Outcomes In Patients With Lymphoproliferative Diseases And Covid-19: Results Of A Subgroup Analysis Of The Chronos19 Registry

Background Patients (pts) with lymphoproliferative diseases (LPD) are at high risk of COVID-19 severe and lethal course. Objective To evaluate treatment outcomes and risk factors in pts with LPD and COVID-19 in a real-world setting. Methods CHRONOS19 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. Results As 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). Conclusions Thirty-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.