Outcomes of COVID-19 in patients with CLL: a multicenter international experience

Anthony R. Mato; Lindsey E. Roeker; Nicole Lamanna; John N. Allan; Lori Leslie; John M. Pagel; Krish Patel; Anders Osterborg; Daniel Wojenski; Manali Kamdar; Scott F. Huntington; Matthew S. Davids; Jennifer R. Brown; Darko Antic; Ryan Jacobs; Inhye E. Ahn; Jeffrey Pu; Krista M. Isaac; Paul M. Barr; Chaitra S. Ujjani; Mark B. Geyer; Ellin Berman; Andrew D. Zelenetz; Nikita Malakhov; Richard R. Furman; Michael Koropsak; Neil Bailey; Lotta Hanson; Guilherme F. Perini; Shuo Ma; Christine E. Ryan; Adrian Wiestner; Craig A. Portell; Mazyar Shadman; Elise A. Chong; Danielle M. Brander; Suchitra Sundaram; Amanda N. Seddon; Erlene Seymour; Meera Patel; Nicolas Martinez-Calle; Talha Munir; Renata Walewska; Angus Broom; Harriet Walter; Dima El-Sharkawi; Helen Parry; Matthew R. Wilson; Piers E.M. Patten; José Ángel Hernández-Rivas; Fatima Miras; Noemi Fernández Escalada; Paola Ghione; Chadi Nabhan; Sonia Lebowitz; Erica Bhavsar; Javier López-Jiménez; Daniel Naya; Jose Antonio Garcia-Marco; Sigrid S. Skånland; Raul Cordoba; Toby A. Eyre

doi:10.1182/blood.2020006965

Outcomes of COVID-19 in patients with CLL: a multicenter international experience

Anthony R. Mato, Lindsey E. Roeker, Nicole Lamanna, John N. Allan, Lori Leslie, John M. Pagel, Krish Patel, Anders Osterborg, Daniel Wojenski, Manali Kamdar, Scott F. Huntington, Matthew S. Davids, Jennifer R. Brown, Darko Antic, Ryan Jacobs, Inhye E. Ahn, Jeffrey Pu, Krista M. Isaac, Paul M. Barr, Chaitra S. UjjaniMark B. Geyer, Ellin Berman, Andrew D. Zelenetz, Nikita Malakhov, Richard R. Furman, Michael Koropsak, Neil Bailey, Lotta Hanson, Guilherme F. Perini, Shuo Ma, Christine E. Ryan, Adrian Wiestner, Craig A. Portell, Mazyar Shadman, Elise A. Chong, Danielle M. Brander, Suchitra Sundaram, Amanda N. Seddon, Erlene Seymour, Meera Patel, Nicolas Martinez-Calle, Talha Munir, Renata Walewska, Angus Broom, Harriet Walter, Dima El-Sharkawi, Helen Parry, Matthew R. Wilson, Piers E.M. Patten, José Ángel Hernández-Rivas, Fatima Miras, Noemi Fernández Escalada, Paola Ghione, Chadi Nabhan, Sonia Lebowitz, Erica Bhavsar, Javier López-Jiménez, Daniel Naya, Jose Antonio Garcia-Marco, Sigrid S. Skånland, Raul Cordoba, Toby A. Eyre

Research output: Contribution to journal › Article › peer-review

251 Scopus citations

Abstract

Given advanced age, comorbidities, and immune dysfunction, chronic lymphocytic leukemia (CLL) patients may be at particularly high risk of infection and poor outcomes related to coronavirus disease 2019 (COVID-19). Robust analysis of outcomes for CLL patients, particularly examining effects of baseline characteristics and CLL-directed therapy, is critical to optimally manage CLL patients through this evolving pandemic. CLL patients diagnosed with symptomatic COVID-19 across 43 international centers (n 5 198) were included. Hospital admission occurred in 90%. Median age at COVID-19 diagnosis was 70.5 years. Median Cumulative Illness Rating Scale score was 8 (range, 4-32). Thirty-nine percent were treatment naive (“watch and wait”), while 61% had received ‡1 CLL-directed therapy (median, 2; range, 1-8). Ninety patients (45%) were receiving active CLL therapy at COVID-19 diagnosis, most commonly Bruton tyrosine kinase inhibitors (BTKi’s; n 5 68/90 [76%]). At a median follow-up of 16 days, the overall case fatality rate was 33%, though 25% remain admitted.

