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Baratè C, Scortechini I, Ciofini S, Picardi P, Angeletti I, Loscocco F, Sanna A, Isidori A, Sportoletti P. Management of infections for patient treated with ibrutinib in clinical practice. Front Oncol 2024; 14:1428464. [PMID: 39319061 PMCID: PMC11420164 DOI: 10.3389/fonc.2024.1428464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 08/23/2024] [Indexed: 09/26/2024] Open
Abstract
Ibrutinib, a highly effective inhibitor of the Bruton tyrosine kinase, has significantly transformed the therapeutic approach in chronic lymphocytic leukemia (CLL). Despite these advancements, the disease continues to be characterized by immune dysfunction and increased susceptibility to infections, with mortality rates from infections showing no significant improvement over the past few decades. Therefore, timely prevention, recognition, and treatment of infections remains an important aspect of the standard management of a patient with CLL. A panel of hematologists with expertise in CLL met to discuss existing literature and clinical insights for the management of infectious in CLL undergoing ibrutinib treatment. Despite not being a fully comprehensive review on the topic, this work provides a set of practical recommendations that can serve as a guide to healthcare professionals who manage these patients in their daily clinical practice.
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Affiliation(s)
- Claudia Baratè
- Oncology Department, Hematology and Bone Marrow Transplant Unit, Pisa, Italy
| | - Ilaria Scortechini
- Clinic of Hematology, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - Sara Ciofini
- Department of Cell Therapies, Hematology Unit, Senese Hospital and University, Siena, Italy
| | - Paola Picardi
- Hematology and Cellular Therapy, Mazzoni Hospital, Ascoli Piceno, Italy
| | | | - Federica Loscocco
- Hematology and Stem Cell Transplant Center, Azienda Sanitaria Territoriale (AST) Pesaro and Urbino, Pesaro, Italy
| | - Alessandro Sanna
- Hematology Unit, Azienda Ospedaliera Universitaria (AOU) Careggi, Florence, Italy
| | - Alessandro Isidori
- Hematology and Stem Cell Transplant Center, Azienda Sanitaria Territoriale (AST) Pesaro and Urbino, Pesaro, Italy
| | - Paolo Sportoletti
- Department of Medicine and Surgery, Institute of Hematology and Center for Hemato-Oncology Research (CREO), University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
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2
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Mauro FR, Frustaci AM, Visentin A, Vitale C, Bartoletti M, Oltolini C, Zappulo E, Mikulska M. Severe infections in patients with chronic lymphocytic leukemia included in trials investigating BTK and BCL2 inhibitors. Crit Rev Oncol Hematol 2024; 201:104408. [PMID: 38880368 DOI: 10.1016/j.critrevonc.2024.104408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/30/2024] [Accepted: 06/04/2024] [Indexed: 06/18/2024] Open
Abstract
Bruton tyrosine kinase inhibitors (BTKi) and the BCL-2 inhibitor venetoclax have significantly improved the prognosis of patients with chronic lymphocytic leukemia (CLL). However, the incidence of severe infections in patients receiving these agents needs to be better understood. Our review aimed to provide an overview of grade ≥3 infections in patients with CLL who received BTKi and venetoclax-based therapy in prospective trials. Infection rates were influenced by the age of patients and the duration of follow-up. For treatment-naive (TN) patients receiving BTKi, infection rates ranged between 11.4 % and 27.4 % and were close to 30 % in relapsed/refractory (R/R) patients. TN and R/R patients receiving fixed-duration venetoclax-based treatments showed variable rates, with maximum values around 20 %. Opportunistic and fatal infections were uncommon. In conclusion, infections remain a concern in patients with CLL receiving targeted agents. A better definition of factors increasing infection vulnerability could help identify those patients who require infection prophylaxis.
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Affiliation(s)
- Francesca R Mauro
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy.
| | | | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Italy
| | - Candida Vitale
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Italy; Department of Molecular Biotechnology and Health Sciences, University of Turin, Italy
| | - Michele Bartoletti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele Milan 20090, Italy; Infectious Disease Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan 20089, Italy
| | - Chiara Oltolini
- Clinic of Infectious Diseases, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Emanuela Zappulo
- Department of Clinical Medicine and Surgery University of Naples Federico II, Napoli, Italy
| | - Malgorzata Mikulska
- Department of Health Sciences (DISSAL) University of Genoa, Italy; Infectious Diseases Unit IRCCS Ospedale Policlinico San Martino Genoa, Italy
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3
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Akbarzadeh MA, Vaez-Gharamaleki Y, Jahanshahlou F, Bavil AG, Hamzehzadeh S, Seifimansour S, Rahimi-Mamaghani A, Hosseini MS. Outcomes of COVID-19 infection in patients with chronic lymphocytic leukemia: a systematic review and meta-analysis. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20240322. [PMID: 39166680 PMCID: PMC11329259 DOI: 10.1590/1806-9282.20240322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 08/23/2024]
Affiliation(s)
- Mohammad Amin Akbarzadeh
- Tabriz University of Medical Sciences, Research Center for Evidence-Based Medicine, Iranian EBM Center: A JBI Center of Excellence – Tabriz, Iran
| | - Yosra Vaez-Gharamaleki
- Tabriz University of Medical Sciences, Hematology and Oncology Research Center – Tabriz, Iran
| | - Farid Jahanshahlou
- Tabriz University of Medical Sciences, Aging Research Institute, Research Center for Integrative Medicine in Aging – Tabriz, Iran
| | - Alireza Ghaffari Bavil
- Tabriz University of Medical Sciences, School of Medicine, Department of Internal Medicine – Tabriz, Iran
| | - Sina Hamzehzadeh
- Tabriz University of Medical Sciences, Medical Philosophy and History Research Center – Tabriz, Iran
- Tabriz University of Medical Sciences, Liver and Gastrointestinal Diseases Research Center – Tabriz, Iran
| | - Sina Seifimansour
- Ardabil University of Medical Sciences, School of Medicine, Student Research Committee – Ardabil, Iran
| | - Alireza Rahimi-Mamaghani
- Tabriz University of Medical Sciences, Clinical Research Development Unit of Tabriz Valiasr Hospital – Tabriz, Iran
| | - Mohammad-Salar Hosseini
- Tabriz University of Medical Sciences, Research Center for Evidence-Based Medicine, Iranian EBM Center: A JBI Center of Excellence – Tabriz, Iran
- Tabriz University of Medical Sciences, Hematology and Oncology Research Center – Tabriz, Iran
- Tabriz University of Medical Sciences, Aging Research Institute, Research Center for Integrative Medicine in Aging – Tabriz, Iran
- Tabriz University of Medical Sciences, Clinical Research Development Unit of Tabriz Valiasr Hospital – Tabriz, Iran
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4
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Thau S, Poulsen CB, Brieghel C, Larsen MK, Wiese L, Nielsen XC, Pedersen LM. COVID-19 severity in patients with chronic lymphocytic leukemia treated with venetoclax: a single-center observational cohort study. Ann Hematol 2024; 103:3053-3060. [PMID: 38634916 PMCID: PMC11283378 DOI: 10.1007/s00277-024-05738-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/31/2024] [Indexed: 04/19/2024]
Abstract
Patients with chronic lymphocytic leukemia (CLL) are at high risk of developing severe COVID-19. The present study was undertaken to elucidate COVID-19 related morbidity and mortality in CLL patients treated with venetoclax. We present a single-center study of 108 patients with small lymphocytic lymphoma or CLL treated with venetoclax. Primary outcome was 30-day COVID-19 mortality. Secondary outcomes included COVID-19 severity and hospitalization rate. Forty-eight (44%) patients had PCR-verified SARS-COV-2 between March 2020 and January 2023. Thirty-six patients (75%) presented with asymptomatic/mild COVID-19 and 12 (25%) with severe/critical disease. The hospitalization rate was 46% with a 30-day mortality rate of only 4% and severe comorbidities as the primary cause of death. COVID-19 severity and mortality were similar before and during the Omicron era. High CIRS-scores (P < 0.02) and thrombocytopenia (P < 0.01) were more frequent in patients with severe/critical disease. In real-world data, most venetoclax treated patients presented with mild COVID-19. Hospitalization and mortality rates were low compared to data of general CLL populations. Our data indicate that venetoclax was a safe treatment option for CLL patients during the pandemic.
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MESH Headings
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Sulfonamides/therapeutic use
- COVID-19/epidemiology
- COVID-19/complications
- Bridged Bicyclo Compounds, Heterocyclic/therapeutic use
- Male
- Aged
- Female
- Middle Aged
- SARS-CoV-2
- Severity of Illness Index
- Aged, 80 and over
- Hospitalization
- Antineoplastic Agents/therapeutic use
- Cohort Studies
- Retrospective Studies
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Affiliation(s)
- Sophie Thau
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark
| | | | - Christian Brieghel
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark
| | | | - Lothar Wiese
- Department of Infectious Diseases, Zealand University Hospital, Roskilde, Denmark
| | - Xiaohui Chen Nielsen
- Department of Clinical Microbiology, Zealand University Hospital, Slagelse, Denmark
| | - Lars Møller Pedersen
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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5
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Stamatopoulos K, Pavlova S, Al‐Sawaf O, Chatzikonstantinou T, Karamanidou C, Gaidano G, Cymbalista F, Kater AP, Rawstron A, Scarfò L, Ghia P, Rosenquist R. Realizing precision medicine in chronic lymphocytic leukemia: Remaining challenges and potential opportunities. Hemasphere 2024; 8:e113. [PMID: 39035106 PMCID: PMC11260284 DOI: 10.1002/hem3.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/29/2024] [Accepted: 06/04/2024] [Indexed: 07/23/2024] Open
Abstract
Patients with chronic lymphocytic leukemia (CLL) exhibit diverse clinical outcomes. An expanding array of genetic tests is now employed to facilitate the identification of patients with high-risk disease and inform treatment decisions. These tests encompass molecular cytogenetic analysis, focusing on recurrent chromosomal alterations, particularly del(17p). Additionally, sequencing is utilized to identify TP53 mutations and to determine the somatic hypermutation status of the immunoglobulin heavy variable gene. Concurrently, a swift advancement of targeted treatment has led to the implementation of novel strategies for patients with CLL, including kinase and BCL2 inhibitors. This review explores both current and emerging diagnostic tests aimed at identifying high-risk patients who should benefit from targeted therapies. We outline existing treatment paradigms, emphasizing the importance of matching the right treatment to the right patient beyond genetic stratification, considering the crucial balance between safety and efficacy. We also take into consideration the practical and logistical issues when choosing a management strategy for each individual patient. Furthermore, we delve into the mechanisms underlying therapy resistance and stress the relevance of monitoring measurable residual disease to guide treatment decisions. Finally, we underscore the necessity of aggregating real-world data, adopting a global perspective, and ensuring patient engagement. Taken together, we argue that precision medicine is not the mere application of precision diagnostics and accessibility of precision therapies in CLL but encompasses various aspects of the patient journey (e.g., lifestyle exposures and comorbidities) and their preferences toward achieving true personalized medicine for patients with CLL.
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Affiliation(s)
- Kostas Stamatopoulos
- Centre for Research and Technology HellasInstitute of Applied BiosciencesThessalonikiGreece
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
| | - Sarka Pavlova
- Department of Internal Medicine, Hematology and Oncology, and Institute of Medical Genetics and GenomicsUniversity Hospital Brno and Medical Faculty, Masaryk UniversityBrnoCzech Republic
- Central European Institute of TechnologyMasaryk UniversityBrnoCzech Republic
| | - Othman Al‐Sawaf
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD)University of Cologne, Faculty of Medicine and University Hospital of CologneCologneGermany
- Francis Crick Institute LondonLondonUK
- Cancer Institute, University College LondonLondonUK
| | | | - Christina Karamanidou
- Centre for Research and Technology HellasInstitute of Applied BiosciencesThessalonikiGreece
| | - Gianluca Gaidano
- Division of Haematology, Department of Translational MedicineUniversity of Eastern PiedmontNovaraItaly
| | | | - Arnon P. Kater
- Department of Hematology, Cancer Center AmsterdamAmsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
| | - Andy Rawstron
- Haematological Malignancy Diagnostic ServiceLeeds Teaching Hospitals TrustLeedsUK
| | - Lydia Scarfò
- Medical SchoolUniversità Vita Salute San RaffaeleMilanoItaly
- Strategic Research Program on CLLIRCCS Ospedale San RaffaeleMilanoItaly
| | - Paolo Ghia
- Medical SchoolUniversità Vita Salute San RaffaeleMilanoItaly
- Strategic Research Program on CLLIRCCS Ospedale San RaffaeleMilanoItaly
| | - Richard Rosenquist
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
- Clinical GeneticsKarolinska University HospitalStockholmSweden
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Sanmartin F, Magrini E, Rando E, Giacomo PD, Dusina A, Matteini E, Carbone A, Puma G, Leanza GM, Frondizi F, Innocenti I, Maiuro G, Liotti FM, Santangelo R, Laurenti L, Cingolani A. A 67-Year-Old Man with Chronic Lymphocytic Leukemia (CLL) on Maintenance Therapy with Ibrutinib with Persistent SARS-CoV-2 Infection Unresponsive to Antiviral Treatments. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e941165. [PMID: 38943241 PMCID: PMC11332969 DOI: 10.12659/ajcr.941165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 05/15/2024] [Accepted: 12/11/2023] [Indexed: 07/01/2024]
Abstract
BACKGROUND SARS-CoV-2 infection can persist in immunocompromised patients with hematological malignancies, despite antiviral treatment. This report is of a 67-year-old man with chronic lymphocytic leukemia (CLL), secondary hypogammaglobulinemia, and thrombocytopenia on maintenance therapy with ibrutinib, with persistent SARS-CoV-2 infection unresponsive to antiviral treatment, including remdesivir, nirmatrelvir/ritonavir (Paxlovid), and tixagevimab/cilgavimab (Evusheld). CASE REPORT The patient was admitted to our hospital 3 times. During his first hospitalization, he was treated with 5-day course of remdesivir and intravenous steroids; however, antigen and molecular nasopharyngeal swabs were persistently positive, and he was discharged home. Due to respiratory worsening, he was rehospitalized, and despite being treated initially with tixagevimab/cilgavimab, and subsequently with a remdesivir course of 5 days, SARS-CoV-2 tests remained persistently positive. During his third hospital stay, our patient was subjected to combined therapy with remdesivir and nirmatrelvir/ritonavir for 5 days, obtaining a significant reduction of viral load at both antigen and molecular testing. As an ultimate attempt to achieve a negative status before discharge, a 10-day course of combined remdesivir and nirmatrelvir/ritonavir was administered, with a temporary reduction of viral load, followed by a sudden increase immediately after the discontinuation of Paxlovid. Due to worsening hematological disease and bacterial over-infections, the patient gradually worsened until death. CONCLUSIONS This is an emblematic case of correlation between persistent SARS-CoV-2 infection and immunosuppression status in hematological hosts. In these patients, the viral load remains high, favoring the evolution of the virus, and the immunodeficiency makes it difficult to identify the appropriate therapeutic approach.
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Affiliation(s)
- Flavia Sanmartin
- Department of Safety and Bioethics – Infectious Diseases Section, Catholic University of Sacred Heart, Rome, Italy
| | - Eugenia Magrini
- Department of Safety and Bioethics – Infectious Diseases Section, Catholic University of Sacred Heart, Rome, Italy
| | - Emanuele Rando
- Department of Safety and Bioethics – Infectious Diseases Section, Catholic University of Sacred Heart, Rome, Italy
| | - Paola Del Giacomo
- Department of Laboratory and Infectious Sciences, Agostino Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Alex Dusina
- Department of Laboratory and Infectious Sciences, Agostino Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Elena Matteini
- Department of Safety and Bioethics – Infectious Diseases Section, Catholic University of Sacred Heart, Rome, Italy
| | - Andrea Carbone
- Department of Safety and Bioethics – Infectious Diseases Section, Catholic University of Sacred Heart, Rome, Italy
| | - Giuseppe Puma
- Department of Safety and Bioethics – Infectious Diseases Section, Catholic University of Sacred Heart, Rome, Italy
| | - Gabriele Maria Leanza
- Department of Safety and Bioethics – Infectious Diseases Section, Catholic University of Sacred Heart, Rome, Italy
| | - Federico Frondizi
- Department of Safety and Bioethics – Infectious Diseases Section, Catholic University of Sacred Heart, Rome, Italy
| | - Idanna Innocenti
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Agostino Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Giuseppe Maiuro
- Department of Laboratory and Infectious Sciences, Agostino Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Flora Marzia Liotti
- Department of Laboratory and Infectious Sciences, Agostino Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Rosaria Santangelo
- Department of Laboratory and Infectious Sciences, Agostino Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Luca Laurenti
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Agostino Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Antonella Cingolani
- Department of Laboratory and Infectious Sciences, Agostino Gemelli University Hospital Foundation IRCCS, Rome, Italy
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7
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Galitzia A, Maccaferri M, Mauro FR, Murru R, Marasca R. Chronic Lymphocytic Leukemia: Management of Adverse Events in the Era of Targeted Agents. Cancers (Basel) 2024; 16:1996. [PMID: 38893115 PMCID: PMC11171383 DOI: 10.3390/cancers16111996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/20/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
The treatment landscape for CLL has undergone a profound transformation with the advent of targeted agents (TAs) like Bruton's Tyrosine Kinase inhibitors (BTKis) and BCL-2 inhibitors (BCL-2is). These agents target crucial cellular pathways in CLL, offering superior efficacy over traditional chemo-immunotherapy, which has led to improved progression-free and overall survival rates. This advancement promises enhanced disease control and potentially normal life expectancy for many patients. However, the journey is not without challenges, as these TAs are associated with a range of adverse events (AEs) that can impact treatment efficacy and patient quality of life. This review focuses on detailing the various AEs related to TA management in CLL, evaluating their frequency and clinical impact. The aim is to present a comprehensive guide to the effective management of these AEs, ensuring optimal tolerability and efficacy of TAs. By reviewing the existing literature and consolidating findings, we provide insights into AE management, which is crucial for maximizing patient outcomes in CLL therapy.
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Affiliation(s)
- Andrea Galitzia
- Hematology and Stem Cell Transplantation Unit, Ospedale San Francesco, 08100 Nuoro, Italy;
| | - Monica Maccaferri
- Hematology Unit, Department of Oncology and Hematology, A.O.U of Modena, Policlinico, 41125 Modena, Italy; (M.M.); (R.M.)
