Close monitoring is recommended despite the reduced risk of COVID-19 mortality in CLL

Patients with chronic lymphocytic leukemia (CLL) have been reported to have low mortality during the Omicron wave of the COVID-19 pandemic, but if the SARS-CoV-2 test is positive, especially in close patients, meticulous Good monitoring and preemptive antiviral therapy are still recommended.Hospital contacts and contacts over the age of 70 with at least one comorbidity, according to data from a study published in blood..¹

The findings showed that hospitalization and intensive care unit (ICU) hospitalization rates were significantly reduced, but 30-day mortality reached 23% during the height of the Omicron subline BA.2 variant. did. However, in a larger population-based cohort of CLL patients, including the hospital cohort, the 30-day mortality rate was 2%.

“Omicron variants have been reported to cause mild illness to the general public. No outcomes have been reported for immunocompromised patients,” said lead research author Rigshospitalet’s clinical associate in Copenhagen, Denmark. Professor and Senior Researcher Carsten Niemann, MD, PhD, and co-authors write in this publication. “Here, hospital-based and population-based data on results[s] CLL infected with the Omicron variant of SARS-CoV-2 requires close monitoring and preemptive treatment if the SARS-CoV-2 test is positive for patients with CLL and frequent hospital contact. is. Other CLL patients can expect a mild course of COVID-19. “

Previous data show high mortality in CLL patients diagnosed with COVID-19. In the general population, mild disease course due to Omicron mutants has been reported, but the outcome of immunocompromised patients is poorly understood.

Therefore, researchers found that in a cohort of Danish CLL patients using the SARS-CoV-2 polymerase chain reaction (PCR) test, the time from admission to admission to ICU and 30 after SARS-CoV-2 infection. We evaluated the daily mortality rate. From the Electronic Medical Record (EHR) from March 2020 to January 2022 (EHR Cohort).

In addition, the researchers investigated a population cohort consisting of patients whose diagnosis of CLL was registered in the Danish CLL registry and identified as positive for the SARS-CoV-2 PCR test through the PERSIMUNE treatment database.

Due to the lack of data on mutations in most patients, researchers grouped patients into four time periods based on the initial positive SARS-CoV-2 test. From March 2020 to December 2020 (Period 1). From January 1, 2021 to November 25, 2021 (Period 2). From November 26, 2021 to December 31, 2021 (Period 3). And from January 1, 2022 to January 28, 2022 (Period 4).

By January 28, 2022, 151 patients in the EHR cohort had 153 COVID-19s, which were confirmed to be positive by PCR. In addition, 640 patients in the population cohort tested positive for PCR.

A total of 59, 40, 32, and 22 patients in the EHR cohort underwent positive PCR tests for periods 1, 2, 3, and 4, respectively. In the population cohort, 24, 66, 73, and 477 patients underwent positive PCR tests for periods 1, 2, 3, and 4, respectively.

No significant difference in baseline characteristics was reported between the four periods. However, patients in the EHR cohort were significantly older than those in the population cohort (P = .0052); Patients in the EHR cohort were diagnosed with CLL much more recently than patients in the population cohort (.P = .024). Similar proportions of patients with EHR and population cohorts were treated with CLL at 39% (n = 43/109) and 30% (n = 190/640), respectively, before testing positive for COVID-19. Was (P = .054).

Additional findings show that in the EHR cohort, hospitalization rates for COVID-19 patients peaked during periods 3 and 4 of the appearance of omicrons, and during the second period compared to the period during which preemptive monoclonal antibodies were administered. Showed that it was more than 75% higher. hospitalized patient(P <.014). Monoclonal antibodies were also administered during outpatient visits during periods 3 and 4. This reflects a 30-day hospitalization rate of 56% to 60% compared to 83% for period 2.

ICU admission peaked before the onset of omniclon, ranging from 12% to 12.5% ​​compared to 0% to 3% in the previous period.

In the EHR cohort, 30-day overall survival (OS) ranges from 77% to 91% over all four periods, compared to the 64% to 73% OS rates reported in the first part of the pandemic. did.

For variants, 5 of the 6 patients who died in period 3 had the delta mutation.

Five patients who died within 30 days of a period 4 positive PCR test were 71 years or older and all had comorbidities, including dementia, other malignancies, diabetes, and comorbid heart and lung disease. rice field. Four of these five cases had Omicron variants. In the last case, there was no variant data. Three of these five patients died of respiratory failure and two died at home without a known cause of death. Treatment included monoclonal antibodies and dexamethasone (n = 2) and remdesivir (n = 1). The other three fatal cases did not receive COVID-19 specific treatment.

In particular, the 30-day survival rate increased from 93.9% to 94.5% and 99.2%, respectively, during periods 2 to 4 of the population cohort. No deaths were reported during period 1, during which time the population study was initiated (P <.002). In both the EHR cohort and the population cohort, the 30-day OS rate increased from 88.0% to 89.6%, 93.3%, and 98.2% from 88.0% to 89.6%, respectively, and the OS for Omicron BA.2 and period 1 was significantly higher. rice field. From 3 (P ≤.0077).

reference

1. Patients with Niemann CU, Cunha-Bang CD, Helleberg M, and other CLLs have a lower risk of death from COVID-19 during the Omicron era. blood.. Published online May 19, 2022. doi: 10.1182 / blood.2022016147