human

Supplementary concepts

  • COVID-19 serotherapy