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, Sapienza University, 00185 Rome, Italy;
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale Oncologico A. Businco, ARNAS G. Brotzu, 09134 Cagliari, Italy
| | - Roberto Marasca
- Hematology Unit, Department of Oncology and Hematology, A.O.U of Modena, Policlinico, 41125 Modena, Italy; (M.M.); (R.M.)
- Department of Medical and Surgical Sciences, Section of Hematology, University of Modena and Reggio Emilia, 41121 Modena, Italy
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8
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Fedeli U, Barbiellini Amidei C, Han X, Jemal A. Changes in mortality associated with different hematologic malignancies during the pandemic in the United States. Int J Cancer 2024; 154:1703-1708. [PMID: 38335457 DOI: 10.1002/ijc.34873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/10/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024]
Abstract
Patients with hematologic malignancies are at increased risk of adverse COVID-19 outcomes; nonetheless, only sparse population-based data are available on mortality related to hematologic cancers during the pandemic. Number of deaths and age-standardized mortality rates for specific hematologic malignancies selected either as the underlying cause of death (UCOD), or mentioned in death certificates (multiple causes of death-MCOD) were extracted from the US National Center for Health Statistics, CDC WONDER Online Database. Joinpoint analysis was applied to identify changes in mortality trends from 1999 to 2021, and to estimate the annual percent change with 95% Confidence Intervals (CI) across time segments. Among the most common malignancies, chronic lymphocytic leukemia showed marked peaks in the monthly number of deaths attributed to COVID-19 during epidemic waves; acute myeloid leukemia showed the least variation, and non-Hodgkin lymphoma and multiple myeloma were characterized by an intermediate pattern. Age-standardized death rates relying solely on the UCOD did not show significant variations during pandemic years. By contrast, rates based on MCOD increased by 14.0% (CI, 10.2-17.9%) per year for chronic lymphocytic leukemia, by 5.1% (CI, 3.1-7.2%) for non-Hodgkin lymphoma and by 3.2% (CI, 0.3-6.1%) per year for multiple myeloma. Surveillance of mortality based on MCOD is warranted to accurately measure the impact of the COVID-19 pandemic and of other epidemics, including seasonal flu, on patients with hematologic malignancies, and to assess the effects of vaccination campaigns and other preventive measures.
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Affiliation(s)
- Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, Padua, Italy
| | | | - Xuesong Han
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Ahmedin Jemal
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
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9
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Mikulska M, Oltolini C, Zappulo E, Bartoletti M, Frustaci AM, Visentin A, Vitale C, Mauro FR. Prevention and management of infectious complications in patients with chronic lymphocytic leukemia (CLL) treated with BTK and BCL-2 inhibitors, focus on current guidelines. Blood Rev 2024; 65:101180. [PMID: 38331696 DOI: 10.1016/j.blre.2024.101180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/27/2024] [Accepted: 01/31/2024] [Indexed: 02/10/2024]
Abstract
CLL is associated with an increased risk of infectious complications. Treatment with BTK or BCL-2 inhibitors does not seem to increase significantly the risk of opportunistic infections, but the role of combination therapies including BTK and/or BCL-2 inhibitors remains to be established. Various infectious complications can be successfully prevented with appropriate risk management strategies. In this paper we reviewed the international guidelines on prevention and management of infectious complications in patients with CLL treated with BTK or BCL-2 inhibitors. Universal pharmacological anti-herpes, antibacterial or antifungal prophylaxis is not warranted. Reactivation of HBV should be prevented in HBsAg-positive subjects. For HBsAg-negative/HBcAb-positive patients recommendations differ, but in case of combination treatment should follow those for other, particularly anti-CD20, agent. Immunization should be provided preferably before the onset of treatment. Immunoglobulin therapy has favourable impact on morbidity but not mortality in patients with hypogammaglobulinemia and severe or recurrent infections. Lack of high-quality data and heterogeneity of patients or protocols included in the studies might explain differences among the main guidelines. Better data collection is warranted.
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Affiliation(s)
- Malgorzata Mikulska
- Infectious Diseases Unit, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | | | - Emanuela Zappulo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Michele Bartoletti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele Milan, Italy; Infectious Disease Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | | | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Italy
| | - Candida Vitale
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Italy; Department of Molecular Biotechnology and Health Sciences, University of Turin, Italy
| | - Francesca R Mauro
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
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10
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Murru R, Galitzia A, Barabino L, Presicci R, La Nasa G, Caocci G. Prediction of severe infections in chronic lymphocytic leukemia: a simple risk score to stratify patients at diagnosis. Ann Hematol 2024; 103:1655-1664. [PMID: 38236391 PMCID: PMC11009768 DOI: 10.1007/s00277-024-05625-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/11/2024] [Indexed: 01/19/2024]
Abstract
Chronic Lymphocytic Leukemia (CLL) is well-known for increasing susceptibility to infections. Factors such as immune dysregulation, IGHV status, hypogammaglobulinemia, and patient comorbidity and treatment, contribute to higher infection rates and mortality. However, the impact of hypogammaglobulinemia on infection rates is controversial. We aimed to identify clinical and biological parameters linked to the risk of severe infectious events. Additionally, we set up a straightforward risk infection score to stratify CLL patients at diagnosis, thereby enabling the development of suitable infection prevention strategies. We retrospectively evaluated 210 unselected CLL patients diagnosed between 1988 and 2018. This evaluation encompassed demographics, Binet stage, immunoglobulin (Ig) levels, treatment history, comorbidities, and IGHV mutational status at diagnosis. The frequency and severity of infectious events were recorded. Analysis revealed that age, IGHV mutational status, Binet stage, and hypogammaglobulinemia were statistically associated with the Time to First Infection (TTFI) in univariate and multivariate analyses. Using hazard ratios from the multivariate analysis, we finally devised a risk scoring system that integrated age, IGHV mutational status, immunoglobulin levels, and Binet stage to stratify patients at diagnosis based on their specific infection risk. In our cohort, disease progression and infections were the leading cause of death. These findings pointed out the clinical need for a screening process strategic for defining infectious risk at the time of CLL diagnosis, with a significant enhancement in the clinical management of these patients.
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Affiliation(s)
- Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale Oncologico A. Businco, ARNAS G. Brotzu, Cagliari, Italy
| | - Andrea Galitzia
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Luca Barabino
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Roberta Presicci
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giorgio La Nasa
- Hematology and Stem Cell Transplantation Unit, Ospedale Oncologico A. Businco, ARNAS G. Brotzu, Cagliari, Italy
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giovanni Caocci
- Hematology and Stem Cell Transplantation Unit, Ospedale Oncologico A. Businco, ARNAS G. Brotzu, Cagliari, Italy.
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
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11
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van Gelder M, Hoogendoorn M, Te Raa D. The GLOW trial in chronic lymphocytic leukaemia. Lancet Oncol 2024; 25:e55. [PMID: 38301697 DOI: 10.1016/s1470-2045(23)00677-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 12/18/2023] [Accepted: 12/21/2023] [Indexed: 02/03/2024]
Affiliation(s)
- Michel van Gelder
- Maastricht University Medical Centre+, 6229 Maastricht, Netherlands.
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12
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Aurer I, Jakšić O, Bašić-Kinda S, Mrđenović S, Ostojić-Kolonić S, Lozić D, Holik H, Novaković-Coha S, Berneš P, Krečak I, Morić-Perić M, Narančić M, Mitrović Z, Valković T. Treatment-Related Risk Factors for Adverse Outcomes of COVID-19 in Patients Treated for Lymphoid Malignancies in the Pre-Omicron Era-A Study of KroHem, the Croatian Group for Hematologic Diseases. Biomedicines 2024; 12:331. [PMID: 38397933 PMCID: PMC10887065 DOI: 10.3390/biomedicines12020331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024] Open
Abstract
Patients with lymphoid malignancies are at increased risk of death or prolonged infection due to COVID-19. Data on the influence of different antineoplastic treatment modalities on outcomes are conflicting. Anti-CD20 monoclonal antibodies increase the risk of prolonged infection. It is unclear whether this risk is affected by the choice of the antibody (rituximab vs. obinutuzumab). To elucidate the role of antineoplastic therapy on COVID-19 outcomes, KroHem collected data on patients with lymphoid malignancies diagnosed with COVID-19 between October 2020 and April 2021. A total of 314 patients were identified, 75 untreated, 61 off treatment and 178 on treatment. The mortality rate in untreated and off-treatment patients was 15% and 16%; 9% and 10% had prolonged infection. In the on-treatment group, 3% were still prolonged positive at time of data collection, 62% recovered and 35% died; 42% had prolonged infection. Disease type, use of anti-CD20 monoclonal antibodies, prior autologous stem-cell transplantation (ASCT) and line of treatment did not significantly affect mortality. Mortality was higher in older patients (p = 0.0078) and those treated with purine analogues (p = 0.012). Prolonged COVID-19 was significantly more frequent in patients treated with anti-CD20 monoclonal antibodies (p = 0.012), especially obinutuzumab, and purine analogues (p = 0.012). Age, prior ASCT and treatment line did not significantly affect risk of prolonged infection. These data suggest that increased age and use of purine analogues are main risk factors for increased mortality of COVID-19 in patients with lymphoid malignancies. Obinutuzumab further increases the risk of prolonged disease, but not of death, in comparison to rituximab. Epidemiological considerations should be taken into account when choosing the appropriate antineoplastic therapy for patients with lymphoid malignancies.
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Affiliation(s)
- Igor Aurer
- University Hospital Centre Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia;
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia or (O.J.); (S.O.-K.); or (Z.M.)
| | - Ozren Jakšić
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia or (O.J.); (S.O.-K.); or (Z.M.)
- University Hospital Dubrava, Av. G. Šuška 6, 10000 Zagreb, Croatia
| | - Sandra Bašić-Kinda
- University Hospital Centre Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia;
| | - Stefan Mrđenović
- University Hospital Centre Osijek, J. Huttlera 4, 31000 Osijek, Croatia;
- Medical School, University of Osijek, J. Huttlera 4, 31000 Osijek, Croatia
| | - Slobodanka Ostojić-Kolonić
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia or (O.J.); (S.O.-K.); or (Z.M.)
- University Hospital Merkur, Zajčeva 19, 10000 Zagreb, Croatia
| | - Dominik Lozić
- University Hospital Centre Split, Spinčićeva 1, 21000 Split, Croatia;
| | - Hrvoje Holik
- General Hospital Dr. Josip Benčević, A. Štampara 42, 35000 Slavonski Brod, Croatia;
| | - Sabina Novaković-Coha
- University Hospital Centre Sisters of Mercy, Vinogradska c. 29, 10000 Zagreb, Croatia;
| | - Petra Berneš
- General Hospital Pula, Santoriova ul. 24a, 52100 Pula, Croatia;
| | - Ivan Krečak
- General Hospital Šibenik, S. Radića 83, 22000 Šibenik, Croatia;
- Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia;
| | - Martina Morić-Perić
- General Hospital Zadar, B. Peričića 5, 23000 Zadar, Croatia; (M.M.-P.); (M.N.)
| | - Marino Narančić
- General Hospital Zadar, B. Peričića 5, 23000 Zadar, Croatia; (M.M.-P.); (M.N.)
| | - Zdravko Mitrović
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia or (O.J.); (S.O.-K.); or (Z.M.)
- University Hospital Dubrava, Av. G. Šuška 6, 10000 Zagreb, Croatia
| | - Toni Valković
- Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia;
- University Hospital Centre Rijeka, Krešimirova 42, 51000 Rijeka, Croatia
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13
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Fedeli U, Barbiellini Amidei C, Han X, Jemal A. Changes in cancer-related mortality during the COVID-19 pandemic in the United States. J Natl Cancer Inst 2024; 116:167-169. [PMID: 37688577 DOI: 10.1093/jnci/djad191] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/11/2023] Open
Abstract
Few studies have examined cancer-related mortality overall, never mind select cancer types, during the COVID-19 pandemic. Data on cancer-related mortality (any mention in death certificates, multiple causes of death approach) was extracted from the US Centers for Disease Control and Prevention WONDER database. Changes in trends for age-standardized mortality rates through 1999-2021 were assessed by Joinpoint analysis. In total, 1 379 643 cancer-related deaths were registered in 2020-2021, with cancer selected as the underlying cause in 88%. After 2 decades of decline, age-standardized cancer-related mortality increased from 2019 to 2021 for all cancers (annual percentage change = 1.6%, 95% confidence interval = 0.6% to 2.6%), especially for prostate cancer (annual percentage change = 5.1%, 95% confidence interval = 2.2% to 8.2%) and hematologic cancers (annual percentage change = 4.8%, 95% confidence interval = 3.1% to 6.6%). Sharp peaks in cancer-related deaths for many cancer sites were observed during pandemic waves in both 2020 and 2021, mostly attributed to COVID-19 as the underlying cause. Multiple causes of death analyses are warranted to fully assess the impact of the pandemic on cancer-related mortality.
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Affiliation(s)
- Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, Padova, Italy
| | | | - Xuesong Han
- Surveillance & Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | - Ahmedin Jemal
- Surveillance & Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
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14
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Visentin A, Chatzikonstantinou T, Scarfò L, Kapetanakis A, Demosthenous C, Karakatsoulis G, Minga E, Chamou D, Allsup D, Cabrero AA, Andres M, Antic D, Baile M, Baliakas P, Besikli-Dimou S, Bron D, Chatzileontiadou S, Cordoba R, Correa JG, Cuéllar-García C, De Paoli L, De Paolis MR, Delgado J, Dimou M, Donaldson D, Catherwood M, Doubek M, Efstathopoulou M, Eichhorst B, Elashwah S, Enrico A, Espinet B, Farina L, Ferrari A, Foglietta M, Frederiksen H, Fürstenau M, García-Marco JA, García-Serra R, Collado R, Gentile M, Gimeno E, Glenthøj A, da Silva MG, Hakobyan YK, Herishanu Y, Hernández-Rivas JÁ, Herold T, Innocenti I, Itchaki G, Jaksic O, Janssens A, Kalashnikova ОB, Kalicińska E, Kater AP, Kersting S, Labrador J, Lad D, Laurenti L, Levin MD, Lista E, Lopez-Garcia A, Malerba L, Marasca R, Marchetti M, Marquet J, Mattsson M, Mauro FR, Morawska M, Motta M, Munir T, Murru R, Niemann CU, Rodrigues RN, Olivieri J, Orsucci L, Papaioannou M, Pavlovsky MA, Piskunova I, Popov VM, Quaglia FM, Quaresmini G, Qvist K, Rigolin GM, Ruchlemer R, Šimkovič M, Špaček M, Sportoletti P, Stanca O, Tadmor T, Capasso A, Del Poeta G, Gutwein O, Karlsson LK, Milosevic I, Mirás F, Reda G, Saghumyan G, Shrestha A, Te Raa D, Tonino SH, Van Der Spek E, van Gelder M, van Kampen R, Wasik-Szczepanek E, Wróbel T, Segundo LYS, Yassin M, Pocali B, Vandenberghe E, Iyengar S, Varettoni M, Vitale C, Coscia M, Rambaldi A, Montserrat E, Cuneo A, Stavroyianni N, Trentin L, Stamatopoulos K, Ghia P. The evolving landscape of COVID-19 and post-COVID condition in patients with chronic lymphocytic leukemia: A study by ERIC, the European research initiative on CLL. Am J Hematol 2023; 98:1856-1868. [PMID: 37772428 DOI: 10.1002/ajh.27093] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/18/2023] [Accepted: 08/23/2023] [Indexed: 09/30/2023]
Abstract
In this retrospective international multicenter study, we describe the clinical characteristics and outcomes of patients with chronic lymphocytic leukemia (CLL) and related disorders (small lymphocytic lymphoma and high-count monoclonal B lymphocytosis) infected by SARS-CoV-2, including the development of post-COVID condition. Data from 1540 patients with CLL infected by SARS-CoV-2 from January 2020 to May 2022 were included in the analysis and assigned to four phases based on cases disposition and SARS-CoV-2 variants emergence. Post-COVID condition was defined according to the WHO criteria. Patients infected during the most recent phases of the pandemic, though carrying a higher comorbidity burden, were less often hospitalized, rarely needed intensive care unit admission, or died compared to patients infected during the initial phases. The 4-month overall survival (OS) improved through the phases, from 68% to 83%, p = .0015. Age, comorbidity, CLL-directed treatment, but not vaccination status, emerged as risk factors for mortality. Among survivors, 6.65% patients had a reinfection, usually milder than the initial one, and 16.5% developed post-COVID condition. The latter was characterized by fatigue, dyspnea, lasting cough, and impaired concentration. Infection severity was the only risk factor for developing post-COVID. The median time to resolution of the post-COVID condition was 4.7 months. OS in patients with CLL improved during the different phases of the pandemic, likely due to the improvement of prophylactic and therapeutic measures against SARS-CoV-2 as well as the emergence of milder variants. However, mortality remained relevant and a significant number of patients developed post-COVID conditions, warranting further investigations.
