Outcome of SARS-CoV-2 infected polish patients with chronic lymphocytic leukemia

ABSTRACT

Introduction: The severe acute respiratory syndrome coronavirus (SARS-CoV-2) has become the cause of a worldwide pandemic. The clinical course of COVID-19 was reported to be more severe in patients with cancer, especially with hematological malignancies. Due to the impairment of the immune system, infections are the leading cause of death in patients with chronic lymphocytic leukemia (CLL). Methods: We performed an observational, retrospective study in polish hematological centers within the Polish Adult Leukemia Study Group analyzing the clinical course of SARSCoV- 2 infection in patients with CLL. Results and conclusions: The study group included 188 patients. The median age of the patients was 67.9 years (range 36-87) and 70 (37.2%) were men. The Median Eastern Cooperative Study Group (ECOG) score was 1 (range 0-4). At the time of SARS-CoV-2 infection, 29 (15.4%) patients were treatment-naïve, 41 (21.8%) have ended the treatment, whereas 118 (62.8%) were during the active phase of CLL therapy. The median number of lines of previous treatment regimens was 1 (range 0-7), whereas 24 (12.8%) patients received four or more treatment regimens. At the time of infection 51 patients (27.1%) were treated with Bruton's tyrosine kinase inhibitor (iBTK), 46 (24.5%) with anti-CD20 antibodies while 37 patients (19.7%) were during venetoclax therapy. In the analyzed cohort 111 patients (59.0%) required hospitalization and 50 patients (26.5%) died due to COVID- 19. Patients with poor performance status (ECOG >1), advanced age (≥65 years), low platelet count (<100 G/l), low hemoglobin levels (<10 g/dl), and elevated lactate dehydrogenase (LDH) were at increased risk of death due to SARSCoV- 2 infection. Poor performance status, low platelet count and hemoglobin levels, elevated LDH and advanced Binet stage at diagnosis were associated with the need for hospitalization for the purpose of COVID-19 treatment. Multivariate analysis revealed that independent factors associated with risk of hospitalization due to SARS-CoV-2 infection and its complications were presence of 17p deletion (p = 0.042), anti- CD20 antibody treatment (p = 0.01), low hemoglobin (p = 0.008) and platelet (p = 0.004) levels and elevated LDH (p = 0.0023). Interestingly, the CLL treatment status (treatment naïve vs. treated) or type of administered treatment (BTKi, anti-CD20, or venetoclax) had no impact on SARS-CoV-2 related risk of death. Univariate survival analysis showed that poor performance status (p = 0.02), advanced age (p = 0.04), low platelet count (p = 0.0012), low hemoglobin level (p = 0.0017) and elevated lactate dehydrogenase (p = 0.008) were associated with significantly shorter overall survival. Multivariate Cox regression analysis showed that only the low platelet count (p < 0.0001) and advanced age (p = 0.019) were associated with patients' shorter overall survival. Considering the abovementioned data, SARS-CoV-2 infection in patients with CLL is associated with the poor outcome regardless of administered CLL-directed treatment.