mortality (37% vs 32%). CLL-directed treatment with BTKi’s at COVID-19 diagnosis did not impact survival (case fatality rate, 34% vs 35%), though the BTKi was held during the COVID-19 course for most patients. These data suggest that the subgroup of CLL patients admitted with COVID-19, regardless of disease phase or treatment status, are at high risk of death. Future epidemiologic studies are needed to assess severe acute respiratory syndrome coronavirus 2 infection risk, these data should be validated independently, and randomized studies of BTKi’s in COVID-19 are needed to provide definitive evidence of benefit.mortality (37% vs 32%). CLL-directed treatment with BTKi’s at COVID-19 diagnosis did not impact survival (case fatality rate, 34% vs 35%), though the BTKi was held during the COVID-19 course for most patients. These data suggest that the subgroup of CLL patients admitted with COVID-19, regardless of disease phase or treatment status, are at high risk of death. Future epidemiologic studies are needed to assess severe acute respiratory syndrome coronavirus 2 infection risk, these data should be validated independently, and randomized studies of BTKi’s in COVID-19 are needed to provide definitive evidence of benefit.

Original language	English (US)
Pages (from-to)	1134-1143
Number of pages	10
Journal	Blood
Volume	136
Issue number	10
DOIs	https://doi.org/10.1182/blood.2020006965
State	Published - Sep 3 2020
Externally published	Yes

ASJC Scopus subject areas

Biochemistry
Immunology
Hematology
Cell Biology

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10.1182/blood.2020006965

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Mato, A. R., Roeker, L. E., Lamanna, N., Allan, J. N., Leslie, L., Pagel, J. M., Patel, K., Osterborg, A., Wojenski, D., Kamdar, M., Huntington, S. F., Davids, M. S., Brown, J. R., Antic, D., Jacobs, R., Ahn, I. E., Pu, J., Isaac, K. M., Barr, P. M., ... Eyre, T. A. (2020). Outcomes of COVID-19 in patients with CLL: a multicenter international experience. Blood, 136(10), 1134-1143. https://doi.org/10.1182/blood.2020006965

Mato, AR, Roeker, LE, Lamanna, N, Allan, JN, Leslie, L, Pagel, JM, Patel, K, Osterborg, A, Wojenski, D, Kamdar, M, Huntington, SF, Davids, MS, Brown, JR, Antic, D, Jacobs, R, Ahn, IE, Pu, J, Isaac, KM, Barr, PM, Ujjani, CS, Geyer, MB, Berman, E, Zelenetz, AD, Malakhov, N, Furman, RR, Koropsak, M, Bailey, N, Hanson, L, Perini, GF, Ma, S, Ryan, CE, Wiestner, A, Portell, CA, Shadman, M, Chong, EA, Brander, DM, Sundaram, S, Seddon, AN, Seymour, E, Patel, M, Martinez-Calle, N, Munir, T, Walewska, R, Broom, A, Walter, H, El-Sharkawi, D, Parry, H, Wilson, MR, Patten, PEM, Hernández-Rivas, JÁ, Miras, F, Escalada, NF, Ghione, P, Nabhan, C, Lebowitz, S, Bhavsar, E, López-Jiménez, J, Naya, D, Garcia-Marco, JA, Skånland, SS, Cordoba, R & Eyre, TA 2020, 'Outcomes of COVID-19 in patients with CLL: a multicenter international experience', Blood, vol. 136, no. 10, pp. 1134-1143. https://doi.org/10.1182/blood.2020006965

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title = "Outcomes of COVID-19 in patients with CLL: a multicenter international experience",

abstract = "Given advanced age, comorbidities, and immune dysfunction, chronic lymphocytic leukemia (CLL) patients may be at particularly high risk of infection and poor outcomes related to coronavirus disease 2019 (COVID-19). Robust analysis of outcomes for CLL patients, particularly examining effects of baseline characteristics and CLL-directed therapy, is critical to optimally manage CLL patients through this evolving pandemic. CLL patients diagnosed with symptomatic COVID-19 across 43 international centers (n 5 198) were included. Hospital admission occurred in 90%. Median age at COVID-19 diagnosis was 70.5 years. Median Cumulative Illness Rating Scale score was 8 (range, 4-32). Thirty-nine percent were treatment naive (“watch and wait”), while 61% had received ‡1 CLL-directed therapy (median, 2; range, 1-8). Ninety patients (45%) were receiving active CLL therapy at COVID-19 diagnosis, most commonly Bruton tyrosine kinase inhibitors (BTKi{\textquoteright}s; n 5 68/90 [76%]). At a median follow-up of 16 days, the overall case fatality rate was 33%, though 25% remain admitted.mortality (37% vs 32%). CLL-directed treatment with BTKi{\textquoteright}s at COVID-19 diagnosis did not impact survival (case fatality rate, 34% vs 35%), though the BTKi was held during the COVID-19 course for most patients. These data suggest that the subgroup of CLL patients admitted with COVID-19, regardless of disease phase or treatment status, are at high risk of death. Future epidemiologic studies are needed to assess severe acute respiratory syndrome coronavirus 2 infection risk, these data should be validated independently, and randomized studies of BTKi{\textquoteright}s in COVID-19 are needed to provide definitive evidence of benefit.mortality (37% vs 32%). CLL-directed treatment with BTKi{\textquoteright}s at COVID-19 diagnosis did not impact survival (case fatality rate, 34% vs 35%), though the BTKi was held during the COVID-19 course for most patients. These data suggest that the subgroup of CLL patients admitted with COVID-19, regardless of disease phase or treatment status, are at high risk of death. Future epidemiologic studies are needed to assess severe acute respiratory syndrome coronavirus 2 infection risk, these data should be validated independently, and randomized studies of BTKi{\textquoteright}s in COVID-19 are needed to provide definitive evidence of benefit.",