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Affiliation(s)
- Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padova, Italy
| | | | - Lydia Scarfò
- Università Vita-Salute San Raffaele and IRCC Ospedale San Raffaele, Milan, Italy
| | - Anargyros Kapetanakis
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | | | - Georgios Karakatsoulis
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
- Department of Mathematics, University of Ioannina, Ioannina, Greece
| | - Eva Minga
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Dimitra Chamou
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - David Allsup
- Centre for Biomedicine, Hull York Medical School, Hull, UK
| | - Alejandro Alonso Cabrero
- Spanish Society of Hematology and Hemotherapy (SEHH: Sociedad Española de Hematología y hemoterapia), Madrid, Spain
- Hematology Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - Martin Andres
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Darko Antic
- University Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Mónica Baile
- Hospital Clinico Universitario de Salamanca (CAUSA/IBSAL), Salamanca, Spain
| | - Panagiotis Baliakas
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
- Department of Clinical Genetics, Uppsala University Hospital, Uppsala, Sweden
| | | | | | - Sofia Chatzileontiadou
- Hematology Unit, 1st Dept of Internal Medicine, AUTH, AHEPA Hospital, Thessaloniki, Greece
| | - Raul Cordoba
- Department of Hematology, Health Research Institute IIS-FJD, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
| | | | | | - Lorenzo De Paoli
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale Amedeo Avogadro, Azienda Ospedaliero-Universitaria Maggiore della Carità Novara, Novara, Italy
| | | | | | - Maria Dimou
- 1st Internal Medicine Department, Propaedeutic, Hematology Clinical Trial Unit, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Michael Doubek
- Department of Internal Medicine-Hematology and Oncology, University Hospital, Brno, Czech Republic
- Faculty of Medicine, Department of Medical Genetics and Genomics, Masaryk University, Brno, Czech Republic
| | - Maria Efstathopoulou
- Department of Haematology, Athens Medical Center-Psychikon Branch, Athens, Greece
| | - Barbara Eichhorst
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Salma Elashwah
- Medical Oncology Unit, Faculty of Medicine, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | | | | | - Lucia Farina
- Hematology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Angela Ferrari
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy
| | | | | | - Moritz Fürstenau
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University Hospital Cologne, University of Cologne, Cologne, Germany
| | - José A García-Marco
- Hematology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Rocío García-Serra
- Department of Hematology, Hospital General Universitario, Valencia, Spain
- Fundaci_on de Investigaci_on del Hospital General Universitario, Valencia, Spain
| | - Rosa Collado
- Department of Hematology, Hospital General Universitario, Valencia, Spain
| | - Massimo Gentile
- Hematology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
- Department of Pharmacy, Health and Nutritional Science, University of Calabria, Rende, Italy
| | - Eva Gimeno
- Department of Hematology, Hospital del Mar, Barcelona, Spain
| | - Andreas Glenthøj
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Yair Herishanu
- Department of Hematology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Tobias Herold
- Department of Medicine III, Laboratory for Leukemia Diagnostics, University Hospital, Munich, Germany
| | - Idanna Innocenti
- Hematology Unit, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gilad Itchaki
- Meir Medical Center, Kfar-Saba, Israel
- The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ozren Jaksic
- Department of Hematology, University Hospital Dubrava, Zagreb, Croatia
| | - Ann Janssens
- Department of Hematology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Оlga B Kalashnikova
- Federal State Budgetary Educational Institution of Higher Education Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia
| | - Elżbieta Kalicińska
- Department and Clinic of Hematology, Blood Neoplasms and Bone Marrow Transplantation Wroclaw Medical University, Wroclaw, Poland
| | - Arnon P Kater
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Sabina Kersting
- Department of Hematology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Jorge Labrador
- Hematology Department, Unit Research, Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | - Deepesh Lad
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Luca Laurenti
- Hematology Unit, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Enrico Lista
- Department of Hematology, Santa Chiara Hospital, Trento, Italy
| | - Alberto Lopez-Garcia
- Department of Hematology, Health Research Institute IIS-FJD, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
| | - Lara Malerba
- Hematology and Stem Cell Transplant Center, Marche Nord Hospital, Pesaro, Italy
| | - Roberto Marasca
- Department of Medical Sciences, Section of Hematology, University of Modena and Reggio E., Modena, Italy
| | - Monia Marchetti
- Hematology Unit and BM Transplant Center, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Juan Marquet
- Hematology Department, Ram_on y Cajal University Hospital, Madrid, Spain
| | - Mattias Mattsson
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
- Department of Hematology, Uppsala University Hospital, Uppsala, Sweden
| | - Francesca R Mauro
- Hematology Unit, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Marta Morawska
- Experimental Hematooncology Department, Medical University of Lublin, Lublin, Poland
- Hematology Department, St. John's Cancer Center, Lublin, Poland
| | - Marina Motta
- S.C. Ematologia, ASST Spedali Civili Brescia, Brescia, Italy
| | - Talha Munir
- Consultant Haematologist, St James's Hospital, Leeds, UK
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale Oncologico A. Businco, ARNAS "G. Brotzu", Cagliari, Italy
| | - Carsten U Niemann
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Jacopo Olivieri
- Hematology Clinic, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Lorella Orsucci
- S.C. Ematologia, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Maria Papaioannou
- Hematology Unit, 1st Dept of Internal Medicine, AUTH, AHEPA Hospital, Thessaloniki, Greece
| | | | - Inga Piskunova
- Consultative Hematology Department with a Day Hospital for Intensive High-Dose Chemotherapy, National Research Center for Hematology, Moscow, Russia
| | - Viola Maria Popov
- HematologyDepartment, Colentina Clinical Hospital, Bucharest, Romania
| | | | - Giulia Quaresmini
- Department of Oncology and Hematology, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII Bergamo, Bergamo, Italy
| | - Kristian Qvist
- Hematologic Section, Department of Internal Medicine, Hospital Union West, Herning, Denmark
| | | | - Rosa Ruchlemer
- Department of Hematology, Shaare-Zedek Medical Center, Affiliated with the Hebrew University Medical School, Jerusalem, Israel
| | - Martin Šimkovič
- Faculty of Medicine in Hradec Králové, 4th Department of Internal Medicine-Haematology, University Hospital and Charles University in Prague, Hradec Kralove, Czech Republic
| | - Martin Špaček
- First Faculty of Medicine, 1st Department of Medicine-Hematology, Charles University and General Hospital in Prague, Prague, Czech Republic
| | - Paolo Sportoletti
- Department of Medicine and Surgery, Institute of Hematology and Center for Hemato-Oncological Research, University of Perugia, Perugia, Italy
| | - Oana Stanca
- Hematology Department, Coltea Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Tamar Tadmor
- Division of Hematology, Bnai-Zion Medical Center, Haifa, Israel
| | | | - Giovanni Del Poeta
- Department of Biomedicine and Prevention Hematology, University Tor Vergata, Rome, Italy
| | - Odit Gutwein
- Department of Hematology, Shamir Medical Center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Ivana Milosevic
- Faculty of Medicine, Clinical Centre of Vojvodina, University of Novi Sad, Novi Sad, Serbia
| | - Fatima Mirás
- Hematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Gianluigi Reda
- Hematology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan, Milan, Italy
| | | | - Amit Shrestha
- Hematology Unit, Nepal Cancer Hospital & Research Centre, Lalitpur, Nepal
| | - Doreen Te Raa
- Department of Hematology, Gelderse Vallei Ede, Ede, the Netherlands
| | - Sanne H Tonino
- Department of Hematology, Lymmcare, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Ellen Van Der Spek
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - Michel van Gelder
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Ewa Wasik-Szczepanek
- Department of Hematooncology and Bone Marrow Transplantation, Medical University in Lublin, Lublin, Poland
| | - Tomasz Wróbel
- Department and Clinic of Hematology, Blood Neoplasms and Bone Marrow Transplantation Wroclaw Medical University, Wroclaw, Poland
| | - Lucrecia Yáñez San Segundo
- Hematology Department, University Hospital and Research Institute of Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Mohamed Yassin
- Hematology Section, Department of Medical Oncology, National Center for Cancer Care and Research, Doha, Qatar
| | | | | | - Sunil Iyengar
- Haemato-oncology Unit, The Royal Marsden Hospital, UK
| | - Marzia Varettoni
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Candida Vitale
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Marta Coscia
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Alessandro Rambaldi
- Department of Medicine and Surgery, Institute of Hematology and Center for Hemato-Oncological Research, University of Perugia, Perugia, Italy
| | | | | | - Niki Stavroyianni
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCC Ospedale San Raffaele, Milan, Italy
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15
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Gutwein O, Herzog Tzarfati K, Apel A, Rahimi-Levene N, Ilana L, Tadmor T, Koren-Michowitz M. Timing of BNT162b2 vaccine prior to COVID-19 infection, influence disease severity in patients with hematologic malignancies: Results from a cohort study. Cancer Med 2023; 12:20503-20510. [PMID: 37877352 PMCID: PMC10660398 DOI: 10.1002/cam4.6397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/09/2023] [Accepted: 07/23/2023] [Indexed: 10/26/2023] Open
Abstract
The COVID-19 pandemic continues to pose challenges to the treatment of hemato-oncology patients. Emergence of COVID-19 variants, availability of vaccine boosters and antiviral treatments could impact their outcome. We retrospectively studied patients with hematologic malignancies and confirmed COVID-19 during the Omicron outbreak. Of 116 evaluated patients, 16% developed severe or critical COVID-19. Diagnosis of chronic lymphocytic leukemia (CLL) was significantly associated with severe COVID-19 (p = 0.01). The vaccine effectiveness was related to the timing of the vaccine, with patients who received a mRNA vaccine within 7-90 days prior to COVID-19 being less likely to develop severe disease compared to all other patients (p = 0.019). There was no correlation between disease severity and antiviral therapies. Importantly, 45% of patients undergoing active hematological treatment had to interrupt their treatment due to COVID-19. In conclusion, patients with hematologic malignancies are at a considerable risk for severe COVID-19 during the Omicron outbreak, with patients with CLL being the most vulnerable. mRNA vaccines have the potential to protect hematological patients from severe COVID-19 if administered within the previous 3 months. Hematological treatment interruption is a frequent adverse outcome of COVID-19 infection.
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Affiliation(s)
- Odit Gutwein
- Department of Hematology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | | | - Arie Apel
- Department of Hematology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Naomi Rahimi-Levene
- Department of Hematology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Levy Ilana
- Hematology Unit, Bnai Zion Medical Center, Haifa, Israel
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Tamar Tadmor
- Hematology Unit, Bnai Zion Medical Center, Haifa, Israel
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Maya Koren-Michowitz
- Department of Hematology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
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16
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Guo W, Zheng Y, Feng S. Omicron related COVID-19 prevention and treatment measures for patients with hematological malignancy and strategies for modifying hematologic treatment regimes. Front Cell Infect Microbiol 2023; 13:1207225. [PMID: 37928188 PMCID: PMC10622671 DOI: 10.3389/fcimb.2023.1207225] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/20/2023] [Indexed: 11/07/2023] Open
Abstract
The Omicron variant of SARS-CoV-2 has rapidly become the dominant strain worldwide due to its high transmissibility, although it appears to be less pathogenic than previous strains. However, individuals with hematological malignancy (HM) and COVID-19 remain susceptible to severe infection and mortality, especially those with chronic lymphocytic leukemia (CLL) and those undergoing chimeric antigen receptor T-cell (CAR-T) treatment. Hematologists should thoroughly assess the severity of the patient's hematological disease and the potential risk of SARS-CoV-2 infection before initiating chemotherapy or immunosuppressive treatment. Vaccination and booster doses are strongly recommended and patients with a poor vaccine response may benefit from long-acting COVID-19 neutralizing monoclonal antibodies (such as Evusheld). Early use of small molecule antiviral drugs is recommended for managing mild COVID-19 in HM patients and those with severe immunodeficiency may benefit from SARS-CoV-2 neutralizing monoclonal antibody therapy and high-titer COVID-19 convalescent plasma (CCP). For moderate to severe cases, low-dose glucocorticoids in combination with early antiviral treatment can be administered, with cytokine receptor antagonists or JAK inhibitors added if the condition persists or worsens. In the treatment of hematological malignancies, delaying chemotherapy is preferable for CLL, acute leukemia (AL), and low-risk myelodysplastic syndrome (MDS), but if the disease progresses, appropriate adjustments in dosage and frequency of treatment are required, with the avoidance of anti-CD20 monoclonal antibody, CAR-T and hematopoietic stem cell transplantation (HSCT). Patients with chronic myelocytic leukemia (CML) and myeloproliferative neoplasms (MPNs) can continue current treatment. What's more, non-drug protective measures, the development of new vaccines and antiviral drugs, and monitoring of mutations in immunocompromised populations are particularly important.
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Affiliation(s)
- Wenjing Guo
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Yizhou Zheng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Sizhou Feng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
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17
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Harel R, Itchaki G. COVID-19 in Patients with Chronic Lymphocytic Leukemia: What Have We Learned? Acta Haematol 2023; 147:60-72. [PMID: 37820599 PMCID: PMC11251671 DOI: 10.1159/000534540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/05/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Chronic lymphocytic leukemia (CLL) is a prevalent hematological malignancy (HM) characterized by inherent immunodeficiency, which is further pronounced by disease-directed therapy. The COVID-19 pandemic has had devastating outcomes, and although its impact has diminished over time, it continues to be a cause of significant morbidity and mortality, particularly among immunodeficient patients. SUMMARY In this review, we describe mechanisms of immune dysfunction in CLL in relation to COVID-19, provide an overview of the clinical outcomes of the disease in this patient population, and identify risk factors associated with severe morbidity and mortality. Additionally, we acknowledge the influence of the rapidly evolving landscape of new disease variants. The review further delineates the humoral and cellular responses to vaccination and their clinical efficacy in preventing COVID-19 in CLL patients. Moreover, we explore potential approaches to enhance these immune responses. Pre- and post-exposure prophylaxis strategies are discussed, along with description of common agents in the treatment of the disease in both outpatient and inpatient setting. Throughout the review, we emphasize the interplay between novel therapies for CLL and COVID-19 outcomes, prevention, and treatment and describe the impact of COVID-19 on the utilization of these novel agents. This information has the potential to guide clinical decision making in the management CLL patients. KEY MESSAGES CLL patients are at risk for severe COVID-19 infection. Vaccinations and COVID-19 directed therapy have improved outcomes in patients with CLL, yet clinical challenges persist.
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Affiliation(s)
- Reut Harel
- Department of Hematology, Emek Medical Center, Afula, Israel
| | - Gilad Itchaki
- Hematology, Meir Medical Center, Kefar Sava, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
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18
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Urso A, Cavazzini F, Ballardini MP, Gambara S, Consolo S, Rigolin GM, Cuneo A. First-Line Treatment of Older Patients with CLL: A New Approach in the Chemo-Free Era. Cancers (Basel) 2023; 15:3859. [PMID: 37568676 PMCID: PMC10417156 DOI: 10.3390/cancers15153859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Bruton tyrosine kinase inhibitors (BTKi) and the BCL2 inhibitor venetoclax, with or without the anti-CD20 monoclonal antibody Obinutuzumab, represent the preferred options for the first-line therapy of CLL because they are more effective and may improve quality of life. However, patient inclusion criteria are heterogeneous across trials designed for older patients, and the identification of CLL-specific parameters identifying unfit patients at risk of developing drug-specific adverse events is required to guide treatment choice. Due to inclusion/exclusion criteria in trials, higher discontinuation rates with BTKi were reported in real-world studies, and registry analyses provided useful information on factors predicting earlier discontinuation in a real-world setting. Though targeted agents were shown to be cost-effective treatments in high-income countries, the out-of-pocket expenses may limit accessibility to these drugs, and the overall expenditure for new drugs in CLL is projected to increase substantially, posing an issue for sustainability. This being said, the choice of a finite-duration treatment based on venetoclax-containing regimens or treatment until progression with BTKi is today possible in high-income countries, and the therapy choice drivers are represented by coexisting medical conditions rather than age, patient expectations, logistics, and sustainability.
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Affiliation(s)
| | | | | | | | | | | | - Antonio Cuneo
- Hematology Unit, University of Ferrara, 44121 Ferrara, Italy (F.C.); (M.P.B.); (S.C.)
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19
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Guarana M, Nucci M. Infections in patients with chronic lymphocytic leukemia. Hematol Transfus Cell Ther 2023; 45:387-393. [PMID: 37407362 PMCID: PMC10499585 DOI: 10.1016/j.htct.2023.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 02/15/2023] [Accepted: 05/28/2023] [Indexed: 07/07/2023] Open
Abstract
INTRODUCTION Infection is a major complication in patients with chronic lymphocytic leukemia (CLL). Newly diagnosed patients are at high risk of developing infection caused by encapsulated bacteria, such as Streptococcus pneumoniae and Haemophylus influenzae. METHOD AND RESULTS However, once treatment is initiated, the spectrum of pathogens causing infection broadens, depending on the treatment regimens. With disease progression, cumulative immunosuppression occurs as a consequence of multiple treatment lines and the risk of infection further increases. On the other hand, the use of targeted therapies in the treatment of CLL have brought new risks of infection, with an increased incidence of invasive fungal diseases, particularly aspergillosis, in patients receiving Bruton kinase inhibitors. CONCLUSION In this article, we review the epidemiology of infection in patients with CLL, taking into account the treatment regimen, and briefly discuss the management of infection.
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Affiliation(s)
- Mariana Guarana
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Marcio Nucci
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil; Grupo Oncoclinicas, Rio de Janeiro, RJ, Brazil.
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20
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Angotzi F, Petrella M, Berno T, Binotto G, Bonetto G, Branca A, Carraro M, Cavaretta CA, Cellini A, D’Amore F, Forlani L, Gianesello I, Gurrieri C, Imbergamo S, Lessi F, Maroccia A, Mazzetto F, Pavan L, Pezone S, Piazza F, Pravato S, Ruocco V, Scapinello G, Vianello F, Zambello R, Zatta I, Zoletto S, Padoan A, Trentin L, Visentin A. Tixagevimab/Cilgavimab as pre-exposure prophylaxis against SARS-CoV-2 in patients with hematological malignancies. Front Oncol 2023; 13:1212752. [PMID: 37427126 PMCID: PMC10324575 DOI: 10.3389/fonc.2023.1212752] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/07/2023] [Indexed: 07/11/2023] Open
Abstract
The approved combination of Tixagevimab/Cilgavimab has been shown to decrease the rate of symptomatic SARS-CoV-2 infection in patients at increased risk of inadequate response to vaccination. However, Tixagevimab/Cilgavimab was tested in a few studies that included patients with hematological malignancies, even if this population has shown an increased risk of unfavorable outcomes following infection (with high rates of hospitalization, intensive care unit admission, and mortality) and poor significant immunization following vaccines. We performed a real-life prospective cohort study to evaluate the rate of SARS-CoV-2 infection following pre-exposure prophylaxis with Tixagevimab/Cilgavimab in anti-spike seronegative patients compared to a cohort of seropositive patients who were observed or received a fourth vaccine dose. We recruited 103 patients with a mean age of 67 years: 35 (34%) received Tixagevimab/Cilgavimab and were followed from March 17, 2022, until November 15, 2022. After a median follow-up of 4.24 months, the 3-month cumulative incidence of infection was 20% versus 12% in the Tixagevimab/Cilgavimab and observation/vaccine groups respectively (HR 1.57; 95% CI: 0.65-3.56; p = 0.34). In this study, we report our experience with Tixagevimab/Cilgavimab and a tailored approach to SARS-CoV-2 infection prevention in patients with hematological malignancies during the SARS-CoV-2 omicron surge.
