COVID-19 in Patients With CLL: Is Neutropenia a Risk Factor?
Posted: Thursday, September 9, 2021
A group of researchers from New York City studied the outcomes of patients with several hematologic malignancies, including chronic lymphocytic leukemia (CLL), who contracted COVID-19. These results were published in Leukemia & Lymphoma by Aaron D. Goldberg, MD, PhD, of Weill Cornell Medical College in New York, and his colleagues.
Researchers conducted a retrospective cohort study of 65 patients with CLL, acute lymphoid leukemia (ALL), chronic myeloid leukemia (CML), acute myeloid leukemia (AML), myelodysplastic syndromes (MDS), and myelodysplastic neoplasm (MPN) who were infected with COVID-19 between March and May 2020. Clinical outcomes for patients were monitored until July 2020. Most patients in this cohort had either CLL (38%) or AML (22%). About half (52%) of patients had received treatment within the 3 months prior to being diagnosed with COVID-19. There were 14 patients (22%) with neutropenia at the time of COVID-19 diagnosis as well. Within this group, 40% of patients received care for COVID-19 in the outpatient setting, and 60% were inpatients.
Regarding treatment of COVID-19 in this cohort, 32% received hydroxychloroquine, 25% received azithromycin, 19% received convalescent plasma, 8% received tocilizumab, and 5% received remdesivir. A total of 2 patients required high-flow nasal cannula therapy, and 12 patients were intubated for mechanical ventilation. There were 11 deaths (17%) attributed to COVID-19–related complications, and the median time from COVID-19 diagnosis to death was 12 days.
Two of the patients with CLL (8%) in this cohort died. However, none of the 10 patients with MDS or CML died due to COVID-19 infection. In addition, 35% of patients with AML, 29% of patients with MPN, and 17% of patients with ALL died of COVID-19. Patients receiving active treatment during the past 3 months had higher odds of dying of COVID-19 (odds ratio = 5.22, P = 0.047). Other factors associated with poor outcomes included low platelet and neutrophil counts; low albumin; and high levels of procalcitonin, ferritin, troponin, aspartate aminotransferase, and total bilirubin.
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