COVID-19 in patients with classic and variant hairy cell leukemia

Abstract

Hairy cell leukemia (HCL), like its variant HCLv, is a B-cell malignancy associated with decreased humoral immunity. We prospectively monitored the largest cohort of HCL/HCLv patients to date (n=503) for COVID-19 by symptoms, antibody, PCR and/or antigen-positivity. Fifty percent (253 of 503) of the HCL/HCLv patients (238 HCL, 15 HCLv) had evidence of COVID-19, with 210 (83%) of 253 testing positive by PCR or rapid-antigen. Of 43 without positive tests, all had nucleocapsid antibodies indicating COVID-19 exposure, 7 recalled no symptoms, and 36 had mild symptoms but without a positive test. Of the 210 testing positive, 23, 46, 129 and 12 occurred in 2020, 2021, 2022 and 2023, respectively. Of 210 testing positive, 175 began treatment for HCL/HCLv 0.4-429 (median 66) months before, and 132 had their last dose of anti-CD20 Mab 0.2-229 (median 63) months before. Two patients died, including a young woman beginning rituximab 2 months after 1st-line cladribine before vaccine availability. Nearly all HCL/HCLv patients recovered uneventfully from COVID-19 including those without vaccination or those with significant immunosuppression and recent treatment. However, decreased normal B-cells from HCL or treatment was associated with lower spike antibody levels as a response to COVID-19 (p=0.0094) and longer recovery time (p=0.0036). Thus, in a large cohort of HCL/HCLv and the first to determine relationships between COVID-19 outcome and immune markers, mortality was relatively low (~1%), sequelae were uncommon, and recovery from COVID-19 was longer if normal B-cells were low after recent treatment.

Hairy cell leukemia 2024: Update on diagnosis, risk‐stratification, and treatment—Annual updates in hematological malignancies

“…During the period of health crisis, the mortality rate related to severe acute respiratory syndrome (SARS)-coronavirus-2 (CoV-2) was rather low even among HCL patients with significant immunosuppression and recent treatment. 23 Autoimmune or unusual clinical manifestations are occasionally reported at diagnosis and/or relapse as bulky abdominal lymph nodes, pleural effusions and ascites, skin lesions 24 or destructive bone lesions, some of which can mimic multiple myeloma. [25][26][27] With the high frequency of routine PB analyses, hairy cells can also be detected in asymptomatic patients.…”

Recommendations for the Management of Patients with Hairy-Cell Leukemia and Hairy-Cell Leukemia-like Disorders: A Work by French-Speaking Experts and French Innovative Leukemia Organization (FILO) Group

“…In the same way, in case of pandemic periods such as COVID-19, it is preferable to delay HCL treatment and, if it is not possible, to recommend BRAFi as a bridging therapy [ 129 ]. However, a recently published study on the largest cohort of HCL/HCL-V patients with COVID-19 infection showed a low mortality rate (about 1%) [ 130 ].…”