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Affiliation(s)
- Francesco Angotzi
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Marco Petrella
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Tamara Berno
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Gianni Binotto
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Giorgia Bonetto
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Antonio Branca
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Marco Carraro
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Chiara Adele Cavaretta
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Alessandro Cellini
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Fabio D’Amore
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Laura Forlani
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Ilaria Gianesello
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Carmela Gurrieri
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Silvia Imbergamo
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Federica Lessi
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Antonio Maroccia
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Federica Mazzetto
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Laura Pavan
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Sara Pezone
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Francesco Piazza
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Stefano Pravato
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Valeria Ruocco
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Greta Scapinello
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Fabrizio Vianello
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Renato Zambello
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Ivan Zatta
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Simone Zoletto
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Andrea Padoan
- Department of Integrated Diagnostic Medicine, Laboratory Medicine Unit, University of Padova, Padova, Italy
| | - Livio Trentin
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Andrea Visentin
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
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21
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Qin K, Honjo K, Sherrill-Mix S, Liu W, Stoltz RM, Oman AK, Hall LA, Li R, Sterrett S, Frederick ER, Lancaster JR, Narkhede M, Mehta A, Ogunsile FJ, Patel RB, Ketas TJ, Cruz Portillo VM, Cupo A, Larimer BM, Bansal A, Goepfert PA, Hahn BH, Davis RS. Exposure of progressive immune dysfunction by SARS-CoV-2 mRNA vaccination in patients with chronic lymphocytic leukemia: A prospective cohort study. PLoS Med 2023; 20:e1004157. [PMID: 37384638 PMCID: PMC10309642 DOI: 10.1371/journal.pmed.1004157] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/31/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Patients with chronic lymphocytic leukemia (CLL) have reduced seroconversion rates and lower binding antibody (Ab) and neutralizing antibody (NAb) titers than healthy individuals following Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) mRNA vaccination. Here, we dissected vaccine-mediated humoral and cellular responses to understand the mechanisms underlying CLL-induced immune dysfunction. METHODS AND FINDINGS We performed a prospective observational study in SARS-CoV-2 infection-naïve CLL patients (n = 95) and healthy controls (n = 30) who were vaccinated between December 2020 and June 2021. Sixty-one CLL patients and 27 healthy controls received 2 doses of the Pfizer-BioNTech BNT162b2 vaccine, while 34 CLL patients and 3 healthy controls received 2 doses of the Moderna mRNA-1273 vaccine. The median time to analysis was 38 days (IQR, 27 to 83) for CLL patients and 36 days (IQR, 28 to 57) for healthy controls. Testing plasma samples for SARS-CoV-2 anti-spike and receptor-binding domain Abs by enzyme-linked immunosorbent assay (ELISA), we found that all healthy controls seroconverted to both antigens, while CLL patients had lower response rates (68% and 54%) as well as lower median titers (23-fold and 30-fold; both p < 0.001). Similarly, NAb responses against the then prevalent D614G and Delta SARS-CoV-2 variants were detected in 97% and 93% of controls, respectively, but in only 42% and 38% of CLL patients, who also exhibited >23-fold and >17-fold lower median NAb titers (both p < 0.001). Interestingly, 26% of CLL patients failed to develop NAbs but had high-titer binding Abs that preferentially reacted with the S2 subunit of the SARS-CoV-2 spike. Since these patients were also seropositive for endemic human coronaviruses (HCoVs), these responses likely reflect cross-reactive HCoV Abs rather than vaccine-induced de novo responses. CLL disease status, advanced Rai stage (III-IV), elevated serum beta-2 microglobulin levels (β2m >2.4 mg/L), prior therapy, anti-CD20 immunotherapy (<12 months), and intravenous immunoglobulin (IVIg) prophylaxis were all predictive of an inability to mount SARS-CoV-2 NAbs (all p ≤ 0.03). T cell response rates determined for a subset of participants were 2.8-fold lower for CLL patients compared to healthy controls (0.05, 95% CI 0.01 to 0.27, p < 0.001), with reduced intracellular IFNγ staining (p = 0.03) and effector polyfunctionality (p < 0.001) observed in CD4+ but not in CD8+ T cells. Surprisingly, in treatment-naïve CLL patients, BNT162b2 vaccination was identified as an independent negative risk factor for NAb generation (5.8, 95% CI 1.6 to 27, p = 0.006). CLL patients who received mRNA-1273 had 12-fold higher (p < 0.001) NAb titers and 1.7-fold higher (6.5, 95% CI 1.3 to 32, p = 0.02) response rates than BNT162b2 vaccinees despite similar disease characteristics. The absence of detectable NAbs in CLL patients was associated with reduced naïve CD4+ T cells (p = 0.03) and increased CD8+ effector memory T cells (p = 0.006). Limitations of the study were that not all participants were subjected to the same immune analyses and that pre-vaccination samples were not available. CONCLUSIONS CLL pathogenesis is characterized by a progressive loss of adaptive immune functions, including in most treatment-naïve patients, with preexisting memory being preserved longer than the capacity to mount responses to new antigens. In addition, higher NAb titers and response rates identify mRNA-1273 as a superior vaccine for CLL patients.
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Affiliation(s)
- Kai Qin
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Kazuhito Honjo
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Scott Sherrill-Mix
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Weimin Liu
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Regina M. Stoltz
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Allisa K. Oman
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Lucinda A. Hall
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Ran Li
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Sarah Sterrett
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Ellen R. Frederick
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Jeffrey R. Lancaster
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Mayur Narkhede
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Amitkumar Mehta
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Foluso J. Ogunsile
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Rima B. Patel
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Thomas J. Ketas
- Department of Microbiology and Immunology, Weill Medical College of Cornell University, New York, New York, United States of America
| | - Victor M. Cruz Portillo
- Department of Microbiology and Immunology, Weill Medical College of Cornell University, New York, New York, United States of America
| | - Albert Cupo
- Department of Microbiology and Immunology, Weill Medical College of Cornell University, New York, New York, United States of America
| | - Benjamin M. Larimer
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Anju Bansal
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Paul A. Goepfert
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Beatrice H. Hahn
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Department of Microbiology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Randall S. Davis
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
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22
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Defrancesco I, Ferretti VV, Morel P, Kyriakou C, Kastritis E, Tohidi-Esfahani I, Tedeschi A, Buske C, García-Sanz R, Vos JM, Peri V, Margiotta Casaluci G, Ferrari A, Piazza F, Oostvogels R, Lovato E, Montes L, Fornecker LM, Grunenberg A, Dimopoulos MA, Tam CS, D’Sa S, Leblond V, Trotman J, Passamonti F, Arcaini L, Varettoni M. SARS-CoV-2 Infection in Patients With Waldenström's Macroglobulinemia: A Multicenter International Cohort Study. Hemasphere 2023; 7:e887. [PMID: 37283569 PMCID: PMC10241499 DOI: 10.1097/hs9.0000000000000887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/04/2023] [Indexed: 06/08/2023] Open
Affiliation(s)
- Irene Defrancesco
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy
| | | | - Pierre Morel
- Service d’Hematologie Clinique et Therapie Cellulaire, Centre Hospitalier Universitaire d’Amiens-Picardie, France
| | - Charalampia Kyriakou
- Centre for Waldenström’s Macroglobulinaemia and Related Conditions, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Greece
| | | | | | - Christian Buske
- Institute of Experimental Cancer Research, Comprehensive Cancer Center Ulm, University Hospital of Ulm, Germany
| | - Ramón García-Sanz
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (University of Salamanca-CSIC), Spain
| | - Josephine M.I. Vos
- Department of Hematology, Amsterdam UMC, Location University of Amsterdam, Cancer Center Amsterdam and LYMMCARE (Lymphoma and Myeloma Center Amsterdam), the Netherlands
| | - Veronica Peri
- Hematology Division, “AOU Città della Salute e della Scienza di Torino,” Italy
| | - Gloria Margiotta Casaluci
- Division of Hematology, Department of Translational Medicine, Hospital Maggiore della Carità, Novara, Italy
| | | | - Francesco Piazza
- Laboratory of Myeloma and Lymphoma Pathobiology, Veneto Institute of Molecular Medicine (VIMM) and Foundation for Advanced Biomedical Research (FABR), Padua, Italy
- Hematology Division, Azienda Ospedaliera Universitaria and Department of Medicine, University of Padua, Italy
| | | | - Ester Lovato
- Department of Medicine, Hematology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Lydia Montes
- Service d’Hematologie Clinique et Therapie Cellulaire, Centre Hospitalier Universitaire d’Amiens-Picardie, France
| | | | | | | | - Constantine S. Tam
- Peter MacCallum Cancer Centre and University of Melbourne, VIC, Australia
- Alfred Health and Monash University, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Shirley D’Sa
- Centre for Waldenström’s Macroglobulinaemia and Related Conditions, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Veronique Leblond
- Département d’Hématologie Hôpital Pitié-Salpêtrière APHP, UPMC Université Paris, France
| | - Judith Trotman
- Haematology Department, Concord Repatriation General Hospital, Sydney, NSW, Australia
- University of Sydney, Camperdown, NSW, Australia
| | - Francesco Passamonti
- Department of Hematology, University Hospital “Ospedale di Circolo e Fondazione Macchi - ASST SetteLaghi,” University of Insubria, Varese, Italy
| | - Luca Arcaini
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Italy
| | - Marzia Varettoni
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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23
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Hus I, Szymczyk A, Mańko J, Drozd-Sokołowska J. COVID-19 in Adult Patients with Hematological Malignancies-Lessons Learned after Three Years of Pandemic. BIOLOGY 2023; 12:biology12040545. [PMID: 37106746 PMCID: PMC10136203 DOI: 10.3390/biology12040545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 04/29/2023]
Abstract
The COVID-19 pandemic is undoubtedly the most difficult health challenge of the 21st century with more than 600 million laboratory-confirmed SARS-CoV-2 infections and over 6.5 million deaths worldwide. The coronavirus pandemic contributed to rapid development of mRNA vaccines, which, along with new antiviral drugs, have been the subject of extensive research for many decades. Nevertheless, elderly, multi-morbid and immunocompromised patients continue to face a more severe clinical course and a higher risk of death from COVID-19, even now that the risk of COVID-19 in the general population is significantly reduced due to the introduction of global vaccination strategies. In this paper, we present the mechanisms of increased susceptibility to infectious complications and the evolution of the clinical course of COVID-19 in patients with hematological malignancies, taking into account the mutation of the virus and the introduction of vaccines and new antiviral drugs. We also present current recommendations for prophylactic and therapeutic management in patients with hematological malignancies.
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Affiliation(s)
- Iwona Hus
- Department of Hematology, National Medical Institute of the Ministry of Interior and Administration, 137 Wołoska Str., 02-507 Warsaw, Poland
- Department of Clinical Transplantology, Medical University of Lublin, 7 Chodźki Str., 20-093 Lublin, Poland
| | - Agnieszka Szymczyk
- Department of Hematology, National Medical Institute of the Ministry of Interior and Administration, 137 Wołoska Str., 02-507 Warsaw, Poland
- Department of Clinical Transplantology, Medical University of Lublin, 7 Chodźki Str., 20-093 Lublin, Poland
| | - Joanna Mańko
- Department of Hematology, National Medical Institute of the Ministry of Interior and Administration, 137 Wołoska Str., 02-507 Warsaw, Poland
| | - Joanna Drozd-Sokołowska
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, 1a Banacha Str., 02-097 Warsaw, Poland
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Šimkovič M, Turcsányi P, Špaček M, Mihályová J, Ryznerová P, Maco M, Vodárek P, Écsiová D, Poul H, Móciková H, Zuchnická J, Panovská A, Lekaa M, Oršulová M, Prchlíková A, Stejskal L, Mašlejová S, Brychtová Y, Bezděková L, Papajík T, Lysák D, Trněný M, Smolej L, Doubek M. COVID-19 in patients with chronic lymphocytic leukemia: a multicenter analysis by the Czech CLL study group. Ann Hematol 2023; 102:811-817. [PMID: 36847805 PMCID: PMC9969021 DOI: 10.1007/s00277-023-05147-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 12/15/2022] [Indexed: 03/01/2023]
Abstract
Patients with chronic lymphocytic leukemia (CLL) have a high risk of poor outcomes related to coronavirus disease 2019 (COVID-19). This multicenter cohort study evaluated the impact of COVID-19 infection on the population of CLL patients in the Czech Republic. Between March 2020 and May 2021, 341 patients (237 males) with CLL and COVID-19 disease were identified. The median age was 69 years (range 38-91). Out of the 214 (63%) patients with the history of therapy for CLL, 97 (45%) were receiving CLL-directed treatment at diagnosis of COVID-19: 29% Bruton tyrosine kinase inhibitor (BTKi), 16% chemoimmunotherapy (CIT), 11% Bcl-2 inhibitor, and 4% phosphoinositide 3-kinase inhibitor. Regarding the severity of COVID-19, 60% pts required admission to the hospital, 21% pts were admitted to the intensive care unit (ICU), and 12% received invasive mechanical ventilation. The overall case fatality rate was 28%. Major comorbidities, age over 72, male gender, CLL treatment in history, CLL-directed treatment at COVID-19 diagnosis were associated with increased risk of death. Of note, concurrent therapy with BTKi compared to CIT was not associated with better outcome of COVID-19.
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Affiliation(s)
- Martin Šimkovič
- 4th Department of Internal Medicine - Hematology, Faculty of Medicine in Hradec Králové, University Hospital and Charles University in Prague, Prague, Czech Republic.
| | - Peter Turcsányi
- Department of Haematology-Oncology, University Hospital, Olomouc, Czech Republic
| | - Martin Špaček
- First Department of Medicine - Haematology, University General Hospital, Prague, Czech Republic
| | - Jana Mihályová
- Department of Hematooncology, University Hospital, Ostrava, Czech Republic
| | - Pavlína Ryznerová
- Department of Haematology-Oncology, University Hospital, Olomouc, Czech Republic
| | - Mária Maco
- Department of Internal Medicine - Haematology, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Pavel Vodárek
- 4th Department of Internal Medicine - Hematology, Faculty of Medicine in Hradec Králové, University Hospital and Charles University in Prague, Prague, Czech Republic
| | - Dominika Écsiová
- 4th Department of Internal Medicine - Hematology, Faculty of Medicine in Hradec Králové, University Hospital and Charles University in Prague, Prague, Czech Republic
| | - Hynek Poul
- Department of Hematology and Transfusion Medicine, Hospital Pelhrimov, Pelhrimov, Czech Republic
| | - Heidi Móciková
- Department of Internal Medicine - Haematology, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Jana Zuchnická
- Department of Hematooncology, University Hospital, Ostrava, Czech Republic
| | - Anna Panovská
- Department of Internal Medicine - Haematology and Oncology, University Hospital, Brno, Czech Republic
| | - Mohammad Lekaa
- Department of Hematology and Oncology, Medical School and Teaching Hospital in Plzen, Charles University in Prague, Plzen, Czech Republic
| | - Martina Oršulová
- Department of Internal Medicine - Haematology and Oncology, University Hospital, Brno, Czech Republic
| | - Adéla Prchlíková
- Department of Internal Medicine - Haematology and Oncology, University Hospital, Brno, Czech Republic
| | - Lukáš Stejskal
- Haematology/Tranfusiology Department, Silesian Hospital Opava, Opava, Czech Republic
| | - Stanislava Mašlejová
- Department of Internal Medicine - Haematology and Oncology, University Hospital, Brno, Czech Republic
| | - Yvona Brychtová
- Department of Internal Medicine - Haematology and Oncology, University Hospital, Brno, Czech Republic
| | - Lucie Bezděková
- Department of Internal Medicine - Haematology and Oncology, University Hospital, Brno, Czech Republic
| | - Tomáš Papajík
- Department of Haematology-Oncology, University Hospital, Olomouc, Czech Republic
| | - Daniel Lysák
- Department of Hematology and Oncology, Medical School and Teaching Hospital in Plzen, Charles University in Prague, Plzen, Czech Republic
| | - Marek Trněný
- First Department of Medicine - Haematology, University General Hospital, Prague, Czech Republic
| | - Lukáš Smolej
- 4th Department of Internal Medicine - Hematology, Faculty of Medicine in Hradec Králové, University Hospital and Charles University in Prague, Prague, Czech Republic
| | - Michael Doubek
- Department of Internal Medicine - Haematology and Oncology, University Hospital, Brno, Czech Republic
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Hematopoietic cell transplantation and cellular therapies in Europe 2021. The second year of the SARS-CoV-2 pandemic. A Report from the EBMT Activity Survey. Bone Marrow Transplant 2023:10.1038/s41409-023-01943-3. [PMID: 36879108 PMCID: PMC9987384 DOI: 10.1038/s41409-023-01943-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/06/2023] [Accepted: 02/16/2023] [Indexed: 03/08/2023]
Abstract
In 2021, 47,412 HCT (19,806 (42%) allogeneic and 27,606 (58%) autologous) in 43,109 patients were reported by 694 European centers. 3494 patients received advanced cellular therapies, 2524 of which were CAR-T treatments, an additional 3245 received DLI. Changes compared to the previous year were CAR-T treatment (+35%), allogeneic HCT +5.4%, autologous HCT +3.9%, more pronounced in non-malignant disorders. Main indications for allogeneic HCT were myeloid malignancies 10,745 (58%), lymphoid malignancies 5127 (28%) and non-malignant disorders 2501 (13%). Main indications for autologous HCT were lymphoid malignancies 22,129 (90%) and solid tumors 1635 (7%). In allogeneic HCT, use of haploidentical donors decreased by -0.9% while use of unrelated and sibling donors increased by +4.3% and +9%. Cord blood HCT decreased by -5.8%. Pediatric HCT increased overall by +5.6% (+6.9% allogeneic and +1.6% autologous). Increase in the use of CAR-T was mainly restricted to high-income countries. The drop in HCT activity reported in 2020 partially recovered in 2021, the second year of the SARS-CoV-2 pandemic. The transplant community confronted with the pandemic challenge, continued in providing patients access to treatment. This annual EBMT report reflects current activities useful for health care resource planning.
