COVID-19 in patients with CLL: improved survival outcomes and update on management strategies

Roeker, Lindsey E.; Eyre, Toby A.; Thompson, Meghan C.; Lamanna, Nicole; Coltoff, Alexander; Davids, Matthew S.; Baker, Peter; Leslie, Lori A.; Rogers, Kerry A.; Allan, John N.; Córdoba, Raúl; López‐García, Alberto; Antić, Darko; Pagel, John M.; Martínez‐Calle, Nicolás; García-Marco, José A.; Hernández-Rivas, José-Ángel; Mirás, Fatima; Coombs, Catherine C.; Österborg, Anders; Hansson, Lotta; Seddon, Amanda N.; López‐Jiménez, Javier; Wilson, Matthew R.; El‐Sharkawi, Dima; Wojenski, Daniel; Ma, Shuo; Munir, Talha; Valenciano, Susana; Seymour, Erlene; Barr, Paul M.; Pu, Jeffrey J.; Patten, Piers; Perini, Guilherme Fleury; Huntington, Scott F.; Parry, Helen; Sundaram, Suchitra; Skarbnik, Alan P; Kamdar, Manali; Jacobs, Ryan; Walter, Harriet S.; Walewska, Renata; Broom, Angus; Lebowitz, Sonia; Isaac, Krista; Portell, Craig A.; Ahn, Inhye E.; Ujjani, Chaitra S.; Shadman, Mazyar; Skånland, Sigrid S.; Chong, Elise A.; Mato, Anthony R.

doi:10.1182/blood.2021011841

Cited by 61 publications

(79 citation statements)

References 23 publications

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“…10,11 The ICU admission rates in general were lower than previously reported in international cohorts of COVID-19 in CLL (26% to 37% for hospitalized patients). 1,2 This could be due to the full implementation of early treatment with mAbs, almost universal treatment with remdesivir for hospitalized patients without renal failure and high vaccination rates.…”

Section: Resultsmentioning

confidence: 99%

Patients with CLL have similar high risk of death upon the omicron variant of COVID-19 as previously during the pandemic

Niemann

Cunha‐Bang

Helleberg

et al. 2022

Preprint

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Previous studies have shown that patients with chronic lymphocytic leukemia (CLL) and coronavirus disease 2019 (COVID-19) have high mortality rates. The omicron variant has been reported to give milder disease in the general population, but outcomes of infections with the omicron variant among immunocompromised patients have not previously been reported. In a population-based cohort we assessed rates of hospitalizations, ICU-admissions, and 30-day all-cause mortality among all patients with CLL from Eastern Denmark testing positive for severe adult respiratory syndrome coronavirus 2 (SARS-CoV-2) in time periods before and after dominance of the omicron variant. Rates of hospitalizations and ICU-admissions declined significantly, whereas 30-day mortality remained as high as 23% in the period with dominance of the omicron sublineage BA.2 variant. Thus, patients with CLL in general and in particular those above 70 years of age with one or more comorbidities should be considered for closer monitoring and pre-emptive antiviral therapy upon a positive SARS-CoV-2 test.

show abstract

Section: Resultsmentioning

confidence: 99%

Patients with CLL have similar high risk of death upon the omicron variant of COVID-19 as previously during the pandemic

Niemann

Cunha‐Bang

Helleberg

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…Data from the European Research Initiative on CLL (ERIC) show that in CLL patients with confirmed COVID‐19, 79% developed severe disease and required hospitalisation and 36.4% died 16 . Even in recent waves of the disease, mortality rates of 11% have been typical 17 . Prolonged live virus shedding of SARS‐CoV‐2 has also been documented in CLL 18,19 …”

Section: Introductionmentioning

confidence: 99%

“…16 Even in recent waves of the disease, mortality rates of 11% have been typical. 17 Prolonged live virus shedding of SARS-CoV-2 has also been documented in CLL. 18,19 Since the advent of COVID-19 vaccines, CLL patients have been included in national and global vaccination programmes.…”

mentioning

confidence: 99%

COVID‐19 vaccine failure in chronic lymphocytic leukaemia and monoclonal B‐lymphocytosis; humoural and cellular immunity

Shen

Freeman

Holland³

et al. 2022

Br J Haematol

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Summary Chronic lymphocytic leukaemia (CLL) is associated with immunocompromise and high risk of severe COVID‐19 disease and mortality. Monoclonal B‐cell lymphocytosis (MBL) patients also have immune impairment. We evaluated humoural and cellular immune responses in 181 patients with CLL (160) and MBL (21) to correlate failed seroconversion [<50 AU/ml SARS‐CoV‐2 II IgG assay, antibody to spike protein; Abbott Diagnostics)] following each of two vaccine doses with clinical and laboratory parameters. Following first and second doses, 79.2% then 45% of CLL, and 50% then 9.5% of MBL patients respectively remained seronegative. There was significant association between post dose two antibody level with pre‐vaccination reduced IgM (p < 0.0001), IgG2 (p < 0.035), and IgG3 (p < 0.046), and CLL therapy within 12 months (p < 0.001) in univariate analysis. By multivariate analysis, reduced IgM (p < 0.0002) and active therapy (p < 0.0002) retained significance. Anti‐spike protein levels varied widely and were lower in CLL than MBL patients, and both lower than in normal donors. Neutralisation activity showed anti‐spike levels <1000 AU/ml were usually negative for both an early viral clade and the contemporary Delta variant and 72.9% of CLL and 53.3% of MBL failed to reach levels ≥1000 AU/ml. In a representative sample, ~80% had normal T‐cell responses. Failed seroconversion occurred in 36.6% of treatment‐naïve patients, in 78.1% on therapy, and in 85.7% on ibrutinib.

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“…Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is of special concern to patients with chronic lymphocytic leukemia (CLL). 1,2 Over time individuals with CLL experience impaired B-cell function and antibody production, leaving patients at increased risk of severe infection or death. Patients with CLL suffer immune dysregulation from the disease, which is further disrupted by the effects of CLL specific treatments.…”

mentioning

confidence: 99%

Cellular and humoral immune response to mRNA COVID-19 vaccination in subjects with chronic lymphocytic leukemia

Lyski¹,

Kim

Lee³

et al. 2022

Blood Advances

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COVID-19 in patients with CLL: improved survival outcomes and update on management strategies

Cited by 61 publications

References 23 publications

Patients with CLL have similar high risk of death upon the omicron variant of COVID-19 as previously during the pandemic

Patients with CLL have similar high risk of death upon the omicron variant of COVID-19 as previously during the pandemic

COVID‐19 vaccine failure in chronic lymphocytic leukaemia and monoclonal B‐lymphocytosis; humoural and cellular immunity

Cellular and humoral immune response to mRNA COVID-19 vaccination in subjects with chronic lymphocytic leukemia

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