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SSRN; 2022.
Preprint in English | SSRN | ID: ppcovidwho-330643


Background: Biologic therapies that target B-cell function are effective for a range of medical conditions. Patients treated with such therapies do not reliably generate robust humoral responses which may increase their risk for severe viral infections, including SARS-CoV2.This study sought to characterize outcomes for patients previously treated with B-cell depleting drugs who were hospitalized with COVID-19 compared to similar patients by demographic background, comorbidities, clinical status and COVID19-specific treatment received. Methods: Registry data was reviewed to identify patients treated with B-cell depletion therapy who were hospitalized with COVID-19 from March 1, 2020 to November 30, 2021. 30-day mortality was the primary outcome, secondary outcomes included time to severe illness or death and time to clinical improvement. Overlap weighting method was applied to adjust for treatment bias, and Cox proportional-hazards models were used to analyze outcomes of interest. Age, BMI and COVID-19 specific medications were included in regression models as covariates. A prespecified subgroup analysis was conducted to examine effects in patients with B-cell treatment ≤ 90 days prior to COVID-19 hospitalization. Results 9,233 patients were admitted to the Johns Hopkins Medicine health system between March 1, 2020 and November 2021. 50 patients were identified that had been treated with B-cell depletion therapy who were hospitalized with COVID-19. 212 were selected as the control group via matching across selected variables. B-cell treated patients experienced a 30-day mortality of 6.0% compared to 4.2% in controls which was not statistically significant in overlap weight adjusted regression analysis, adjusted hazard ratio 1.13 (95%CI 0.23 to 5.48). The time to severe illness or death was 2.4 days (IQR 0.5 to 4.0 days) in the B-cell treated patients and 2.1 days (IQR 0.9 to 4.3 days) among controls, adjusted hazard ratio 1.01 (95% CI 0.47 to 2.18). Patients treated with B-cell depletion experienced a statistically significant longer time to clinical improvement, adjusted HR 0.66 (95% CI 0.47-0.94). The median time to improve or discharge was 6.3 days in B-cell depleted group (IQR 3.3 to 11.2 days) and 4.1 days in the matched control (IQR 2.1 to 7.7 days). These results were similar in subgroup analysis for patients who received B-cell depletion in the 90 days prior to hospitalization. Interpretation Patients treated with B-cell depletion were found to have more prolonged hospital courses however they did not experience higher mortality or a time to severe illness compared to controls. With appropriate close follow-up and clinical care, individuals can still receive life-saving B-cell depleting therapies in the middle of a pandemic. Further work should be devoted to characterizing the course of these patients considering new therapies and variants.

Leukemia ; 35(7): 1864-1872, 2021 07.
Article in English | MEDLINE | ID: covidwho-1216445


Standard treatment options in classic HCL (cHCL) result in high response rates and near normal life expectancy. However, the disease itself and the recommended standard treatment are associated with profound and prolonged immunosuppression, increasing susceptibility to infections and the risk for a severe course of COVID-19. The Hairy Cell Leukemia Foundation (HCLF) has recently convened experts and discussed different clinical strategies for the management of these patients. The new recommendations adapt the 2017 consensus for the diagnosis and management with cHCL to the current COVID-19 pandemic. They underline the option of active surveillance in patients with low but stable blood counts, consider the use of targeted and non-immunosuppressive agents as first-line treatment for cHCL, and give recommendations on preventive measures against COVID-19.

COVID-19/complications , Leukemia, Hairy Cell/therapy , COVID-19/epidemiology , COVID-19/pathology , COVID-19/virology , Consensus , Humans , Leukemia, Hairy Cell/complications , Pandemics , Practice Guidelines as Topic , SARS-CoV-2/isolation & purification , Severity of Illness Index