ABCL-274: Outcomes in Patients with Lymphoproliferative Diseases and COVID-19: Results of a Subgroup Analysis of the CHRONOS19 Registry

Abstract

BackgroundPatients (pts) with lymphoproliferative diseases (LPD) are at high risk of COVID-19 severe and lethal course.ObjectiveTo evaluate treatment outcomes and risk factors in pts with LPD and COVID-19 in a real-world setting.MethodsCHRONOS19 is an ongoing nationwide observational cohort study of adult (≥18 y) pts with hematologic disease and COVID-19. Data from 15 centers were collected on a web-based platform and managed in a de-identified manner. We performed a subgroup analysis of pts with LPD and COVID-19. Primary endpoint was 30-day all-cause mortality. Long-term follow-up was at 90 and 180 days.ResultsAs of data cutoff on April 14, 2021, 626 pts were included, 170 of them with LPD were eligible for primary endpoint assessment n(%): CLL – 64 (38%), Hodgkin lymphoma – 18 (10%), B-cell lymphomas aggressive/indolent – 49(29%) / 19(11%); M/F 96 (56%) / 74(44%), median age 56 [19–90] years, induction phase/R/R/remission 62(36%) / 68(40%) / 40(24%); comorbidities in 86 (51%) pts. Complications occurred in 126 (74%) pts; one-third had severe COVID-19, 25% were admitted to ICU, and 20% required mechanical ventilation. Comparative analysis of basic characteristics between pts with LPD and all other hematologic diseases did not reveal any significant clinical differences. All-cause mortality at 30 days was 14% in pts with LPD vs 15% in pts with other hematologic diseases (p=0.87); 86% of deaths were due to COVID-19 complications. Eight additional deaths due to COVID-19 at 90 days and 5 deaths due to LPD progression at 180 days occurred. In multivariate analysis, ICU + mechanical ventilation (HR, 71.99 [19.5–271.0]), and age ≥60 years (HR, 5.360 [1.08–11.8] were the most significant risk factors of death. COVID-19 affected treatment of LPD in 55% of pts, and 52% experienced treatment delay for a median of 4 [1–10] weeks. Early relapsed/refractory disease occurred in 5 of 170 (2.9%) pts; the association of relapses with impaired treatment is unknown. COVID-19 re-infection occurred in 1 patient. Data on antibodies after SARS-CoV-2 infection are available for 65 patients with LPD: anti-SARS-CoV-2 IgG was detected in 44 (66%) pts and only in 60% of pts with CD20-positive LPD vs 100% of pts with T-cell and Hodgkin lymphomas (p=0.004).ConclusionsThirty-day all-cause mortality in SARS-CoV-2-infected pts with LPD was comparable with other hematological diseases and higher than in the general population. Lower frequency of anti-SARS-CoV-2 IgG in CD20-positive patients is probably due to anti-CD20 therapy.