Pb2326: outcomes of anti-cancer therapy in patients with progressive refractory/relapsed b-cell lymphoma during severe coronavirus disease 2019 (covid-19): a real-world study from china

Topic: 19. Aggressive Non-Hodgkin lymphoma - Clinical Background: In patients with refractory or relapsed (R/R) B-cell lymphoma, the persistence of positive laboratory tests (polymerase chain reaction, PCR) was significantly prolonged and the timing of cancer treatment was significantly affected. There have been few clinical trials of cancer treatment in the setting of persistently positive PCR in R/R B-cell lymphoma. Aims: The purpose of this study was to evaluate the outcomes of COVID-19 and the prognosis of lymphoma in patients with R/R B-cell lymphoma after cancer treatments performed during the positive molecular phase of COVID-19. Methods: From December 2022 to February 2023, 40 patients with COVID-19 infection were enrolled. Median age was 33 (25-81) years. Diagnoses included DLBCL(NOS)(n=23), MCL(n=2),TFL(n=3), BL (n=3),and Other(n=9). 36/40 (90%) patients were at stage III-IV at the time of salvage therapy. The median IPI score was 2 (range 1-5). All patients were those with progressive disease who had failed multi-line therapy, including CD19 CAR -T therapy (n=30). Patients were heavily pretreated with a median of 6 (range 2-13) cycles of therapy. in 17/25 patients with COVID-19, therapy with CAR -T cells lasted less than 3 months, and in 6/25 of them less than 1 month.COVID-19 treatments included nirmatrelvir/ritonavir, azvudine, human immunoglobulin (PH4). Treatments with glucocorticoids and/or targeted interleukin-6 had severe COVID-19. To further reduce tumor burden, anti-cancer drugs were approved for patients with rapid tumor progression with COVID-19. Results: Weakness, cough, and fever occurred in 32/40 (80%), 22/40 (55%), and 23/40 (57.5%) of patients, respectively, and 10/40 (25%) had severe COVID-19. The median duration of persistent positive PCR was 32 days (4-58), with a median follow-up of 49 days (28-70).During follow-up, 14/40 (35%) patients had persistent positive PCR even after receiving COVID-19 treatment, and the number of those who had severe COVID-19 pneumonia was higher than those who had negative PCR (8/14, 57.1% vs2/26, 7.69%, p=0.0012).We found no increase in severe COVID-19 pneumonia and grade III-IV CRS in patients with positive molecules treated with CART within three months. Patients with COVID-19 showed decreased numbers of all T-cell subsets. The median CD4/CD8 ratio was 0.59 (range 0.12-1.65).Anti-cancer treatments were approved for 37/40 (92.5%) patients with rapid tumor progression to COVID -19, of whom 14/37 (37.8%) were treated with CAR -T and 23/37 (62.1%) received chemotherapy. The number of patients with persistently positive PCR was 13/37 (35.1%) in the treated cohort compared with 1/3 (33.3%) in the untreated cohort (P=0.337). 6/14 (42.8%) in the CART cohort and 7/23 (30.4%) in the chemotherapy cohort of patients with persistent positive PCR (P=0.49). There were 7/37 (18.9%) cases of severe COVID-19 in the treated cohort and 3/3 (100%) cases in the untreated cohort. After cancer treatment, 15/30 (50%) of evaluable patients had controlled progression of lymphoma. 3 patients (3/40, 7.5%) died of disease progression and 3 patients (3/40, 7.5%) died of severe and fatal COVID -19. Summary/Conclusion: Both tumor progression and COVID-19 may affect survival of patients with progressive R/R B-cell lymphoma, and anti-cancer drugs should be approved for R/R B-cell lymphoma patients with positive PCR. Keywords: Non-Hodgkin’s lymphoma, CAR-T, PCR, COVID-19