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COVID-19 Breakthrough Infections in Vaccinated Patients With CLL in Israel. Hemasphere 2023; 7:e839. [PMID: 36751514 PMCID: PMC9894345 DOI: 10.1097/hs9.0000000000000839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/03/2023] [Indexed: 01/28/2023] Open
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27
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Oliva-Ariza G, Fuentes-Herrero B, Carbonell C, Lecrevisse Q, Pérez-Pons A, Torres-Valle A, Pozo J, Martín-Oterino JÁ, González-López Ó, López-Bernús A, Bernal-Ribes M, Belhassen-García M, Pérez-Escurza O, Pérez-Andrés M, Vazquez L, Hernández-Pérez G, García Palomo FJ, Leoz P, Costa-Alba P, Pérez-Losada E, Yeguas A, Santos Sánchez M, García-Blázquez M, Morán-Plata FJ, Damasceno D, Botafogo V, Muñoz-García N, Fluxa R, Contreras-Sanfeliciano T, Almeida J, Marcos M, Orfao A. High frequency of low-count monoclonal B-cell lymphocytosis in hospitalized COVID-19 patients. Blood 2023; 141:309-314. [PMID: 36399707 PMCID: PMC9906370 DOI: 10.1182/blood.2022017439] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Guillermo Oliva-Ariza
- Translational and Clinical Research Program, Centro de Investigación del Cáncer and Instituto de Biología Molecular y Celular del Cáncer (IBMCC), Consejo Superior de Investigaciones Científicas (CSIC), and University of Salamanca (Universidad de Salamanca), Salamanca, Spain; Cytometry Service (NUCLEUS), Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
| | - Blanca Fuentes-Herrero
- Translational and Clinical Research Program, Centro de Investigación del Cáncer and Instituto de Biología Molecular y Celular del Cáncer (IBMCC), Consejo Superior de Investigaciones Científicas (CSIC), and University of Salamanca (Universidad de Salamanca), Salamanca, Spain; Cytometry Service (NUCLEUS), Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
| | - Cristina Carbonell
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
- Department of Internal Medicine, University Hospital of Salamanca, Salamanca, Spain
| | - Quentin Lecrevisse
- Translational and Clinical Research Program, Centro de Investigación del Cáncer and Instituto de Biología Molecular y Celular del Cáncer (IBMCC), Consejo Superior de Investigaciones Científicas (CSIC), and University of Salamanca (Universidad de Salamanca), Salamanca, Spain; Cytometry Service (NUCLEUS), Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
- Department of Infectious Diseases, University Hospital of Salamanca, Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), Salamanca, Spain
| | - Alba Pérez-Pons
- Translational and Clinical Research Program, Centro de Investigación del Cáncer and Instituto de Biología Molecular y Celular del Cáncer (IBMCC), Consejo Superior de Investigaciones Científicas (CSIC), and University of Salamanca (Universidad de Salamanca), Salamanca, Spain; Cytometry Service (NUCLEUS), Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
| | - Alba Torres-Valle
- Translational and Clinical Research Program, Centro de Investigación del Cáncer and Instituto de Biología Molecular y Celular del Cáncer (IBMCC), Consejo Superior de Investigaciones Científicas (CSIC), and University of Salamanca (Universidad de Salamanca), Salamanca, Spain; Cytometry Service (NUCLEUS), Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
| | - Julio Pozo
- Translational and Clinical Research Program, Centro de Investigación del Cáncer and Instituto de Biología Molecular y Celular del Cáncer (IBMCC), Consejo Superior de Investigaciones Científicas (CSIC), and University of Salamanca (Universidad de Salamanca), Salamanca, Spain; Cytometry Service (NUCLEUS), Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
| | - José Ángel Martín-Oterino
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
- Department of Internal Medicine, University Hospital of Salamanca, Salamanca, Spain
| | - Óscar González-López
- Translational and Clinical Research Program, Centro de Investigación del Cáncer and Instituto de Biología Molecular y Celular del Cáncer (IBMCC), Consejo Superior de Investigaciones Científicas (CSIC), and University of Salamanca (Universidad de Salamanca), Salamanca, Spain; Cytometry Service (NUCLEUS), Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
| | - Amparo López-Bernús
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
- Department of Internal Medicine, University Hospital of Salamanca, Salamanca, Spain
- Department of Infectious Diseases, University Hospital of Salamanca, Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), Salamanca, Spain
| | - Marta Bernal-Ribes
- Translational and Clinical Research Program, Centro de Investigación del Cáncer and Instituto de Biología Molecular y Celular del Cáncer (IBMCC), Consejo Superior de Investigaciones Científicas (CSIC), and University of Salamanca (Universidad de Salamanca), Salamanca, Spain; Cytometry Service (NUCLEUS), Salamanca, Spain
- Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
| | - Moncef Belhassen-García
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
- Department of Internal Medicine, University Hospital of Salamanca, Salamanca, Spain
- Department of Infectious Diseases, University Hospital of Salamanca, Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), Salamanca, Spain
| | - Oihane Pérez-Escurza
- Translational and Clinical Research Program, Centro de Investigación del Cáncer and Instituto de Biología Molecular y Celular del Cáncer (IBMCC), Consejo Superior de Investigaciones Científicas (CSIC), and University of Salamanca (Universidad de Salamanca), Salamanca, Spain; Cytometry Service (NUCLEUS), Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
| | - Martín Pérez-Andrés
- Translational and Clinical Research Program, Centro de Investigación del Cáncer and Instituto de Biología Molecular y Celular del Cáncer (IBMCC), Consejo Superior de Investigaciones Científicas (CSIC), and University of Salamanca (Universidad de Salamanca), Salamanca, Spain; Cytometry Service (NUCLEUS), Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
- Biomedical Research Networking Centre Consortium of Oncology (CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
| | - Lourdes Vazquez
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Hematology, University Hospital of Salamanca, Salamanca, Spain
| | - Guillermo Hernández-Pérez
- Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
- Department of Internal Medicine, University Hospital of Salamanca, Salamanca, Spain
| | | | - Pilar Leoz
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Hematology, University Hospital of Salamanca, Salamanca, Spain
| | - Pilar Costa-Alba
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Emergency Department, University Hospital of Salamanca, Salamanca, Spain
| | - Elena Pérez-Losada
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Intensive Care department, University Hospital of Salamanca, Salamanca, Spain
| | - Ana Yeguas
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Hematology, University Hospital of Salamanca, Salamanca, Spain
| | - Miryam Santos Sánchez
- Translational and Clinical Research Program, Centro de Investigación del Cáncer and Instituto de Biología Molecular y Celular del Cáncer (IBMCC), Consejo Superior de Investigaciones Científicas (CSIC), and University of Salamanca (Universidad de Salamanca), Salamanca, Spain; Cytometry Service (NUCLEUS), Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
| | | | - Francisco Javier Morán-Plata
- Translational and Clinical Research Program, Centro de Investigación del Cáncer and Instituto de Biología Molecular y Celular del Cáncer (IBMCC), Consejo Superior de Investigaciones Científicas (CSIC), and University of Salamanca (Universidad de Salamanca), Salamanca, Spain; Cytometry Service (NUCLEUS), Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
| | - Daniela Damasceno
- Translational and Clinical Research Program, Centro de Investigación del Cáncer and Instituto de Biología Molecular y Celular del Cáncer (IBMCC), Consejo Superior de Investigaciones Científicas (CSIC), and University of Salamanca (Universidad de Salamanca), Salamanca, Spain; Cytometry Service (NUCLEUS), Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
- Biomedical Research Networking Centre Consortium of Oncology (CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
| | - Vitor Botafogo
- Translational and Clinical Research Program, Centro de Investigación del Cáncer and Instituto de Biología Molecular y Celular del Cáncer (IBMCC), Consejo Superior de Investigaciones Científicas (CSIC), and University of Salamanca (Universidad de Salamanca), Salamanca, Spain; Cytometry Service (NUCLEUS), Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
| | - Noemí Muñoz-García
- Translational and Clinical Research Program, Centro de Investigación del Cáncer and Instituto de Biología Molecular y Celular del Cáncer (IBMCC), Consejo Superior de Investigaciones Científicas (CSIC), and University of Salamanca (Universidad de Salamanca), Salamanca, Spain; Cytometry Service (NUCLEUS), Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
| | | | | | - Julia Almeida
- Translational and Clinical Research Program, Centro de Investigación del Cáncer and Instituto de Biología Molecular y Celular del Cáncer (IBMCC), Consejo Superior de Investigaciones Científicas (CSIC), and University of Salamanca (Universidad de Salamanca), Salamanca, Spain; Cytometry Service (NUCLEUS), Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
- Biomedical Research Networking Centre Consortium of Oncology (CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
| | - Miguel Marcos
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
- Department of Internal Medicine, University Hospital of Salamanca, Salamanca, Spain
| | - Alberto Orfao
- Translational and Clinical Research Program, Centro de Investigación del Cáncer and Instituto de Biología Molecular y Celular del Cáncer (IBMCC), Consejo Superior de Investigaciones Científicas (CSIC), and University of Salamanca (Universidad de Salamanca), Salamanca, Spain; Cytometry Service (NUCLEUS), Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
- Biomedical Research Networking Centre Consortium of Oncology (CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
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One-year breakthrough SARS-CoV-2 infection and correlates of protection in fully vaccinated hematological patients. Blood Cancer J 2023; 13:8. [PMID: 36599843 PMCID: PMC9812742 DOI: 10.1038/s41408-022-00778-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 01/06/2023] Open
Abstract
The long-term clinical efficacy of SARS-CoV-2 vaccines according to antibody response in immunosuppressed patients such as hematological patients has been little explored. A prospective multicenter registry-based cohort study conducted from December 2020 to July 2022 by the Spanish Transplant and Cell Therapy group, was used to analyze the relationship of antibody response over time after full vaccination (at 3-6 weeks, 3, 6 and 12 months) (2 doses) and of booster doses with breakthrough SARS-CoV-2 infection in 1551 patients with hematological disorders. At a median follow-up of 388 days after complete immunization, 266 out of 1551 (17%) developed breakthrough SARS-CoV-2 infection at median of 86 days (range 7-391) after full vaccination. The cumulative incidence was 18% [95% confidence interval (C.I.), 16-20%]. Multivariate analysis identified higher incidence in chronic lymphocytic leukemia patients (29%) and with the use of corticosteroids (24.5%), whereas female sex (15.5%) and more than 1 year after last therapy (14%) were associated with a lower incidence (p < 0.05 for all comparisons). Median antibody titers at different time points were significantly lower in breakthrough cases than in non-cases. A serological titer cut-off of 250 BAU/mL was predictive of breakthrough infection and its severity. SARS-CoV-2 infection-related mortality was encouragingly low (1.9%) in our series. Our study describes the incidence of and risk factors for COVID-19 breakthrough infections during the initial vaccination and booster doses in the 2021 to mid-2022 period. The level of antibody titers at any time after 2-dose vaccination is strongly linked with protection against both breakthrough infection and severe disease, even with the Omicron SARS-CoV-2 variant.
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Benjamini O, Gershon R, Bar‐Haim E, Lustig Y, Cohen H, Doolman R, Kedmi M, Ribakovsky E, Kneller A, Hod T, Erez N, Levy I, Rahav G, Avigdor A. Cellular and humoral response to the fourth BNT162b2 mRNA COVID-19 vaccine dose in patients with CLL. Eur J Haematol Suppl 2023; 110:99-108. [PMID: 36208015 PMCID: PMC9874468 DOI: 10.1111/ejh.13878] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 01/27/2023]
Abstract
We assessed the humoral and cellular response to the fourth BNT162b2 mRNA COVID-19 vaccine dose in patients with CLL. A total of 67 patients with CLL and 85 age matched controls tested for serologic response and pseudo-neutralization assay. We also tested the functional T-cell response by interferon gamma (IFNγ) to spike protein in 26 patients. Two weeks after the fourth vaccine antibody serologic response was evident in 37 (55.2%) patients with CLL, 20 /22 (91%) of treatment naïve, and 9/32 (28%) patients with ongoing therapy, compared with 100% serologic response in age matched controls. The antibody titer increased by 10-fold in patients with CLL, however, still 88-folds lower than age matched controls. Predictors of better chances of post fourth vaccination serologic response were previous positive serologies after second, third, and pre-fourth vaccination, neutralizing assay, and treatment naïve patients. T-cell response improved from 42.3% before the fourth vaccine to 84.6% 2 weeks afterwards. During the time period of 3 months after the fourth vaccination, 14 patients (21%) developed COVID-19 infection, all recovered uneventfully. Our data demonstrate that fourth SARS-CoV-2 vaccination improves serologic response in patients with CLL to a lesser extent than healthy controls and induces functional T-cell response.
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Affiliation(s)
- Ohad Benjamini
- Hematology DivisionChaim Sheba Medical CentreTel‐HashomerIsrael,Sackler Faculty of MedicineTel‐Aviv UniversityTel AvivIsrael
| | - Rotem Gershon
- Sackler Faculty of MedicineTel‐Aviv UniversityTel AvivIsrael
| | - Erez Bar‐Haim
- Department of Biochemistry and Molecular GeneticsIsrael Institute for Biological ResearchNess‐ZionaIsrael
| | - Yaniv Lustig
- Central Virology LaboratoryMinistry of Health and Chaim Sheba Medical CenterTel‐HashomerIsrael
| | - Hila Cohen
- Department of Biochemistry and Molecular GeneticsIsrael Institute for Biological ResearchNess‐ZionaIsrael
| | - Ram Doolman
- The Dworman Automated‐Mega LaboratorySheba Medical CenterTel‐HashomerIsrael
| | - Meirav Kedmi
- Hematology DivisionChaim Sheba Medical CentreTel‐HashomerIsrael,Sackler Faculty of MedicineTel‐Aviv UniversityTel AvivIsrael,The Mina and Everard Goodman Faculty of Life ScienceBar‐Ilan UniversityRamat‐GanIsrael
| | | | - Abraham Kneller
- Hematology DivisionChaim Sheba Medical CentreTel‐HashomerIsrael
| | - Tammy Hod
- Sackler Faculty of MedicineTel‐Aviv UniversityTel AvivIsrael,Nephrology DepartmentChaim Sheba Medical CentreTel‐HashomerIsrael
| | - Noam Erez
- Department of Infectious DiseasesIsrael Institute for Biological ResearchNess‐ZionaIsrael
| | - Itzhak Levy
- Sackler Faculty of MedicineTel‐Aviv UniversityTel AvivIsrael,The Infectious Disease UnitChaim Sheba Medical CenterTel‐HashomerIsrael
| | - Galia Rahav
- Sackler Faculty of MedicineTel‐Aviv UniversityTel AvivIsrael,The Infectious Disease UnitChaim Sheba Medical CenterTel‐HashomerIsrael
| | - Abraham Avigdor
- Hematology DivisionChaim Sheba Medical CentreTel‐HashomerIsrael,Sackler Faculty of MedicineTel‐Aviv UniversityTel AvivIsrael
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COVID-19 Vaccination Response and Its Practical Application in Patients With Chronic Lymphocytic Leukemia. Hemasphere 2023; 7:e811. [PMID: 36570695 PMCID: PMC9771252 DOI: 10.1097/hs9.0000000000000811] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/09/2022] [Indexed: 12/27/2022] Open
Abstract
Patients with chronic lymphocyticleukemia (CLL) typically have innate/adaptive immune system dysregulation, thus the protective effect of coronavirus disease 2019 (COVID-19) vaccination remains uncertain. This prospective review evaluates vaccination response in these patients, including seropositivity rates by CLL treatment status, type of treatment received, and timing of vaccination. Antibody persistence, predictors of poor vaccine response, and severity of COVID-19 infection in vaccinated patients were also analyzed. Practical advice on the clinical management of patients with CLL is provided. Articles reporting COVID-19 vaccination in patients with CLL, published January 1, 2021-May 1, 2022, were included. Patients with CLL displayed the lowest vaccination responses among hematologic malignancies; however, seropositivity increased with each vaccination. One of the most commonly reported independent risk factors for poor vaccine response was active CLL treatment; others included hypogammaglobulinemia and age >65-70 years. Patients who were treatment-naive, off therapy, in remission, or who had a prior COVID-19 infection displayed the greatest responses. Further data are needed on breakthrough infection rates and a heterologous booster approach in patients with hematologic malignancies. Although vaccine response was poor for patients on active therapy regardless of treatment type, CLL management in the context of COVID-19 should aim to avoid delays in antileukemic treatment, especially with the advent of numerous strategies to mitigate risk of severe COVID-19 such as pre-exposure prophylaxis, and highly effective antivirals and monoclonal antibody therapy upon confirmed infection. Patients with CLL should remain vigilant in retaining standard prevention measures such as masks, social distancing, and hand hygiene.
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Visentin A, Molinari MC, Pravato S, Cellini A, Angotzi F, Cavaretta CA, Ruocco V, Imbergamo S, Piazza F, Proietti G, Mauro FR, Trentin L. A Retrospective Study on the Efficacy of Subcutaneous Immunoglobulin as Compared to Intravenous Formulation in Patients with Chronic Lymphocytic Leukemia and Secondary Antibody Deficiency. Curr Oncol 2022; 30:274-283. [PMID: 36661671 PMCID: PMC9857433 DOI: 10.3390/curroncol30010022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/11/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Secondary antibody deficiency (SAD) is a common complication in chronic lymphocytic leukemia (CLL) which favors the development of life-threatening infections. Subcutaneous immunoglobulins (IG) (SCIG) have been proven to be as effective as intravenous immunoglobulin (IVIG) in primary immunodeficiencies. Since only a few studies investigated SCIG in secondary antibody deficiency, the aim of this study was to assess the efficacy and safety of SCIG or IVIG in CLL patients with secondary antibody deficiency. One hundred and sixteen CLL patients were recruited, 63% were males, and the median age was 68 years; 44% had bronchiectasis and 76% never smoked. Forty-nine patients received IVIG and 88 SCIG, including 28 patients who shifted from IVIG to SCIG. Despite similar baseline IgG levels, patients receiving SCIG achieved higher IgG after at least +6 months (p = 0.0009). We observed that SCIG can decrease the cumulative incidence of first (HR 0.39 p < 0.0001) and second (HR 0.56 p = 0.0411) infection more than IVIG. The effect was remarkable in that patients were able to reach at least 6 g/L of IgG after 6 months of treatments (p < 0.0001). Replacement therapies were well tolerated with less adverse events and a lower discontinuation rate in patients was managed with SCIG than IVIG. In this study we describe the clinical features of a large cohort of CLL with secondary antibody deficiency receiving IG. We demonstrated that SCIG are active and well tolerated drugs that allows to reach higher IgG levels and decrease the rate of infections better than IVIG, in particular when IgG levels reach 6 g/L.
