Andrea Visentin, MD, PhD

Patients with chronic lymphocytic leukemia (CLL) infected with COVID-19 during the most recent phases of the pandemic had fewer hospitalizations, rarely required ICU admission, and rarely died as a result of COVID-19 compared with patients with CLL with COVID-19 in the early stages of the pandemic, according to findings published at ASH 2022.

“Previous studies by the European Research Initiative on CLL showed that patients with CLL have a very-high risk of severe COVID-19,” the researchers wrote. “In particular, age, CLL-directed treatment, and cardiac failure were identified as significant risk factors of overall survival (OS). Since the beginning of 2020, different treatment strategies have been used to fight COVID-19, and different SARS-CoV-2 variants alternated during the pandemic; however, very few studies analyzed their impact on patients with CLL.

Andrea Visentin, MD, PhD, and colleagues examined the manifestations, treatments, and outcomes associated with COVID-19 among patients with CLL/small lymphocytic lymphoma (SLL) and monoclonal B-cell lymphocytosis (MBL) in a retrospective, multicenter, international study from January 2020 through May 2022. They described the pandemic in four phases: 1) January 2020 through June 2020; 2) July 2020 through February 2021; 3) March 2021 through December 2021; and 4) January 2022 through May 2022.

Distribution of Infection & Outcomes Throughout Pandemic

The study included 1,540 patients, including 93.8% with CLL, 4.1% with SLL, and 2.1% with MBL (65% male). Median age at the time of COVID-19 infection was 69. Approximately half of patients (49.6%) were treated in the 12 months prior to COVID-19 infection, and 38.8% were receiving treatment at the time of COVID-19 onset.

Regarding COVID-19 treatment, 34.4% of patients was managed at home, 49.9% required hospitalization, and 15.7% were admitted to the ICU. After a median follow-up of 2.7 months, the infection resolved in 73% of cases; 23% of patients died and 3.6% were still under medical observation.

Most patients were infected with COVID-19 during the second (48%) and fourth (23.3%) phases. Fewer patients were infected during the first (19.8%) and third (8.9%) phases. Age at the time of COVID-19 infection and the distribution of biological markers was similar across phases, but more patients in the latter phases had arrhythmias (P=0.01), chronic renal disease (P=0.003), and other malignancies (P=0.04). Patients who had been vaccinated against COVID-19 and those who received treatment for CLL in the previous 12 months were also more common in the last phases (both P<0.001).

Better Outcomes Seen in Later Phases of Pandemic

Fever and dyspnea were less common in the later phases of the pandemic, but fatigue, cough, headache, anosmia/ageusia, and myalgia/arthralgia were more common (all P<0.001). Treatment for COVID-19 also evolved, with fewer patients receiving therapy in the later phases, and fewer patients were hospitalized, required ICU admission, or died through these phases. These improvements resulted in an increased OS, with 2-month OS rates of 70% in the first phase, 74% in the second, 81% in the third, and 83% in the fourth (P=0.0015).

“We analyzed one of the largest series of patients with CLL infected by SARS-CoV-2 over more than 2 years of [the] COVID-19 pandemic,” Dr. Visentin and colleagues wrote. “Patients infected during the most recent phases, though carrying a higher comorbidity burden, were less frequently hospitalized, only rarely needed ICU admission, and died due to the SARS-CoV-2 infection in a lower proportion compared to initial phases. The improvement in COVID-19 management with effective antiviral drugs, [monoclonal antibodies], and the high rate of vaccination together with the change in SARS-CoV-2 variants over time may have played an important role in this outcome.”