COVID-19 and Untreated Patients With CLL: Case Reports Shed Light on Clinical Risks
Posted: Wednesday, May 6, 2020
According to Paul Moss, PhD, of the University of Birmingham, United Kingdom, and colleagues, treatment-naive patients with B-cell chronic lymphocytic leukemia (CLL) who had been infected with COVID-19 showed increased lymphocytosis upon infection—as well as high mortality rates. Generally, COVID-19 infections result in lymphopenia. Four patient profiles, which were published in Leukemia Research, suggest that untreated patients with CLL may be at a higher risk of severe COVID-19 infection than the general public.
The first patient, a 49-year-old man with Binet stage C disease, was admitted with respiratory failure due to COVID-19. By day 3, there was a sixfold increase in white blood cell count to 202 x 109/L (177 lymphocytes). His cell counts eventually returned to baseline, and he recovered.
The second patient was an 81-year-old man with CLL of a CD19+, CD5+ CD23+ phenotype who presented with a cough, fever, common cold symptoms, and an elevated white blood cell count of 37.5 x 109/L (32 lymphocytes). His lymphocyte count increased due to steroid treatments 2 years prior; however, this time it was considerably higher. The patient was diagnosed with COVID-19 and died 4 days later.
The third patient, an 80-year-old woman with Binet stage C disease, presented with shortness of breath and a fever as a result of COVID-19. Upon admission, her lymphocyte count was 253 x 109/, although it reached to 346 x 109/L before she died.
The fourth and final patient was a 79-year-old woman with CLL who had an atypical immunophenotype of CD19+, CD5+/-, CD23+/-, CD79b–, CD10–. She was admitted after experiencing acute respiratory symptoms due to COVID-19. Prior to hospitalization, she had a lymphocyte count of 2.8 x 109/L. Her lymphocyte count rose to 8 x 109/L after infection, and she died shortly after.
“[COVID-induced lymphocytosis] may result from very high levels of endogenous steroids during intense inflammation, but additional mechanisms may be in operation and deserve further investigation,” the investigators commented.
Disclosure: The study authors reported no conflicts of interest.