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Treating Lymphopenia in a Patient With COVID-19 and Treatment-Naive CLL

By: Joseph Fanelli
Posted: Wednesday, November 18, 2020

According to a case report presented in Clinical Lymphoma, Myeloma & Leukemia, it is unclear whether COVID-19–induced lymphocytosis in patients with chronic lymphocytic leukemia (CLL) can be used as a prognostic factor in treatment-naive populations. According to Damoun Safarpour, MD, of Midwestern University, Downers Grove, Illinois, and colleagues, this report is a rare description of the new phenomenon of COVID-19–induced lymphocytosis.

“Despite the early disease stage, treatment-naive status, absence of lymphadenopathy, favorable cytogenetics, and stable cell counts before infection with COVID-19, our patient’s lymphocyte counts had increased more than threefold, with the resulting poor outcome,” the authors said.

The authors describe the case of an 80-year-old man with stage 0 CLL. The patient reported to an emergency room with a productive cough and shortness of breath. A COVID-19 test returned positive, and the patient was intubated for 4 days because of his worsening hypoxic respiratory failure.

On day 13, the patient had an absolute lymphocyte count of 113.7 × 103/μL, at which point methylprednisolone was started. After the initiation of steroids, the patient’s white blood cell count decreased but then gradually increased, reaching a peak of 132.4 × 103/μL, with an absolute lymphocyte count of 116 × 103/μL on day 23. The patient died on day 27 of admission.

One hypothesis, the authors noted, for this patient’s lymphocytosis, was that it resulted from the effects of the antiviral and interleukin-6 receptor antigen treatment on the lymphocyte count. The authors also mentioned that methylprednisolone's effect was in contrast to clinical trials, with lymphocytes decreasing suddenly after the initial dose but then gradually increasing.

Based on several early studies of Bruton’s tyrosine kinase (BTK) inhibitors such as acalabrutinib and zanubrutinib in patients with COVID-19, a trial of a BTK inhibitor might be worth considering in a patient with COVID-19–induced lymphocytosis or hyperlymphocytosis, the authors noted.

Disclosure: The authors reported no conflicts of interest.



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