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Affiliation(s)
- Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
- Hematology Unit, Department of Medicine of Systems (DIDAS), Azienda Ospedale Università Padova, 35128 Padova, Italy
| | - Maria Chiara Molinari
- Hematology Unit, Department of Translational and Precision Medicine, Sapienza University, 00185 Rome, Italy
| | - Stefano Pravato
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Alessandro Cellini
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Francesco Angotzi
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Chiara Adele Cavaretta
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Valeria Ruocco
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Silvia Imbergamo
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Francesco Piazza
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Giulia Proietti
- Hematology Unit, Department of Translational and Precision Medicine, Sapienza University, 00185 Rome, Italy
| | - Francesca Romana Mauro
- Hematology Unit, Department of Translational and Precision Medicine, Sapienza University, 00185 Rome, Italy
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
- Hematology Unit, Department of Medicine of Systems (DIDAS), Azienda Ospedale Università Padova, 35128 Padova, Italy
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32
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Qin K, Honjo K, Sherrill-Mix S, Liu W, Stoltz R, Oman AK, Hall LA, Li R, Sterrett S, Frederick ER, Lancaster JR, Narkhede M, Mehta A, Ogunsile FJ, Patel RB, Ketas TJ, Cruz Portillo VM, Cupo A, Larimer BM, Bansal A, Goepfert PA, Hahn BH, Davis RS. SARS-CoV-2 mRNA vaccination exposes progressive adaptive immune dysfunction in patients with chronic lymphocytic leukemia. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.12.19.22283645. [PMID: 36597532 PMCID: PMC9810225 DOI: 10.1101/2022.12.19.22283645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Chronic lymphocytic leukemia (CLL) patients have lower seroconversion rates and antibody titers following SARS-CoV-2 vaccination, but the reasons for this diminished response are poorly understood. Here, we studied humoral and cellular responses in 95 CLL patients and 30 healthy controls after two BNT162b2 or mRNA-2173 mRNA immunizations. We found that 42% of CLL vaccinees developed SARS-CoV-2-specific binding and neutralizing antibodies (NAbs), while 32% had no response. Interestingly, 26% were seropositive, but had no detectable NAbs, suggesting the maintenance of pre-existing endemic human coronavirus-specific antibodies that cross-react with the S2 domain of the SARS-CoV-2 spike. These individuals had more advanced disease. In treatment-naïve CLL patients, mRNA-2173 induced 12-fold higher NAb titers and 1.7-fold higher response rates than BNT162b2. These data reveal a graded loss of immune function, with pre-existing memory being preserved longer than the capacity to respond to new antigens, and identify mRNA-2173 as a superior vaccine for CLL patients.
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Affiliation(s)
- Kai Qin
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA,These authors contributed equally
| | - Kazuhito Honjo
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA,These authors contributed equally
| | - Scott Sherrill-Mix
- Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA,These authors contributed equally
| | - Weimin Liu
- Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA,These authors contributed equally
| | - Regina Stoltz
- Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA,These authors contributed equally
| | - Allisa K. Oman
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Lucinda A. Hall
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Ran Li
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Sarah Sterrett
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Ellen R. Frederick
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Jeffrey R. Lancaster
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Mayur Narkhede
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA,O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Amitkumar Mehta
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA,O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Foluso J. Ogunsile
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Rima B. Patel
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Thomas J. Ketas
- Department of Microbiology and Immunology, Weill Medical College of Cornell University, New York, NY 10065, USA
| | - Victor M Cruz Portillo
- Department of Microbiology and Immunology, Weill Medical College of Cornell University, New York, NY 10065, USA
| | - Albert Cupo
- Department of Microbiology and Immunology, Weill Medical College of Cornell University, New York, NY 10065, USA
| | - Benjamin M. Larimer
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA,O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Anju Bansal
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA,O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Paul A. Goepfert
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA,O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA,Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Beatrice H. Hahn
- Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA,Department of Microbiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Randall S. Davis
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA,O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA,Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA,Department of Biochemistry & Molecular Genetics, University of Alabama at Birmingham, Birmingham, AL 35294, USA,Lead Contact,Correspondence: (R.S.D.)
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33
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Tiacci E, Mancini A, Marchetti M, D'Elia GM, Candoni A, Morotti A, Romano A, Gozzetti A, Broccoli A, De Carolis L, Bruna R, Tisi MC, Selleri C, Capponi M, Vallisa D, Cattaneo C, Della Porta MG, Busca A, Falini B, Massaia M, Bertù L, Pulsoni A, Rivela P, Corradini P, Passamonti F. SARS-CoV-2 infection and vaccination in patients with hairy-cell leukaemia. Br J Haematol 2022; 201:411-416. [PMID: 36541031 PMCID: PMC9877728 DOI: 10.1111/bjh.18606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/25/2022] [Accepted: 12/04/2022] [Indexed: 12/24/2022]
Abstract
Little is known of the course of COVID-19 and the antibody response to infection or vaccination in patients with hairy-cell leukaemia (HCL). Among a total of 58 HCL cases we studied in these regards, 37 unvaccinated patients, mostly enjoying a relatively long period free from anti-leukaemic treatment, developed COVID-19 between March 2020 and December 2021 with a usually favourable outcome (fatality rate: 5/37, 14%); however, active leukaemia, older age and more comorbidities were associated with a worse course. Postinfection (n = 11 cases) and postvaccination (n = 28) seroconversion consistently developed, except after recent anti-CD20 or venetoclax therapy, correlating with perivaccine B-cell count. Vaccination appeared to protect from severe COVID-19 in 11 patients with breakthrough infection.
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Affiliation(s)
- Enrico Tiacci
- Istituto di Ematologia e Centro di Ricerche Emato‐Oncologiche, Dipartimento di Medicina e Chirurgia, Università e Ospedale di PerugiaPerugiaItaly
| | - Alessandro Mancini
- Istituto di Ematologia e Centro di Ricerche Emato‐Oncologiche, Dipartimento di Medicina e Chirurgia, Università e Ospedale di PerugiaPerugiaItaly
| | - Monia Marchetti
- Hematology UnitAzienda Ospedaliera Ss Antonio e Biagio e Cesare ArrigoAlessandriaItaly
| | | | - Anna Candoni
- Clinica Ematologica, Azienda Sanitaria Universitaria Friuli Centrale‐ASUFCUdineItaly
| | - Alessandro Morotti
- Dipartimento di Scienze Cliniche e Biologiche, Università di TorinoTurinItaly
| | | | | | - Alessandro Broccoli
- IRCCS Azienda Ospedaliero‐Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”e Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di BolognaBolognaItaly
| | - Luca De Carolis
- Istituto di Ematologia e Centro di Ricerche Emato‐Oncologiche, Dipartimento di Medicina e Chirurgia, Università e Ospedale di PerugiaPerugiaItaly
| | | | | | | | - Monia Capponi
- Istituto di Ematologia e Centro di Ricerche Emato‐Oncologiche, Dipartimento di Medicina e Chirurgia, Università e Ospedale di PerugiaPerugiaItaly
| | | | | | - Matteo Giovanni Della Porta
- IRCCS Humanitas Clinical and Research Center & Humanitas University, Department of Biomedical SciencesMilanItaly
| | - Alessandro Busca
- SSD Trapianto Cellule Staminali, AOU Città della Salute e della ScienzaTurinItaly
| | - Brunangelo Falini
- Istituto di Ematologia e Centro di Ricerche Emato‐Oncologiche, Dipartimento di Medicina e Chirurgia, Università e Ospedale di PerugiaPerugiaItaly
| | - Massimo Massaia
- SC Ematologia, AO S. Croce e Carle, Cuneo, and Molecular Biotechnology Center "G. Tarone" ‐ Università di TorinoTurinItaly
| | - Lorenza Bertù
- Dipartimento di Medicina e Chirurgia, Università dell'InsubriaVareseItaly
| | | | - Paolo Rivela
- Hematology UnitAzienda Ospedaliera Ss Antonio e Biagio e Cesare ArrigoAlessandriaItaly
| | - Paolo Corradini
- Divisione di Ematologia, IRCCS Istituto Nazionale Tumori di Milano, Università di MilanoMilanItaly
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34
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Hybrid immunity in immunocompromised patients with CLL after SARS-CoV-2 infection followed by booster mRNA vaccination. Blood 2022; 140:2403-2407. [PMID: 36150168 PMCID: PMC9512527 DOI: 10.1182/blood.2022016815] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/03/2022] [Indexed: 01/21/2023] Open
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35
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Seganfredo FB, Dias AR, Santos PR, Rebelo M, João C, Mendes D, Carmo E. Successful treatment of persistent and severe SARS-CoV-2 infection in a high-risk chronic lymphocytic leukemia patient using Ronapreve™ antibodies. Clin Case Rep 2022; 10:e6548. [PMID: 36408087 PMCID: PMC9666912 DOI: 10.1002/ccr3.6548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/29/2022] [Accepted: 10/15/2022] [Indexed: 11/17/2022] Open
Abstract
Patients with lymphoproliferative diseases are at an increased risk of an incomplete immune response following vaccination or SARS-CoV-2 infection and might develop persistent viral infection and severe COVID-19 disease. We present a case of successful treatment of persistent and mechanical-ventilation-requiring SARS-CoV-2 infection in a del17+ CLL patient using exogenous antibodies.
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Affiliation(s)
- Fernanda Braga Seganfredo
- Haematology DepartmentInstituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG)LisbonPortugal
| | - Ana Raquel Dias
- Haematology DepartmentHospital do Divino Espírito Santo de Ponta DelgadaPonta DelgadaPortugal
| | - Pedro R. Santos
- Intensive Care UnitCentro Hospitalar Lisboa Ocidental – Hospital Egas MonizLisbonPortugal
| | - Marta Rebelo
- Intensive Care UnitCentro Hospitalar Lisboa Ocidental – Hospital Egas MonizLisbonPortugal
| | - Cristina João
- Haematology DepartmentFundação ChampalimaudLisbonPortugal
| | - Dina Mendes
- Pharmaceutical DepartmentCentro Hospitalar Lisboa Ocidental – Hospital Egas MonizLisbonPortugal
| | - Eduarda Carmo
- Intensive Care UnitCentro Hospitalar Lisboa Ocidental – Hospital Egas MonizLisbonPortugal
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36
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Muacevic A, Adler JR, Malkawi L, Rozi W, Yassin MA. SARS-CoV-2 Omicron Variant in Patients With Chronic Lymphocytic Leukemia: Case Series. Cureus 2022; 14:e32041. [PMID: 36600852 PMCID: PMC9801485 DOI: 10.7759/cureus.32041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 12/05/2022] Open
Abstract
The Coronavirus disease 2019 (COVID-19) is considered the largest pandemic in modern history. Since the first case was reported in 2019, several mutations have affected the severe acute respiratory syndrome-Coronavirus-2 (SARS-CoV-2), resulting in the emergence of new strains. These strains vary significantly in severity and transmissibility. The Omicron (B.1.1.529) variant was reported to cause mild disease in those affected, but little is known about the effect of Omicron on patients with chronic lymphocytic leukemia (CLL). We are reporting a case series of three patients with CLL who experienced infection with the SARS-CoV-2 Omicron variant and their outcomes.
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37
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Merli M, Ferrarini I, Merli F, Busca A, Mina R, Falini B, Bruna R, Cairoli R, Marchetti M, Romano A, Cavo M, Arcaini L, Trentin L, Cattaneo C, Derenzini E, Fracchiolla NS, Marchesi F, Scattolin A, Billio A, Bocchia M, Massaia M, Gambacorti‐Passerini C, Mauro FR, Gentile M, Mohamed S, Della Porta MG, Coviello E, Cilloni D, Visani G, Federici AB, Tisi MC, Cudillo L, Galimberti S, Gherlinzoni F, Pagano L, Guidetti A, Bertù L, Corradini P, Passamonti F, Visco C. SARS-CoV-2 infection in patients with chronic lymphocytic leukemia: The Italian Hematology Alliance on COVID-19 cohort. Hematol Oncol 2022; 41:128-138. [PMID: 36265128 PMCID: PMC9874469 DOI: 10.1002/hon.3092] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 10/15/2022] [Accepted: 10/17/2022] [Indexed: 02/03/2023]
Abstract
COVID-19, the disease caused by SARS-CoV-2, is still afflicting thousands of people across the globe. Few studies on COVID-19 in chronic lymphocytic leukemia (CLL) are available. Here, we analyzed data from the CLL cohort of the Italian Hematology Alliance on COVID-19 (NCT04352556), which included 256 CLL patients enrolled between 25 February 2020 and 1 February 2021. Median age was 70 years (range 38-94) with male preponderance (60.1%). Approximately half of patients (n = 127) had received at least one line of therapy for CLL, including 108 (83.7%) who were on active treatment at the time of COVID-19 or received their last therapy within 12 months. Most patients (230/256, 89.9%) were symptomatic at COVID-19 diagnosis and the majority required hospitalization (n = 176). Overall, after a median follow-up of 42 days (IQR 24-96), case fatality rate was 30.1%, and it was 37.5% and 24.4% in the first (25 February 2020-22 June 2020) and second wave (23 June 2020-1 February 2021), respectively (p = 0.03). At multivariate analysis, male sex (HR 1.82, 95% CI 1.03-3.24, p = 0.04), age over than 70 years (HR 2.23, 95% CI 1.23-4.05, p = 0.01), any treatment for CLL given in the last 12 months (HR 1.72, 95% CI 1.04-2.84, p = 0.04) and COVID-19 severity (severe: HR 5.66, 95% CI 2.62-12.33, p < 0.0001; critical: HR 15.99, 95% CI 6.93-36.90, p < 0.0001) were independently associated with poor survival. In summary, we report a dismal COVID-related outcome in a significant fraction of CLL patients, that can be nicely predicted by clinical parameters.
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Affiliation(s)
- Michele Merli
- Division of HematologyUniversity Hospital Ospedale di Circolo e Fondazione Macchi ‐ASST Sette LaghiUniversity of InsubriaVareseItaly
| | - Isacco Ferrarini
- Department of MedicineSection of HematologyUniversity of VeronaVeronaItaly
| | - Francesco Merli
- HematologyAzienda Unità Sanitaria Locale‐Istituto di Ricovero e Cura a Carattere Scientifico Reggio EmiliaReggio EmiliaItaly
| | - Alessandro Busca
- Stem Cell Transplant CenterAzienda Ospedaliera Universitaria Citta’ della Salute e della ScienzaTurinItaly
| | - Roberto Mina
- Myeloma UnitDivision of HematologyUniversity of TurinAzienda Ospedaliera Universitaria Citta’ della Salute e della ScienzaTurinItaly
| | | | - Riccardo Bruna
- Division of HematologyDepartment of Translational MedicineUniversity of Eastern Piedmont and Ospedale Maggiore della CaritàNovaraItaly
| | - Roberto Cairoli
- HematologyAzienda Socio‐Sanitaria Territoriale Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Monia Marchetti
- HematologyAzienda Ospedaliera Santissimi Antonio e Biagio e Cesare ArrigoAlessandriaItaly
| | - Alessandra Romano
- HematologyDipartimento di Chirurgia e Specialità Medico ChirurgicheUniversità degli Studi di CataniaCataniaItaly
| | - Michele Cavo
- IRCCS Azienda Ospedaliero‐Universitaria di BolognaSeràgnoli Institute of HematologyDepartment of Experimental, Diagnostic and Specialty MedicineBologna University School of MedicineBolognaItaly
| | - Luca Arcaini
- Department of Molecular MedicineUniversity of Pavia & Division of HematologyFondazione IRCCS Policlinico San MatteoPaviaItaly
| | - Livio Trentin
- Hematology and Clinical Immunology UnitDepartment of MedicineUniversity of PaduaPaduaItaly
| | - Chiara Cattaneo
- HematologyAzienda Socio‐Sanitaria Territoriale‐Spedali CiviliBresciaItaly
| | - Enrico Derenzini
- Onco‐Hematology DivisionIEO European Institute of Oncology IRCCS & Department of Health SciencesUniversity of MilanMilanItaly
| | | | - Francesco Marchesi
- Hematology and Stem Cell Transplant UnitIstituto di Ricovero e Cura a Carattere Scientifico Regina Elena National Cancer InstituteRomeItaly
| | | | - Atto Billio
- Division of Hematology and BMTHospital S. MaurizioBolzanoItaly
| | - Monica Bocchia
- Hematology UnitUniversity of SienaAzienda Ospedaliero Universitaria SeneseSienaItaly
| | | | | | - Francesca Romana Mauro
- HematologyDepartment of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Massimo Gentile
- Hematology UnitDepartment of Hemato‐Oncology, Ospedale AnnunziataCosenzaItaly
| | - Sara Mohamed
- UCO EmatologiaAzienda Sanitaria Universitaria Giuliano IsontinaTriesteItaly
| | - Matteo Giovanni Della Porta
- Humanitas Clinical and Research Hospital Istituto di Ricovero e Cura a Carattere Scientifico and Department of Biomedical SciencesHumanitas UniversityMilanItaly
| | - Elisa Coviello
- Hematology and Bone Marrow TransplantIstituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San MartinoGenovaItaly
| | - Daniela Cilloni
- Department of Clinical and Biological SciencesUniversity of TurinSan Luigi HospitalTurinItaly
| | - Giuseppe Visani
- Dipartimento di Onco‐EmatologiaAzienda Ospedaliera Ospedali Riuniti Marche NordPesaroItaly
| | | | | | | | - Sara Galimberti
- Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | | | - Livio Pagano
- Dipartimento di Scienze Radiologiche ed EmatologicheFondazione Policlinico Universitario A Gemelli–IRCCS–Università Cattolica del Sacro CuoreRomeItaly
| | - Anna Guidetti
- Hematology and Bone Marrow TransplantationFondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei TumoriUniversity of MilanMilanItaly
| | - Lorenza Bertù
- Division of HematologyUniversity Hospital Ospedale di Circolo e Fondazione Macchi ‐ASST Sette LaghiUniversity of InsubriaVareseItaly
| | - Paolo Corradini
- Hematology and Bone Marrow TransplantationFondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei TumoriUniversity of MilanMilanItaly
| | - Francesco Passamonti
- Division of HematologyUniversity Hospital Ospedale di Circolo e Fondazione Macchi ‐ASST Sette LaghiUniversity of InsubriaVareseItaly
| | - Carlo Visco
- Department of MedicineSection of HematologyUniversity of VeronaVeronaItaly
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38
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Infante MS, Salmanton-García J, Fernández-Cruz A, Marchesi F, Jaksic O, Weinbergerová B, Besson C, Duarte RF, Itri F, Valković T, Szotkovski T, Busca A, Guidetti A, Glenthøj A, Collins GP, Bonuomo V, Sili U, Seval GC, Machado M, Cordoba R, Blennow O, Abu-Zeinah G, Lamure S, Kulasekararaj A, Falces-Romero I, Cattaneo C, Van Doesum J, Piukovics K, Omrani AS, Magliano G, Ledoux MP, de Ramon C, Cabirta A, Verga L, López-García A, Da Silva MG, Stojanoski Z, Meers S, Lahmer T, Martín-Pérez S, Dávila-Vals J, Van Praet J, Samarkos M, Bilgin YM, Karlsson LK, Batinić J, Nordlander A, Schönlein M, Hoenigl M, Ráčil Z, Mladenović M, Hanakova M, Zambrotta GPM, De Jonge N, Adžić-Vukičević T, Nunes-Rodrigues R, Prezioso L, Navrátil M, Marchetti M, Cuccaro A, Calbacho M, Giordano A, Cornely OA, Hernández-Rivas JÁ, Pagano L. B-cell malignancies treated with targeted drugs and SARS-CoV-2 infection: A European Hematology Association Survey (EPICOVIDEHA). Front Oncol 2022; 12:992137. [PMID: 36276116 PMCID: PMC9583921 DOI: 10.3389/fonc.2022.992137] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/31/2022] [Indexed: 01/26/2023] Open
Abstract
Patients with lymphoproliferative diseases (LPD) are vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Here, we describe and analyze the outcome of 366 adult patients with chronic lymphocytic leukemia (CLL) or non-Hodgkin Lymphoma (NHL) treated with targeted drugs and laboratory-confirmed COVID-19 diagnosed between February 2020 and January 2022. Median follow-up was 70.5 days (IQR 0-609). Most used targeted drugs were Bruton-kinase inhibitors (BKIs) (N= 201, 55%), anti-CD20 other than rituximab (N=61, 16%), BCL2 inhibitors (N=33, 9%) and lenalidomide (N=28, 8%).Only 16.2% of the patients were vaccinated with 2 or more doses of vaccine at the onset of COVID-19. Mortality was 24% (89/366) on day 30 and 36%(134/366) on the last day of follow-up. Age >75 years (p<0.001, HR 1.036), active malignancy (p<0.001, HR 2.215), severe COVID-19 (p=0.017, HR 2.270) and admission to ICU (p<0.001, HR 5.751) were risk factors for mortality at last day of follow up. There was no difference in OS rates in NHL vs CLL patients (p=0.306), nor in patients treated with or without BKIs (p=0.151). Mortality in ICU was 66% (CLL 61%, NHL 76%). Overall mortality rate decreased according to vaccination status, being 39% in unvaccinated patients, 32% and 26% in those having received one or two doses, respectively, and 20% in patients with a booster dose (p=0.245). Overall mortality rate dropped from 41% during the first semester of 2020 to 25% at the last semester of 2021. These results show increased severity and mortality from COVID-19 in LPDs patients treated with targeted drugs.
