Marginal lymphoma and COVID-19: features of clinical presentation and outcome

ABSTRACT

There is now sufficient evidence to show conclusively that, together with various comorbidities, the presence of a malignancy, especially of haematopoietic nature, significantly worsens the course and prognosis of the new coronavirus infection COVID-19 caused by SARSCoV-2. It has been shown that of great importance for the outcome of COVID-19 is the variant of the disease, the type of antitumour treatment and its stage (primary diagnosis, remission, relapse). The national and international literature presents generalised data, which combine large cohorts of patients with tumour and COVID-19, without detailing individual immunomorphological variants and peculiarities of the course of the viral infection. An analysis of the course of COVID-19 in patients with a previous immunodeficiency state caused by another viral infection, in particular viral hepatitis C and associated non-Hodgkin lymphoma, seems to us a particularly relevant and understudied problem. The aim of our study was to assess the incidence and impact of COVID-19 on the course and outcome in patients with hepatitis C-associated marginal zone lymphoma (HCV+MZL) and patients with marginal zone lymphoma (MZL). Materials and methods: A total of 27 patients with HCV+MZL and 32 patients with MZL were included in the study. The HCV+MZL group of 27 patients (group 1) received interferon and ribavirin therapy for an average of 24 months (12-36 months). The MZL group of patients (group 2) 32 received immunochemotherapy. Clinical characteristics of patients in groups 1 and 2 differed significantly median age was 43 and 58 years ( p = 0.005), 74% and 52%, respectively, had advanced stage III-IV disease ( p = 0.01). The incidence of splenic form was 54% in group 1 and 27% in group 2 ( p = 0.005). Results: In HCV+MZL patients treated with interferon (group 1), COVID-19 infection was diagnosed in two cases during the pandemic and in one patient was found to have a high titre of antibodies to COVID-19 (3 of 27 -11% total). The age of the patients was 47 and 76 years. Both patients developed COVID-19 infection on the background of relapsed HCV+MZL, which required administration of rituximab. One patient, due to the severity of the respiratory syndrome and the extent of lung tissue damage, was hospitalized and died on day 7 against the background of increasing respiratory failure. All MZL group 2 patients had completed immunochemotherapy by the time of the COVID-19 pandemic. During the pandemic, COVID-19 infection was diagnosed in 21 patients, and two patients had a high titre of antibodies to COVID-19 at routine examination (23 of 32 patients = 72%). The age ranged from 33 to 76 years (median age 61 years). Fifteen patients (47%) were hospitalized for 10 to 23 days (median 14 days) because of severity of respiratory syndrome, extent of lung tissue involvement and comorbidities. Of 23 patients with COVID-19 seven patients died against the background of increasing respiratory failure (22%). Thus the incidence of infection with COVID-19 was 11% and 72% respectively ( p > 0.001), with a moderate and severe course of infection in 4% and 47% ( p > 0.005), the mortality rate of COVID-19 was 4% and 22% respectively ( p = 0.01). Conclusion: Patients with marginal zone lymphoma have a high risk of morbidity and a severe course of the new coronavirus infection COVID-19. In a pandemic setting, interferon alpha therapy is the safest and preferred treatment option in this patient population..