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

被引:255
作者
Mato, Anthony R. [1 ]
Roeker, Lindsey E. [1 ]
Lamanna, Nicole [2 ]
Allan, John N. [3 ]
Leslie, Lori [4 ]
Pagel, John M. [5 ]
Patel, Krish [5 ]
Osterborg, Anders [6 ]
Wojenski, Daniel [7 ]
Kamdar, Manali [8 ]
Huntington, Scott F. [9 ]
Davids, Matthew S. [10 ]
Brown, Jennifer R. [10 ]
Antic, Darko [11 ]
Jacobs, Ryan [12 ]
Ahn, Inhye E. [13 ]
Pu, Jeffrey [14 ]
Isaac, Krista M. [15 ]
Barr, Paul M. [16 ]
Ujjani, Chaitra S. [17 ]
Geyer, Mark B. [1 ]
Berman, Ellin [1 ]
Zelenetz, Andrew D. [1 ]
Malakhov, Nikita [3 ]
Furman, Richard R. [3 ]
Koropsak, Michael [4 ]
Bailey, Neil [5 ]
Hanson, Lotta [6 ]
Perini, Guilherme F. [18 ]
Ma, Shuo [7 ]
Ryan, Christine E. [10 ]
Wiestner, Adrian [13 ]
Portell, Craig A. [15 ]
Shadman, Mazyar [17 ]
Chong, Elise A. [19 ]
Brander, Danielle M. [20 ]
Sundaram, Suchitra [21 ]
Seddon, Amanda N. [22 ]
Seymour, Erlene [23 ]
Patel, Meera [23 ]
Martinez-Calle, Nicolas [24 ]
Munir, Talha [25 ]
Walewska, Renata [26 ]
Broom, Angus [27 ]
Walter, Harriet [28 ]
El-Sharkawi, Dima [29 ]
Parry, Helen [30 ]
Wilson, Matthew R. [31 ]
Patten, Piers E. M. [32 ]
Hernandez-Rivas, Jose-angel [33 ]
机构
[1] Mem Sloan Kettering Canc Ctr, 1275 York Ave, New York, NY 10065 USA
[2] Columbia Univ, Med Ctr, New York, NY USA
[3] Weill Cornell Med, New York Presbyterian Hosp, New York, NY USA
[4] Hackensack Univ, Med Ctr, John Theurer Canc Ctr, Hackensack, NJ USA
[5] Swedish Canc Inst, Seattle, WA USA
[6] Karolinska Inst, Solna, Sweden
[7] Northwestern Univ, Robert H Lurie Comprehens Canc Ctr, Chicago, IL 60611 USA
[8] Univ Colorado, Ctr Canc, Aurora, CO USA
[9] Yale Univ, Dept Internal Med, Div Hematol & Oncol, New Haven, CT USA
[10] Dana Farber Canc Inst, Boston, MA 02115 USA
[11] Univ Belgrade, Clin Ctr Serbia, Belgrade, Serbia
[12] Atrium Hlth, Levine Canc Inst, Charlotte, NC USA
[13] NHLBI, NIH, Bldg 10, Bethesda, MD 20892 USA
[14] Upstate Canc Ctr, Syracuse, NY USA
[15] Emily Couric Clin Canc Ctr, Charlottesville, VA USA
[16] Univ Rochester, Wilmot Canc Inst, Rochester, NY USA
[17] Fred Hutchinson Canc Res Ctr, 1124 Columbia St, Seattle, WA 98104 USA
[18] Hosp Israelita Albert Einstein, Sao Paulo, Brazil
[19] Univ Penn, Abramson Canc Ctr, Philadelphia, PA 19104 USA
[20] Duke Univ, Sch Med, Dept Internal Med, Div Hematol & Oncol, Durham, NC USA
[21] Roswell Park Comprehens Canc Ctr, Buffalo, NY USA
[22] Rush Univ, Med Ctr, Chicago, IL 60612 USA
[23] Wayne State Univ, Karmanos Canc Inst, Detroit, MI USA
[24] Nottingham Univ Hosp NHS Trust, Nottingham, England
[25] St James Univ Hosp, Leeds, W Yorkshire, England
[26] Royal Bournemouth Hosp, Bournemouth, Dorset, England
[27] Western Gen Hosp, Edinburgh, Midlothian, Scotland
[28] Leicester Royal Infirm, Leicester, Leics, England
[29] Royal Marsden Hosp, London, England
[30] Univ Birmingham, Dept Internal Med, Div Hematol & Oncol, Birmingham, W Midlands, England
[31] Beatson West Scotland Canc Ctr, Glasgow, Lanark, Scotland
[32] Kings Coll London, Comprehens Canc Ctr, London, England
[33] Hosp Univ Infanta Leonor, Madrid, Spain
[34] Univ Hosp Doce Octubre, Madrid, Spain
[35] Marques Valdecilla Univ Hosp, Santander, Spain
[36] Caris Life Sci, Irving, TX USA
[37] Univ Hosp Ramon & Cajal, Madrid, Spain
[38] Univ Hosp Infanta Elena, Madrid, Spain
[39] Puerta Hierra Majadahonda Univ Hosp, Madrid, Spain
[40] Univ Oslo, Inst Canc Res, Dept Canc Immunol, Oslo, Norway
[41] Fdn Jimenez Diaz Univ Hosp, Madrid, Spain
[42] Oxford Univ Hosp NHS Fdn Trust, Dept Haematol, Oxford, England
基金
美国国家卫生研究院;
关键词
D O I
10.1182/blood.2020006965
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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 COVI D-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.
引用
收藏
页码:1134 / 1143
页数:10
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