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Affiliation(s)
| | - Jon Salmanton-García
- 2Faculty of Medicine and University Hospital Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany,3Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany,*Correspondence: Jon Salmanton-García,
| | | | - Francesco Marchesi
- 5Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Ozren Jaksic
- 6Department of Hematology, University Hospital Dubrava, Zagreb, Croatia
| | - Barbora Weinbergerová
- 7Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czechia
| | | | | | - Federico Itri
- 9San Luigi Gonzaga Hospital - Orbassano, Orbassano, Italy
| | - Toni Valković
- 10University Hospital Centre Rijeka, Rijeka, Croatia,11Croatian Cooperative Group for Hematological Diseases (CROHEM), Zagreb, Croatia,12Faculty of Medicine and Faculty of Health Studies University of Rijeka, Rijeka, Croatia
| | | | - Alessandro Busca
- 14Stem Cell Transplant Center, AOU Citta’ della Salute e della Scienza, Turin, Italy
| | - Anna Guidetti
- 15Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andreas Glenthøj
- 16Department of Hematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Graham P. Collins
- 17NIHR Oxford Biomedical Research Centre, Churchill Hospital, Oxford, United Kingdom
| | - Valentina Bonuomo
- 18Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Uluhan Sili
- 19Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | | | - Marina Machado
- 21Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Raul Cordoba
- 22Health Research Institute IIS-FJD, Fundación Jimenez Diaz University Hospital, Madrid, Spain
| | - Ola Blennow
- 19Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Ghaith Abu-Zeinah
- 23Division of Hematology and Oncology, Weill Cornell Medicine, New York, NY, United States
| | - Sylvain Lamure
- 24Departement d’Hematologie Clinique, CHU de Montpellier, UMR-CNRS 5535, Universite de Montpellier, Montpellier, France
| | - Austin Kulasekararaj
- 25King’s College Hospital, London, United Kingdom,26King’s College London, London, United Kingdom
| | | | | | - Jaap Van Doesum
- 29University Medical Center Groningen, Groningen, Netherlands
| | - Klára Piukovics
- 30Department of Internal Medicine, Albert Szent-Györgyi Health Center, Faculty of Medicine University of Szeged, Szeged, Hungary
| | - Ali S. Omrani
- 31Communicable Disease Center, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Cristina de Ramon
- 34Hematology Department, Hospital Universitario de Salamanca, Salamanca, Spain,35IBSAL, Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Alba Cabirta
- 36Department of Hematology, Vall d’Hebron Hospital Universitari, Experimental Hematology, Vall d’Hebron Institute of Oncology (VHIO), Vall d’Hebron Barcelona, Spain,37Hospital Campus, Barcelona, Spain,38Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Luisa Verga
- 39Azienda Ospedaliera San Gerardo - Monza, Monza, Italy,40Università Milano-Bicocca, Milan, Italy
| | - Alberto López-García
- 41Health Research Institute IIS-FJD, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
| | | | | | | | - Tobias Lahmer
- 45Medizinische Klinik II, Klinikum rechts der Isar, TU München, Munich, Germany
| | | | | | - Jens Van Praet
- 47Department of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
| | | | | | - Linda Katharina Karlsson
- 16Department of Hematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | | | - Anna Nordlander
- 19Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Schönlein
- 51Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Hoenigl
- 52Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, San Diego, CA, United States,53Clinical and Translational Fungal-Working Group, University of California San Diego, La Jolla, CA, United States,54Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Zdeněk Ráčil
- 55Institute of Hematology and Blood Transfusion, Prague, Czechia
| | | | | | | | - Nick De Jonge
- 57Amsterdam UMC, location VUmc, Amsterdam, Netherlands
| | | | | | - Lucia Prezioso
- 58U.O. Ematologia e Centro Trapianti Midollo Osseo, Ospedale Maggiore, Parma, Italy
| | | | - Monia Marchetti
- 60Hematology and BMT Unit, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Annarosa Cuccaro
- 61Hematology Unit, Center for Translational Medicine, Azienda USL Toscana NordOvest, Livorno, Italy
| | - Maria Calbacho
- 62Hematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Antonio Giordano
- 63Hematology Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy,64Hematology Unit, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Oliver A. Cornely
- 2Faculty of Medicine and University Hospital Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany,3Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany,65University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), Cologne, Germany,66University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Molecular Medicine Cologne (CMMC), Cologne, Germany,67German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | | | - Livio Pagano
- 64Hematology Unit, Università Cattolica del Sacro Cuore, Rome, Italy
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Wiestner A. Beyond SARS-CoV2, the role of viruses in the pathogenesis of hematologic malignancies. Semin Hematol 2022; 59:175-176. [PMID: 36805884 PMCID: PMC9800017 DOI: 10.1053/j.seminhematol.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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40
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COVID-19 Infection in Patients With Chronic Lymphocytic Leukemia Receiving Acalabrutinib in the Phase 3B ASSURE Study. Hemasphere 2022; 6:e780. [PMID: 36168519 PMCID: PMC9509175 DOI: 10.1097/hs9.0000000000000780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/28/2022] [Indexed: 11/25/2022] Open
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Antic D, Milic N, Chatzikonstantinou T, Scarfò L, Otasevic V, Rajovic N, Allsup D, Alonso Cabrero A, Andres M, Baile Gonzales M, Capasso A, Collado R, Cordoba R, Cuéllar-García C, Correa JG, De Paoli L, De Paolis MR, Del Poeta G, Dimou M, Doubek M, Efstathopoulou M, El-Ashwah S, Enrico A, Espinet B, Farina L, Ferrari A, Foglietta M, Lopez-Garcia A, García-Marco JA, García-Serra R, Gentile M, Gimeno E, da Silva MG, Gutwein O, Hakobyan YK, Herishanu Y, Hernández-Rivas JÁ, Herold T, Itchaki G, Jaksic O, Janssens A, Kalashnikova OB, Kalicińska E, Kater AP, Kersting S, Koren-Michowitz M, Labrador J, Lad D, Laurenti L, Fresa A, Levin MD, Mayor Bastida C, Malerba L, Marasca R, Marchetti M, Marquet J, Mihaljevic B, Milosevic I, Mirás F, Morawska M, Motta M, Munir T, Murru R, Nunes R, Olivieri J, Pavlovsky MA, Piskunova I, Popov VM, Quaglia FM, Quaresmini G, Reda G, Rigolin GM, Shrestha A, Šimkovič M, Smirnova S, Špaček M, Sportoletti P, Stanca O, Stavroyianni N, Te Raa D, Tomic K, Tonino S, Trentin L, Van Der Spek E, van Gelder M, Varettoni M, Visentin A, Vitale C, Vukovic V, Wasik-Szczepanek E, Wróbel T, Segundo LYS, Yassin M, Coscia M, Rambaldi A, Montserrat E, Foà R, Cuneo A, Carrier M, Ghia P, Stamatopoulos K. Thrombotic and bleeding complications in patients with chronic lymphocytic leukemia and severe COVID-19: a study of ERIC, the European Research Initiative on CLL. J Hematol Oncol 2022; 15:116. [PMID: 36028857 PMCID: PMC9415249 DOI: 10.1186/s13045-022-01333-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/08/2022] [Indexed: 12/03/2022] Open
Abstract
Background Patients with chronic lymphocytic leukemia (CLL) may be more susceptible to COVID-19 related poor outcomes, including thrombosis and death, due to the advanced age, the presence of comorbidities, and the disease and treatment-related immune deficiency. The aim of this study was to assess the risk of thrombosis and bleeding in patients with CLL affected by severe COVID-19. Methods This is a retrospective multicenter study conducted by ERIC, the European Research Initiative on CLL, including patients from 79 centers across 22 countries. Data collection was conducted between April and May 2021. The COVID-19 diagnosis was confirmed by the real-time polymerase chain reaction (RT-PCR) assay for SARS-CoV-2 on nasal or pharyngeal swabs. Severe cases of COVID-19 were defined by hospitalization and the need of oxygen or admission into ICU. Development and type of thrombotic events, presence and severity of bleeding complications were reported during treatment for COVID-19. Bleeding events were classified using ISTH definition. STROBE recommendations were used in order to enhance reporting. Results A total of 793 patients from 79 centers were included in the study with 593 being hospitalized (74.8%). Among these, 511 were defined as having severe COVID: 162 were admitted to the ICU while 349 received oxygen supplementation outside the ICU. Most patients (90.5%) were receiving thromboprophylaxis. During COVID-19 treatment, 11.1% developed a thromboembolic event, while 5.0% experienced bleeding. Thrombosis developed in 21.6% of patients who were not receiving thromboprophylaxis, in contrast to 10.6% of patients who were on thromboprophylaxis. Bleeding episodes were more frequent in patients receiving intermediate/therapeutic versus prophylactic doses of low-molecular-weight heparin (LWMH) (8.1% vs. 3.8%, respectively) and in elderly. In multivariate analysis, peak D-dimer level and C-reactive protein to albumin ratio were poor prognostic factors for thrombosis occurrence (OR = 1.022, 95%CI 1.007‒1.038 and OR = 1.025, 95%CI 1.001‒1.051, respectively), while thromboprophylaxis use was protective (OR = 0.199, 95%CI 0.061‒0.645). Age and LMWH intermediate/therapeutic dose administration were prognostic factors in multivariate model for bleeding (OR = 1.062, 95%CI 1.017–1.109 and OR = 2.438, 95%CI 1.023–5.813, respectively). Conclusions Patients with CLL affected by severe COVID-19 are at a high risk of thrombosis if thromboprophylaxis is not used, but also at increased risk of bleeding under the LMWH intermediate/therapeutic dose administration.
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Affiliation(s)
- Darko Antic
- Lymphoma Center, Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia. .,Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Natasa Milic
- Department of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Thomas Chatzikonstantinou
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece.,Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Lydia Scarfò
- Università Vita-Salute San Raffaele and IRCC Ospedale San Raffaele, Milan, Italy
| | - Vladimir Otasevic
- Lymphoma Center, Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Nina Rajovic
- Department of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - David Allsup
- Centre for Atherothrombosis and Metabolic Disease, Hull York Medical School, Hull, UK
| | | | - Martin Andres
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - Rosa Collado
- Department of Hematology, Hospital General Universitario, Valencia, Spain.,Fundación de Investigación del Hospital General Universitario, Valencia, Spain
| | - Raul Cordoba
- Department of Hematology, Health Research Institute IIS-FJD, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
| | | | | | - Lorenzo De Paoli
- Division of Internal Medicine, Hematology Unit, ASL Vercelli, Vercelli, Italy
| | | | - Giovanni Del Poeta
- Department of Biomedicine and Prevention Hematology, University Tor Vergata, Rome, Italy
| | - Maria Dimou
- 1st Internal Medicine Department, Propaedeutic, Hematology Clinical Trial Unit, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Doubek
- Department of Internal Medicine - Hematology and Oncology, University Hospital, Brno, Czechia.,Department of Medical Genetics and Genomics, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Maria Efstathopoulou
- Department of Haematology Athens Medical Center-Psychikon Branch, Athens, Greece
| | - Shaimaa El-Ashwah
- Clinical Hematology Unit, Oncology Center, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt
| | | | - Blanca Espinet
- Department of Hematology, Hospital del Mar, Barcelona, Spain
| | - Lucia Farina
- Hematology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Angela Ferrari
- Hematology Unit, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | | | - Alberto Lopez-Garcia
- Department of Hematology, Health Research Institute IIS-FJD, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
| | - José A García-Marco
- Hematology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Rocío García-Serra
- Department of Hematology, Hospital General Universitario, Valencia, Spain.,Fundación de Investigación del Hospital General Universitario, Valencia, Spain
| | | | - Eva Gimeno
- Department of Hematology, Hospital del Mar, Barcelona, Spain
| | - Maria Gomes da Silva
- Hematology Department, Portuguese Institute of Oncology Lisbon, Lisbon, Portugal
| | - Odit Gutwein
- Department of Hematology, Shamir Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Yair Herishanu
- Department of Hematology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Tobias Herold
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Gilad Itchaki
- Division of Hematology, Rabin Medical Center, Petah Tikva, and the Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ozren Jaksic
- Department of Hematology, University Hospital Dubrava, Zagreb, Croatia
| | - Ann Janssens
- Department of Hematology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Olga B Kalashnikova
- Federal State Budgetary Educational Institution of Higher Education Academician I.P. Pavlov, First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia
| | - Elżbieta Kalicińska
- Department and Clinic of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Pasteura Street 4, 50-367, Wrocław, Poland
| | - Arnon P Kater
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Sabina Kersting
- Department of Hematology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Maya Koren-Michowitz
- Department of Hematology, Shamir Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jorge Labrador
- Hematology Department, Unit Research, Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | - Deepesh Lad
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Luca Laurenti
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy.,Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alberto Fresa
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy.,Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Carlota Mayor Bastida
- Haematology Department, Hospital Universitario de La Princesa, Madrid, Spain.,Spanish Society of Haematology and Hemotherapy (SEHH: Sociedad Española de Hematología y Hemoterapia), Madrid, Spain
| | - Lara Malerba
- Hematology and Stem Cell Transplant Center Marche Nord Hospital, Pesaro, Italy
| | - Roberto Marasca
- Section of Hematology, Department of Medical Sciences, University of Modena and Reggio E., Modena, Italy
| | - Monia Marchetti
- Hematology Unit & TMO Center, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Juan Marquet
- Hematology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Biljana Mihaljevic
- Lymphoma Center, Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Milosevic
- Clinical Centre of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Fatima Mirás
- Hematology Department, Hospital Universitario 12de Octubre, Madrid, Spain
| | - Marta Morawska
- Experimental Hematooncology Department, Medical University of Lublin, Lublin, Poland.,Hematology Department, St. John's Cancer Center, Lublin, Poland
| | - Marina Motta
- S.C. Ematologia ASST Spedali Civili Brescia, Brescia, Italy
| | - Talha Munir
- Consultant Haematologist, St James's Hospital, Leeds, LS9 7TF, UK
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale Oncologico A. Businco, ARNAS "G. Brotzu", Cagliari, Italy
| | - Raquel Nunes
- Hematology Department, Portuguese Institute of Oncology Lisbon, Lisbon, Portugal
| | | | | | - Inga Piskunova
- Consultative Hematology Department with a Day Hospital for Intensive High-Dose Chemotherapy, National Research Center for Hematology, Moscow, Russia
| | - Viola Maria Popov
- Hematology Department, Colentina Clinical Hospital, Bucharest, Romania
| | | | | | - Gianluigi Reda
- Hematology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan, Milan, Italy
| | | | - Amit Shrestha
- Hematology Unit, Nepal Cancer Hospital and Research Center, Lalitpur, Nepal
| | - Martin Šimkovič
- 4th Department of Internal Medicine - Haematology, Faculty of Medicine in Hradec Králové, University Hospital and Charles University in Prague, Hradec Kralove, Czech Republic
| | - Svetlana Smirnova
- Consultative Hematology Department with a Day Hospital for Intensive High-Dose Chemotherapy, National Research Center for Hematology, Moscow, Russia
| | - Martin Špaček
- 1st Department of Medicine - Hematology, First Faculty of Medicine, Charles University and General Hospital in Prague, Prague, Czech Republic
| | - Paolo Sportoletti
- Department of Medicine and Surgery, Institute of Hematology and Center for Hemato-Oncological Research, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Oana Stanca
- Hematology Department from Coltea Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Niki Stavroyianni
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Doreen Te Raa
- Department of Hematology, Gelderse Vallei Ede, Ede, The Netherlands
| | - Kristina Tomic
- Lymphoma Center, Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Sanne Tonino
- Department of Hematology, Lymmcare, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padua, Italy
| | - Ellen Van Der Spek
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Michel van Gelder
- Department Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marzia Varettoni
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padua, Italy
| | - Candida Vitale
- Division of Hematology, A.O.U. Cittàdella Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Vojin Vukovic
- Lymphoma Center, Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Ewa Wasik-Szczepanek
- Department Hematooncology and Bone Marrow Transplantation, Medical University in Lublin, Lublin, Poland
| | - Tomasz Wróbel
- Department and Clinic of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Pasteura Street 4, 50-367, Wrocław, Poland
| | | | - Mohamed Yassin
- Hematology Section, Department of Medical Oncology, National Center for Cancer Care and Research, Doha, Qatar
| | - Marta Coscia
- Division of Hematology, A.O.U. Cittàdella Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | | | | | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | | | - Marc Carrier
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, K1H 8L6, Canada
| | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCC Ospedale San Raffaele, Milan, Italy
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
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42
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Steffanoni S, Calimeri T, Laurenge A, Fox CP, Soussain C, Grommes C, Tisi MC, Boot J, Crosbie N, Visco C, Arcaini L, Chaganti S, Sassone MC, Alencar A, Armiento D, Romano I, Dietrich J, Itchaki G, Bruna R, Fracchiolla NS, Arletti L, Venditti A, Booth S, Musto P, Hoang Xuan K, Batchelor T, Cwynarski K, Ferreri AJM. Impact of severe acute respiratory syndrome coronavirus-2 infection on the outcome of primary central nervous system lymphoma treatment: A study of the International PCNSL Collaborative Group. Br J Haematol 2022; 199:507-519. [PMID: 35945164 PMCID: PMC9538907 DOI: 10.1111/bjh.18396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/18/2022] [Accepted: 07/22/2022] [Indexed: 01/19/2023]
Abstract
To optimise management of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection identifying high-risk patients and maintaining treatment dose intensity is an important issue in patients with aggressive lymphomas. In the present study, we report on the presentation, management, and outcome of an international series of 91 patients with primary central nervous system lymphoma and SARS-CoV-2 infection. SARS-CoV-2 was diagnosed before/during first-line treatment in 64 patients, during follow-up in 21, and during salvage therapy in six. Among the 64 patients infected before/during first-line chemotherapy, 38 (59%) developed pneumonia and 26 (41%) did not clear the virus. Prolonged exposure to steroids before viral infection and/or treatment with high-dose cytarabine favoured pneumonia development and virus persistence and were associated with poorer survival; 81% of patients who did not clear virus died early from coronavirus disease 2019 (COVID-19). Vaccination was associated with lower pneumonia incidence and in-hospital mortality. Chemotherapy was initiated/resumed in 43 (67%) patients, more commonly among patients who did not develop pneumonia, cleared the virus, or did not receive steroids during infection. Chemotherapy resumption in patients with viral persistence should be indicated cautiously as it was associated with a poorer survival (6-month, 70% and 87%, p = 0.07). None of the 21 patients infected during follow-up died from COVID-19, requiring similar measures as infected subjects in the general population.