author = "Mato, {Anthony R.} and Roeker, {Lindsey E.} and Nicole Lamanna and Allan, {John N.} and Lori Leslie and Pagel, {John M.} and Krish Patel and Anders Osterborg and Daniel Wojenski and Manali Kamdar and Huntington, {Scott F.} and Davids, {Matthew S.} and Brown, {Jennifer R.} and Darko Antic and Ryan Jacobs and Ahn, {Inhye E.} and Jeffrey Pu and Isaac, {Krista M.} and Barr, {Paul M.} and Ujjani, {Chaitra S.} and Geyer, {Mark B.} and Ellin Berman and Zelenetz, {Andrew D.} and Nikita Malakhov and Furman, {Richard R.} and Michael Koropsak and Neil Bailey and Lotta Hanson and Perini, {Guilherme F.} and Shuo Ma and Ryan, {Christine E.} and Adrian Wiestner and Portell, {Craig A.} and Mazyar Shadman and Chong, {Elise A.} and Brander, {Danielle M.} and Suchitra Sundaram and Seddon, {Amanda N.} and Erlene Seymour and Meera Patel and Nicolas Martinez-Calle and Talha Munir and Renata Walewska and Angus Broom and Harriet Walter and Dima El-Sharkawi and Helen Parry and Wilson, {Matthew R.} and Patten, {Piers E.M.} and Hern{\'a}ndez-Rivas, {Jos{\'e} {\'A}ngel} and Fatima Miras and Escalada, {Noemi Fern{\'a}ndez} and Paola Ghione and Chadi Nabhan and Sonia Lebowitz and Erica Bhavsar and Javier L{\'o}pez-Jim{\'e}nez and Daniel Naya and Garcia-Marco, {Jose Antonio} and Sk{\aa}nland, {Sigrid S.} and Raul Cordoba and Eyre, {Toby A.}",

year = "2020",

month = sep,

day = "3",

doi = "10.1182/blood.2020006965",

language = "English (US)",

volume = "136",

pages = "1134--1143",

journal = "Blood",

issn = "0006-4971",

publisher = "Elsevier B.V.",

number = "10",

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TY - JOUR

T1 - Outcomes of COVID-19 in patients with CLL

T2 - a multicenter international experience

AU - Mato, Anthony R.

AU - Roeker, Lindsey E.

AU - Lamanna, Nicole

AU - Allan, John N.

AU - Leslie, Lori

AU - Pagel, John M.

AU - Patel, Krish

AU - Osterborg, Anders

AU - Wojenski, Daniel

AU - Kamdar, Manali

AU - Huntington, Scott F.

AU - Davids, Matthew S.

AU - Brown, Jennifer R.

AU - Antic, Darko

AU - Jacobs, Ryan

AU - Ahn, Inhye E.

AU - Pu, Jeffrey

AU - Isaac, Krista M.

AU - Barr, Paul M.

AU - Ujjani, Chaitra S.

AU - Geyer, Mark B.

AU - Berman, Ellin

AU - Zelenetz, Andrew D.

AU - Malakhov, Nikita

AU - Furman, Richard R.

AU - Koropsak, Michael

AU - Bailey, Neil

AU - Hanson, Lotta

AU - Perini, Guilherme F.

AU - Ma, Shuo

AU - Ryan, Christine E.

AU - Wiestner, Adrian

AU - Portell, Craig A.

AU - Shadman, Mazyar

AU - Chong, Elise A.

AU - Brander, Danielle M.

AU - Sundaram, Suchitra

AU - Seddon, Amanda N.

AU - Seymour, Erlene

AU - Patel, Meera

AU - Martinez-Calle, Nicolas

AU - Munir, Talha

AU - Walewska, Renata

AU - Broom, Angus

AU - Walter, Harriet

AU - El-Sharkawi, Dima

AU - Parry, Helen

AU - Wilson, Matthew R.

AU - Patten, Piers E.M.

AU - Hernández-Rivas, José Ángel

AU - Miras, Fatima

AU - Escalada, Noemi Fernández

AU - Ghione, Paola

AU - Nabhan, Chadi

AU - Lebowitz, Sonia

AU - Bhavsar, Erica

AU - López-Jiménez, Javier

AU - Naya, Daniel

AU - Garcia-Marco, Jose Antonio

AU - Skånland, Sigrid S.

