Outcomes of COVID-19 in Patients with CLL: A Multicenter, International Experience.
Given advanced age, comorbidities, and immune dysfunction, CLL patients may be at particularly high risk of infection and poor outcomes related to coronavirus disease-19 (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 CIRS score was 8 (range 4-32). Thirty-nine percent were treatment-naïve ("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 BTK inhibitors (BTKi; n=68/90, 76%). At a median follow-up of 16 days, the overall case fatality rate (CFR) was 33%, though 25% remain admitted. "Watch and wait" and treated cohorts had similar rates of admission (89% vs. 90%), ICU admission (35% vs. 36%), intubation (33% vs. 25%), and mortality (37% vs. 32%). CLL-directed treatment with BTKi at COVID-19 diagnosis did not impact survival (CFR 34% vs. 35%), though BTKi was held during 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 SARS-CoV-2 infection risk, these data should be validated independently, and randomized studies of BTKi in COVID-19 are needed to provide definitive evidence of benefit.
Mato, Anthony R; Roeker, Lindsey Elizabeth; Lamanna, Nicole; Allan, John; Leslie, Lori Ann; Pagel, John M; Patel, Krish; Osterborg, Anders; Wojenski, Daniel; Kamdar, Manali; Huntington, Scott F; Davids, Matthew S; Brown, Jennifer R; Antic, Darko; Jacobs, Ryan W; Ahn, Inhye E; Pu, Jeffrey J; Isaac, Krista; Barr, Paul M; Ujjani, Chaitra; Geyer, Mark Blaine; Berman, Ellin; Zelenetz, Andrew D; Malakhov, Nikita; Furman, Richard R; Koropsak, Michael; Bailey, Neil; Hansson, Lotta; Perini, Guilherme Fleury; Ma, Shuo; Ryan, Christine E; Wiestner, Adrian; Portell, Craig A; Shadman, Mazyar; Chong, Elise A; Brander, Danielle M; Sundaram, Suchitra; Seddon, Amanda N; Seymour, Erlene; Patel, Meera; Martinez-Calle, Nicolas; Munir, Talha; Walewska, Renata; Broom, Angus; Walter, Harriet Sarah; El-Sharkawi, Dima; Parry, Helen; Wilson, Matthew R; Patten, Piers E; Hernández-Rivas, José-Ángel; Miras, Fatima; Fernández Escalada, Noemi; Ghione, Paola; Nabhan, Chadi; Lebowitz, Sonia; Bhavsar, Erica B; López-Jiménez, Javier; Naya, Daniel; Garcia-Marco, Jose Antonio; Skånland, Sigrid S; Cordoba, Raul; and Eyre, Toby Andrew, "Outcomes of COVID-19 in Patients with CLL: A Multicenter, International Experience." (2020). Articles, Abstracts, and Reports. 3294.