Covid-19 in patients with chronic lymphocytic leukemia: clinical outcome and B- and T-cell immunity during 13 months in consecutive patients

• Published in: Leukemia Vol. 36; no. 2; pp. 476 - 481
• Main Authors: Blixt, Lisa, Bogdanovic, Gordana, Buggert, Marcus, Gao, Yu, Hober, Sophia, Healy, Katie, Johansson, Hemming, Kjellander, Christian, Mravinacova, Sara, Muschiol, Sandra, Nilsson, Peter, Palma, Marzia, Pin, Elisa, Smith, C. I. Edvard, Stromberg, Olga, Sällberg Chen, Margaret, Zain, Rula, Hansson, Lotta, Österborg, Anders
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-02-2022; Nature Publishing Group
• Subjects: 13/1; 14/35; 692/308/575; 692/699/1541/1990/283/1895; 80 and over; 82; 96/31; 96/63; Adult; Age; Aged; Aged, 80 and over; Antibodies; Antibodies, Neutralizing - blood; Antibodies, Neutralizing - immunology; Antibodies, Viral - blood; Antibodies, Viral - immunology; antibody response; anticoagulant agent; antineoplastic monoclonal antibody; B lymphocyte; B-Cell; B-Lymphocytes; B-Lymphocytes - immunology; bendamustine; blood; body mass; Bruton tyrosine kinase inhibitor; Cancer Research; cellular immunity; Chronic; chronic lymphatic leukemia; Chronic lymphocytic leukemia; Combined Modality Therapy; complication; controlled study; coronavirus disease 2019; Coronaviruses; corticosteroid; COVID-19; COVID-19 - complications; COVID-19 - immunology; COVID-19 - transmission; COVID-19 - virology; Critical Care Medicine; Cumulative Illness Rating Scale; enzyme linked immunospot assay; Enzyme-linked immunosorbent assay; Female; follow up; Follow-Up Studies; gamma interferon; Hematology; hospitalization; human; Humans; humoral immunity; hydroxychloroquine; hypertensive agent; Immunity; immunoglobulin; immunoglobulin G antibody; Immunology; Intensive; intensive care; Internal Medicine; isolation and purification; Leukemia; Leukemia, Lymphocytic, Chronic, B-Cell - immunology; Leukemia, Lymphocytic, Chronic, B-Cell - therapy; Leukemia, Lymphocytic, Chronic, B-Cell - virology; Lymphatic leukemia; Lymphocytes; Lymphocytes T; Lymphocytic; major clinical study; Male; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Middle Aged; mortality rate; multimodality cancer therapy; Multivariate analysis; Neutralizing; neutralizing antibody; Oncology; Pandemics; Patients; Prognosis; remdesivir; Risk analysis; Risk factors; rituximab; Robustness (mathematics); Saliva; SARS-CoV-2; SARS-CoV-2 - immunology; SARS-CoV-2 - isolation & purification; SARS-CoV-2 antibody; SARS-CoV-2 convalescent plasma; Seroconversion; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Subgroups; Sweden; T lymphocyte; T-Lymphocytes; T-Lymphocytes - immunology; tocilizumab; venetoclax; very elderly; Viral; virology; virus antibody
• ISSN: 0887-6924; 1476-5551; 1476-5551
• DOI: 10.1038/s41375-021-01424-w

We studied clinical and immunological outcome of Covid-19 in consecutive CLL patients from a well-defined area during month 1–13 of the pandemic. Sixty patients (median age 71 y, range 43–97) were identified. Median CIRS was eight (4–20). Patients had indolent CLL (
n
 = 38), had completed (
n
 = 12) or ongoing therapy (
n
 = 10). Forty-six patients (77%) were hospitalized due to severe Covid-19 and 11 were admitted to ICU. Severe Covid-19 was equally distributed across subgroups irrespective of age, gender, BMI, CLL status except CIRS (
p
 < 0.05). Fourteen patients (23%) died; age ≥75 y was the only significant risk factor (p < 0.05, multivariate analysis with limited power). Comparing month 1–6 vs 7–13 of the pandemic, deaths were numerically reduced from 32% to 18%, ICU admission from 37% to 15% whereas hospitalizations remained frequent (86% vs 71%). Seroconversion occurred in 33/40 patients (82%) and anti-SARS-CoV-2 antibodies were detectable at six and 12 months in 17/22 and 8/11 patients, respectively. Most (13/17) had neutralizing antibodies and 19/28 had antibodies in saliva. SARS-CoV-2-specific T-cells (ELISpot) were detected in 14/17 patients. Covid-19 continued to result in high admission even among consecutive and young early- stage CLL patients. A robust and durable B and/or T cell immunity was observed in most convalescents.