AU - Cordoba, Raul

AU - Eyre, Toby A.

PY - 2020/9/3

Y1 - 2020/9/3

N2 - Given advanced age, comorbidities, and immune dysfunction, chronic lymphocytic leukemia (CLL) patients may be at particularly high risk of infection and poor outcomes related to coronavirus disease 2019 (COVID-19). Robust analysis of outcomes for CLL patients, particularly examining effects of baseline characteristics and CLL-directed therapy, is critical to optimally manage CLL patients through this evolving pandemic. CLL patients diagnosed with symptomatic COVID-19 across 43 international centers (n 5 198) were included. Hospital admission occurred in 90%. Median age at COVID-19 diagnosis was 70.5 years. Median Cumulative Illness Rating Scale score was 8 (range, 4-32). Thirty-nine percent were treatment naive (“watch and wait”), while 61% had received ‡1 CLL-directed therapy (median, 2; range, 1-8). Ninety patients (45%) were receiving active CLL therapy at COVID-19 diagnosis, most commonly Bruton tyrosine kinase inhibitors (BTKi’s; n 5 68/90 [76%]). At a median follow-up of 16 days, the overall case fatality rate was 33%, though 25% remain admitted.mortality (37% vs 32%). CLL-directed treatment with BTKi’s at COVID-19 diagnosis did not impact survival (case fatality rate, 34% vs 35%), though the BTKi was held during the COVID-19 course for most patients. These data suggest that the subgroup of CLL patients admitted with COVID-19, regardless of disease phase or treatment status, are at high risk of death. Future epidemiologic studies are needed to assess severe acute respiratory syndrome coronavirus 2 infection risk, these data should be validated independently, and randomized studies of BTKi’s in COVID-19 are needed to provide definitive evidence of benefit.mortality (37% vs 32%). CLL-directed treatment with BTKi’s at COVID-19 diagnosis did not impact survival (case fatality rate, 34% vs 35%), though the BTKi was held during the COVID-19 course for most patients. These data suggest that the subgroup of CLL patients admitted with COVID-19, regardless of disease phase or treatment status, are at high risk of death. Future epidemiologic studies are needed to assess severe acute respiratory syndrome coronavirus 2 infection risk, these data should be validated independently, and randomized studies of BTKi’s in COVID-19 are needed to provide definitive evidence of benefit.

AB - Given advanced age, comorbidities, and immune dysfunction, chronic lymphocytic leukemia (CLL) patients may be at particularly high risk of infection and poor outcomes related to coronavirus disease 2019 (COVID-19). Robust analysis of outcomes for CLL patients, particularly examining effects of baseline characteristics and CLL-directed therapy, is critical to optimally manage CLL patients through this evolving pandemic. CLL patients diagnosed with symptomatic COVID-19 across 43 international centers (n 5 198) were included. Hospital admission occurred in 90%. Median age at COVID-19 diagnosis was 70.5 years. Median Cumulative Illness Rating Scale score was 8 (range, 4-32). Thirty-nine percent were treatment naive (“watch and wait”), while 61% had received ‡1 CLL-directed therapy (median, 2; range, 1-8). Ninety patients (45%) were receiving active CLL therapy at COVID-19 diagnosis, most commonly Bruton tyrosine kinase inhibitors (BTKi’s; n 5 68/90 [76%]). At a median follow-up of 16 days, the overall case fatality rate was 33%, though 25% remain admitted.mortality (37% vs 32%). CLL-directed treatment with BTKi’s at COVID-19 diagnosis did not impact survival (case fatality rate, 34% vs 35%), though the BTKi was held during the COVID-19 course for most patients. These data suggest that the subgroup of CLL patients admitted with COVID-19, regardless of disease phase or treatment status, are at high risk of death. Future epidemiologic studies are needed to assess severe acute respiratory syndrome coronavirus 2 infection risk, these data should be validated independently, and randomized studies of BTKi’s in COVID-19 are needed to provide definitive evidence of benefit.mortality (37% vs 32%). CLL-directed treatment with BTKi’s at COVID-19 diagnosis did not impact survival (case fatality rate, 34% vs 35%), though the BTKi was held during the COVID-19 course for most patients. These data suggest that the subgroup of CLL patients admitted with COVID-19, regardless of disease phase or treatment status, are at high risk of death. Future epidemiologic studies are needed to assess severe acute respiratory syndrome coronavirus 2 infection risk, these data should be validated independently, and randomized studies of BTKi’s in COVID-19 are needed to provide definitive evidence of benefit.

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Outcomes of COVID-19 in patients with CLL: a multicenter international experience

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