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Evaluating the Risk of Severe COVID-19 in Patients with Chronic Lymphocytic Leukemia

Patients with CLL may be at increased risk for developing severe COVID-19. Experts have provided insights on how to protect them while still delivering optimal care.
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The ongoing COVID-19 pandemic has been a global public health crisis, resulting in nearly 123 million cases of disease and an estimated 2.7 million deaths.1 Over time, doctors have identified several risk factors that contribute to the development of severe disease, including being male, being >65 years of age, and having medical conditions such as heart, lung, or kidney disease, diabetes, or cancer.2

Patients with chronic lymphocytic leukemia (CLL) tend to have characteristics that put them at increased risk of severe COVID-19.2,3 Additionally, patients with CLL may also have a weakened immune system due to their disease or treatment that could put them at increased risk of viral infection.2,3

In a recent study, researchers from 141 centers from around the world partnered to evaluate the clinical courses and outcomes of patients with CLL who contracted COVID-19.3 The main objective of the study was to estimate the proportion of patients with CLL who died among all of those who were hospitalized with a COVID-19 infection.3 Researchers also sought to identify characteristics that could be predictive of having a fatal case of COVID-19, including possible treatment effects.3

Overall, cases from 411 hospitalized patients were evaluated.3 Patients were grouped into 1 of 2 groups depending on the location of their medical center: one group that was entirely European, and a group that consisted of clinics mostly in the United States and United Kingdom.3

As is typical for a population of patients with CLL, those in this study tended to be older (most were aged >68 years when first diagnosed with COVID-19), male, and a large number of them had multiple other medical conditions, including diabetes and heart, lung, and kidney disease.3 In the European group, about half had never been treated for CLL and about one-quarter were receiving treatment at the time they were diagnosed with COVID-19.3 In the US/UK group, slightly more than one-third were never treated, and half were on therapy at the time of their COVID-19 diagnosis.3

In both groups, 90% of patients required supplemental oxygen, and about one-third of the patients with CLL and COVID-19 in this study died.3 Looking closer at the data, researchers concluded that gender, CLL treatment history, and COVID-19 management strategies were not predictors of COVID-19 outcome in this population.3 Only advanced patient age at the time of COVID-19 diagnosis was found to be a reliable predictor of worse outcomes.3

Given that patients with CLL are at increased risk for developing serious COVID-19, experts recommend limiting their exposure to the virus by minimizing the number of clinic visits and substituting them with remote check-ins where possible.2 Additionally, treatments should be postponed as long as clinically possible.2 When treatments must be administered, those that require the fewest number of clinic visits and are the least likely to suppress the patient’s immune system should be selected.2 Finally, patients with CLL should be monitored for the earliest signs and symptoms of COVID-19 so that appropriate assessment and management can be started immediately.2


References

  1. World Health Organization (WHO). WHO Coronavirus Dashboard. https://covid19.who.int. Accessed March 22, 2021.
  2. Rossi D, Shadman M, Condoluci A, et al. How we manage patients with chronic lymphocytic leukemia during the SARS-CoV-2 pandemic. Hemasphere. 2020;4:e432.
  3. Roeker LE, Scarfo L, Chatzikonstantinou T, et al. Worldwide examination of patients with CLL hospitalized for COVID-19. Presented at the 62nd American Society for Hematology Annual Meeting and Exposition; December 5, 2020. Abstract 1590.

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Last modified: April 19, 2021

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