Age, Recent Treatment Appear to Influence Severity of COVID-19 in Patients With CLL

Patients with chronic lymphocytic leukemia (CLL) who contract coronavirus disease 2019 (COVID-19) face more severe symptoms if they are older, though recent treatment with antileukemic agents appears to have a beneficial, rather than detrimental, effect on outcomes, a new study found. The study also suggests that the presence of comorbidities does not lead to higher mortality rates.

The retrospective analysis is based on 190 patients with CLL who had confirmed COVID-19 cases between late March and late May. The results were published in the journal Leukemia.

Corresponding author Kostas Stamatopoulos, MD, PhD, of the Center for Research and Technology Hellas, in Greece, wrote along with colleagues that CLL is a “paradigmatic example” of a malignancy that has been associated with impaired immune responses to pathogens, which they said could have negative impacts on outcomes when patients with CLL contract COVID-19. The investigators added that antileukemic treatments could further hamper the immune system’s ability to fight off a virus like SARS-CoV-2, though they said it’s not a straightforward proposition.

“On the other hand, the severity of COVID-19 and [multiorgan failure] occurrence seem to be related to clinical and laboratory parameters of inflammatory response (lymphopenia, hypoalbuminemia, higher levels of alanine aminotransferase, lactate dehydrogenase, C-reactive protein, ferritin, and D-dimer) and markedly higher levels of proinflammatory cytokines (interleukin-2 receptor, IL6, IL-10, and tumor necrosis factor-α),” they said. “On these grounds, therapies targeting inflammation (eg, IL6/IL6R antibodies or steroids) have been used and shown potential benefit in full-blown COVID-19 patients.”

In an effort to ascertain a real-world understanding of what patients with CLL who contract the virus should expect, Stamatopoulos and colleagues analyzed the 190 colleagues based on age, gender, and comorbidities; severity of COVID-19; and whether and how long ago they had been treated with antileukemic therapies.

The investigators found a strong majority (151, or 79%) of patients presented with severe symptoms, such as requiring oxygen or admission to an intensive care unit. Patients were more likely to have severe symptoms if they were aged 65 or older.

Recent treatment appeared to make a significant difference. Only 4 in 10 patients with severe symptoms had received antileukemic treatment within the past 12 months. However, among those with mild symptoms, 76.9% had undergone recent treatment. Among those with severe symptoms, the likelihood of hospitalization was lower if they had received therapy with ibrutinib (Imbruvica).

More than one-third (36.4%) of patients with severe symptoms died from COVID-19; versus just 1 of the 38 patients with mild symptoms succumbed.

Stamatopoulos and colleagues noted that the apparent link between age and mortality among patients with CLL tracks with known data from the general population. However, they said comorbidities did not appear to have a significant impact on whether a patient had mild or severe symptoms.

As for the impact of antileukemic therapies, the authors said a disproportionate percentage of their study population had been prescribed bruton kinase inhibitors. Thus, they did not have sufficient data to compare the impact of BTK inhibitors to other types of therapy.

Still, they said their data seems to support the idea that recent antileukemic therapy is beneficial against COVD-19.

“Altogether, these data seem to further underscore the possible protective role of specific targeted therapies against a dismal evolution of the SARS-CoV-2 infection,” they said.

Reference

Scarfò L, Chatzikonstantinou T, Rigolin GM, et al. COVID-19 severity and mortality in patients with chronic lymphocytic leukemia: a joint study by ERIC, the European Research Initiative on CLL, and CLL Campus. Leukemia. Published online July 9, 2020. doi:10.1038/s41375-020-0959-x