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Affiliation(s)
- Sara Steffanoni
- Lymphoma Unit, Department of Onco‐HematologyIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Teresa Calimeri
- Lymphoma Unit, Department of Onco‐HematologyIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Alice Laurenge
- Service de Neurologie 2‐MazarinHôpitaux Universitaires La Pitié Salpêtrière, APHP, Sorbonne UniversitéParisFrance
| | | | - Carole Soussain
- Hôpital René Huguenin‐Institut Curie, Saint‐CloudParisFrance
| | - Christian Grommes
- Department of NeurologyMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | | | - Jesca Boot
- BarkingHavering and Redbridge University Hospitals NHS TrustLondonUK
| | | | - Carlo Visco
- Department of Medicine, Section of HematologyUniversity of VeronaVeronaItaly
| | - Luca Arcaini
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo and Department of Molecular MedicineUniversity of PaviaPaviaItaly
| | | | - Marianna C. Sassone
- Lymphoma Unit, Department of Onco‐HematologyIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Alvaro Alencar
- Department of Hematology and OncologyUniversity of Miami/Sylvester Comprehensive Cancer CenterMiamiFloridaUSA
| | | | | | - Jorg Dietrich
- Division of Neuro‐OncologyMassachusetts General Hospital Cancer CenterBostonMassachusettsUSA
| | - Gilad Itchaki
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical CenterPetah‐TikvaIsrael
| | | | | | - Laura Arletti
- Division of HematologyAzienda USL‐IRCCS of Reggio EmiliaReggio EmiliaItaly
| | - Adriano Venditti
- Department of Biomedicine and PreventionUniversity Tor VergataRomeItaly
| | - Stephen Booth
- NIHR Oxford Biomedical Research CentreChurchill HospitalOxfordUK
| | - Pellegrino Musto
- Department of Emergency and Organ Transplantation‘Aldo Moro’ University School of Medicine, and Unit of Hematology and Stem Cell Transplantation, AOUC PoliclinicoBariItaly
| | - Khê Hoang Xuan
- Service de Neurologie 2‐MazarinHôpitaux Universitaires La Pitié Salpêtrière, APHP, Sorbonne UniversitéParisFrance
| | - Tracy T. Batchelor
- Department of NeurologyBrigham and Women’s HospitalBostonMassachusettsUSA
| | - Kate Cwynarski
- Department of HaematologyUniversity College London HospitalLondonUK
| | - Andrés J. M. Ferreri
- Lymphoma Unit, Department of Onco‐HematologyIRCCS San Raffaele Scientific InstituteMilanItaly
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Niemann CU, da Cunha-Bang C, Helleberg M, Ostrowski SR, Brieghel C. Patients with CLL have a lower risk of death from COVID-19 in the Omicron era. Blood 2022; 140:445-450. [PMID: 35588468 PMCID: PMC9122776 DOI: 10.1182/blood.2022016147] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/12/2022] [Indexed: 12/15/2022] Open
Abstract
Previous studies have shown that patients with chronic lymphocytic leukemia (CLL) and coronavirus disease 2019 (COVID-19) have high mortality rates. Infection with the Omicron variant has been described as a milder disease course in the general population. However, the outcome for immunocompromised patients has not previously been reported. In a cohort of patients with CLL tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at hospital test sites in the time periods before and after dominance of the Omicron variant, rates of hospitalizations and intensive care unit admissions declined significantly, whereas 30-day mortality remained as high as 23% in the period with dominance of the Omicron sublineage BA.2 variant. However, for a larger population-based cohort of patients with CLL (including the hospital cohort), 30-day mortality was 2%. Thus, patients with CLL with close hospital contacts and, in particular, those >70 years of age with 1 or more comorbidities should be considered for closer monitoring and preemptive antiviral therapy upon a positive SARS-CoV-2 test.
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Affiliation(s)
- Carsten U Niemann
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Marie Helleberg
- Department of Infectious Diseases
- Center of Excellence for Health, Immunity and Infections, and
| | - Sisse R Ostrowski
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Immunology, Rigshospitalet, Copenhagen, Denmark; and
| | - Christian Brieghel
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark
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Cheon H, Elghawy O, Shemo BC, Feith DJ, Loughran TP. LGL leukemia patients exhibit substantial protective humoral responses following SARS-CoV-2 vaccination. EJHAEM 2022; 3:919-923. [PMID: 35941882 PMCID: PMC9348025 DOI: 10.1002/jha2.472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 11/25/2022]
Abstract
Large granular lymphocyte leukemia is a rare chronic lymphoproliferative disorder of cytotoxic cells. Other hematological malignancies such as CLL and multiple myeloma have been associated with poor vaccination response and markedly increased severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mortality rates, specifically in patients who have undergone immunosuppressive therapy. Given the immunosuppressive therapies often used to treat the disease, large granular lymphocytic (LGL) patients may be especially vulnerable to SARS-CoV-2 infection. A questionnaire was sent to all patients in the LGL Leukemia Registry at the University of Virginia (UVA) to obtain information on vaccination status, type of vaccine received, side effects of vaccination, patient treatment status before, during, and after vaccination, antibody testing, history of coronavirus disease 2019 (COVID-19) infection, and presence or absence of booster vaccination. Antibody testing of 27 patients who had quantitative SARS-CoV-2 Spike Protein IgG levels determined by University of Virginia medical laboratories via the Abbott Architect SARS-CoV-2 IgG II assay were collected. The assay was scored as reactive at a threshold of ≥50.0 AU/mL or nonreactive with a threshold of <50.0 AU/mL. LGL patients without treatment as well as patients who held treatment prior to their vaccination have a robust humoral response to SARS-CoV-2 vaccines. Patients who did not hold their immunosuppressive treatments have signifigantly diminished vaccine response compared to those who held their immunosuppressive treatment. Our findings support a dual strategy of pausing immunotherapy during the vaccination window and administration of the SARS-CoV-2 booster to all LGL leukemia patients to maximize protective antibodies.
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Affiliation(s)
- Heejin Cheon
- University of Virginia Cancer CenterCharlottesvilleVirginiaUSA
| | - Omar Elghawy
- University of Virginia Cancer CenterCharlottesvilleVirginiaUSA
| | - Bryna C. Shemo
- University of Virginia Cancer CenterCharlottesvilleVirginiaUSA
| | - David J. Feith
- University of Virginia Cancer CenterCharlottesvilleVirginiaUSA
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Galitzia A, Barabino L, Murru R, Caocci G, Greco M, Angioni G, Mulas O, Oppi S, Massidda S, Costa A, La Nasa G. Patients with Chronic Lymphocytic Leukemia Have a Very High Risk of Ineffective Response to the BNT162b2 Vaccine. Vaccines (Basel) 2022; 10:vaccines10071162. [PMID: 35891328 PMCID: PMC9317769 DOI: 10.3390/vaccines10071162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 11/24/2022] Open
Abstract
Patients with CLL have high rates of either severe disease or death from COVID-19 and a low response rate after COVID-19 vaccination has been reported. We conducted a single-center study with the main objective to evaluate the immunogenicity of the BNT1162b2 mRNA vaccines in 42 patients affected by CLL with the assessment of antibody response after the second and the third dose. After the second dose of vaccine, 13 patients (30%) showed an antibody response. The presence of hypogammaglobulinemia and the use of steroids or IVIG were the main factors associated with poor response. After the third dose, 5/27 (18%) patients showed an antibody response while in non-responders to the second dose, only 1 patient (4%) showed an elicitation of the immune response by the third dose, with no statistically significant difference. Our data, despite the small size of our cohort, demonstrate that patients with CLL have a low rate of effective response to the BNT162b2 vaccine. However, the effective role of a subsequent dose is still unclear, highlighting the need for alternative methods of immunization in this particularly fragile group of patients.
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Affiliation(s)
- Andrea Galitzia
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy; (L.B.); (O.M.); (A.C.); (G.L.N.)
- Correspondence: (A.G.); (G.C.)
| | - Luca Barabino
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy; (L.B.); (O.M.); (A.C.); (G.L.N.)
| | - Roberta Murru
- Hematology and Transplant Centre, Ospedale Oncologico Armando Businco, ARNAS G. Brotzu, 09121 Cagliari, Italy; (R.M.); (M.G.); (S.O.); (S.M.)
| | - Giovanni Caocci
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy; (L.B.); (O.M.); (A.C.); (G.L.N.)
- Hematology and Transplant Centre, Ospedale Oncologico Armando Businco, ARNAS G. Brotzu, 09121 Cagliari, Italy; (R.M.); (M.G.); (S.O.); (S.M.)
- Correspondence: (A.G.); (G.C.)
| | - Marianna Greco
- Hematology and Transplant Centre, Ospedale Oncologico Armando Businco, ARNAS G. Brotzu, 09121 Cagliari, Italy; (R.M.); (M.G.); (S.O.); (S.M.)
| | - Giancarlo Angioni
- Laboratory of Clinical Chemical Analysis and Microbiology, ARNAS G. Brotzu, 09134 Cagliari, Italy;
| | - Olga Mulas
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy; (L.B.); (O.M.); (A.C.); (G.L.N.)
- Hematology and Transplant Centre, Ospedale Oncologico Armando Businco, ARNAS G. Brotzu, 09121 Cagliari, Italy; (R.M.); (M.G.); (S.O.); (S.M.)
| | - Sara Oppi
- Hematology and Transplant Centre, Ospedale Oncologico Armando Businco, ARNAS G. Brotzu, 09121 Cagliari, Italy; (R.M.); (M.G.); (S.O.); (S.M.)
| | - Stefania Massidda
- Hematology and Transplant Centre, Ospedale Oncologico Armando Businco, ARNAS G. Brotzu, 09121 Cagliari, Italy; (R.M.); (M.G.); (S.O.); (S.M.)
| | - Alessandro Costa
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy; (L.B.); (O.M.); (A.C.); (G.L.N.)
| | - Giorgio La Nasa
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy; (L.B.); (O.M.); (A.C.); (G.L.N.)
- Hematology and Transplant Centre, Ospedale Oncologico Armando Businco, ARNAS G. Brotzu, 09121 Cagliari, Italy; (R.M.); (M.G.); (S.O.); (S.M.)
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Luan C, Wang H, Zhou J, Ma X, Long Z, Cheng X, Chen X, Xia R, Ge J. Delayed Diagnosis and Multi-TKI Intolerance: A Case Report of CML Concurrent With COVID-19. Front Oncol 2022; 12:921587. [PMID: 35756668 PMCID: PMC9213692 DOI: 10.3389/fonc.2022.921587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 05/16/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction The hematological manifestations of corona virus disease 2019 (COVID-19) can confound the diagnosis and therapy of other diseases. In this paper, we firstly reported a case of chronic myeloid leukemia (CML) of delayed diagnosis and intolerance to tyrosine kinase inhibitors (TKIs) concurrent with COVID-19. Case Presentation A 56-year-old female was diagnosed as COVID-19 with no obvious leukocytosis [white blood cell (WBC), ≤17 × 109/L] or splenomegaly until ablation of the virus. Bone marrow aspiration was conducted to establish the diagnosis of CML. She accepted an adjusted dosage of imatinib initially and had to suspend it after myelosuppression (day 41). After hematopoietic therapy, imatinib was given again (day 62), but she was still non-tolerant, and nilotinib at 150 mg twice a day was prescribed from day 214. At just about 4 weeks later, nilotinib was discontinued due to myelosuppression. Then, it was reduced to 150 mg per day and was re-initiated (day 349), but she was still non-tolerant to it. Similarly, from day 398, flumatinib at 200 mg per day was tried, but she was non-tolerant. Her white blood cell or platelet count fluctuated markedly with poor therapeutic response. Considering that she was relatively tolerant and responsive to imatinib, the medication was re-initiated at 200 mg and reduced to 100 mg per day. Her follow-up revealed stable WBC and PLT counts. The latest BCR-ABL-210/ABL was decreased to 0.68% at about 6 months after imatinib was re-initiated, which means an improved response. Conclusion The offset effect between CML and SARS-CoV-2 infection was supposed to be the underlying mechanism for the absence of leukocytosis or splenomegaly. The impact of immune network by SARS-CoV-2 preserved and disrupted the patient’s response to TKIs despite the virus’ ablation. We suggest that a continued elevation of basophils may be a useful indicator for CML concurrent with COVID-19, and individualized treatment with adjusted dosage and suitable type of TKIs should be considered to improve the patient’s health outcome.
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Affiliation(s)
- Chengxin Luan
- Department of Hematology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Haixia Wang
- Department of Hematology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Junjie Zhou
- Department of Hematology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiaoyu Ma
- Department of Hematology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhangbiao Long
- Department of Hematology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xin Cheng
- Department of Hematology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiaowen Chen
- Department of Hematology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ruixiang Xia
- Department of Hematology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jian Ge
- Department of Hematology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Bronstein Y, Gat R, Levi S, Cohen YC, Luttwak E, Benyamini N, Shragai T, Vitkon R, Neaman M, Eilaty N, Levi M, Trestman S, Perry C, Herishanu Y, Avivi I. COVID-19 in patients with lymphoproliferative diseases during the Omicron variant surge. Cancer Cell 2022; 40:578-580. [PMID: 35477028 PMCID: PMC9021039 DOI: 10.1016/j.ccell.2022.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Yotam Bronstein
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Roi Gat
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shai Levi
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yael C Cohen
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Luttwak
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Noam Benyamini
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tamir Shragai
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Roy Vitkon
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Miriam Neaman
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nili Eilaty
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Mor Levi
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Svetlana Trestman
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Chava Perry
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Herishanu
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Irit Avivi
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Outcome of COVID-19 in Patients With Mantle Cell Lymphoma—Report From the European MCL Registry. Hemasphere 2022; 6:e0711. [PMID: 35425889 PMCID: PMC9000040 DOI: 10.1097/hs9.0000000000000711] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/14/2022] [Indexed: 12/13/2022] Open
Abstract
Data on outcome of patients with mantle cell lymphoma (MCL) and COVID-19 infection are limited. The European MCL (EMCL) registry is a centralized registry of the EMCL network, collecting real-world information about treatments and disease courses. During the COVID-19 pandemic, additional data on MCL patients with COVID-19 infection were collected, aiming to identify risk factors for mortality from COVID-19. In our retrospective, multicenter, international study, we collected data from 63 MCL patients with a median age of 64 years (range, 44–84) in 9 countries with evidence of a COVID-19 infection between February 2020 and October 2021. The overall mortality rate was high (44.4%), especially in hospitalized patients (61%) and in patients with need for intensive care unit care (94%). Patients receiving rituximab had significantly poorer survival than patients not receiving rituximab (P = 0.04). Our data highlight the importance of prevention strategies and underline the need for effective vaccination in this vulnerable cohort.
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Sharafeldin N, Bates B, Vachhani P. How the COVID-19 Pandemic Reshaped the Management of Leukemia and Affected Patient Outcomes. Curr Treat Options Oncol 2022; 23:688-702. [PMID: 35334062 PMCID: PMC8951659 DOI: 10.1007/s11864-022-00975-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 11/29/2022]
Abstract
The coronavirus disease-19 (COVID-19) pandemic has posed numerous challenges to the global healthcare system. Of particular gravity is adult and pediatric patients with hematologic malignancies who are among the most vulnerable groups of patients at risk of severe COVID-19 outcomes. In the early phases of the pandemic, several treatment modifications were proposed for patients with leukemia. Largely speaking, these were adopting less-intense therapies and more utilization of the outpatient setting. Over time, our understanding and management have become more nuanced. Furthermore, equipped with vaccinations to prevent COVID-19 infection and availability of treatments in the presence of COVID-19 infection, the recommendations on management of patients with leukemia have evolved. Patient’s leukemia characteristics, possibility of targeted therapy, vaccination status, symptomatology, comorbidities, goal of anti-leukemic therapy, the intensity of therapy, the setting of treatment, as well as loco regional factors like dynamic incidence of COVID-19 in the community and hospital/ICU bed status are among many factors that influence the decisions. Furthermore, the oncology community has adopted delaying the anti-leukemia therapy for a limited time frame, if clinically possible, so as to still deliver most appropriate therapy while minimizing risks. Early adoption of growth factor support and conservative blood transfusion practices have helped as well. In this review, we discuss the impact of COVID-19 on outcomes and share considerations for treatments of leukemias. We describe the impact on both clinical care (from diagnosis to treatment) and research, and cover the literature on vaccines and treatments for COVID-19 in relation to leukemia.
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Affiliation(s)
- Noha Sharafeldin
- Division of Hematology and Oncology and O'Neal Comprehensive Cancer Center, Heersink School of Medicine, University of Alabama at Birmingham (UAB), 1600 7th Avenue South, Lowder 500, Birmingham, AL, 35233, USA.
| | - Benjamin Bates
- The Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA
| | - Pankit Vachhani
- Division of Hematology and Oncology and O'Neal Comprehensive Cancer Center, Heersink School of Medicine, University of Alabama at Birmingham (UAB), 1600 7th Avenue South, Lowder 500, Birmingham, AL, 35233, USA
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