B-cell–depleting immunotherapy may cause B-cell aplasia and impair the body’s immune response. A retrospective, multicentric French study of patients with lymphoma and persistent COVID-19 infection has found that those treated with B-cell–depleting therapies within the previous 12 months had nearly double the risk of prolonged hospitalization—and more than double the risk of death. Being older than age 70 or having refractory or relapsed disease were also significantly associated with decreased overall survival and a prolonged hospital stay (longer than 30 days). The study by Lamure et al was presented at the AACR Virtual Meeting: COVID-19 and Cancer (Abstract S09-02).
Study Methodology
The researchers collected data on 111 adult patients with lymphoma who had been admitted to one of 16 French hospitals with severe COVID-19 symptoms between March and April of 2020. Persistent COVID-19 was defined as continuing severe COVID-19 symptoms requiring a hospital stay of 30 days or longer. Patients who experienced severe COVID-19 symptoms after their initial improvement, requiring repeated hospitalizations for a total hospital stay of 30 days or longer, were added to the persistent COVID-19 cases.
"Patients with B-cell non-Hodgkin lymphoma hospitalized for COVID-19 have a high incidence of prolonged evolution of SARS-CoV-2 infection. Administration of anti-CD20 therapy within the last 12 months is one of the main risk factors for longer in-hospital stay and death [from] COVID-19. The risk of persistent COVID-19 was also higher in patients older than 70 years or with refractory or relapsed disease."— Lamure et al
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Results
The researchers found that of the 111 patients included in the study, 63 (57%) had previously received B-cell–depleting therapy, and 29% of all patients required a prolonged hospital stay due to severe COVID-19 symptoms.
Patients with persistent COVID-19 had a median age of 64 years (range = 43–87), and 63% were male. Twenty-two patients (69%) had at least one significant comorbidity. None of the patients with T-cell (n = 8) lymphoma or classical Hodgkin lymphoma (n = 8) experienced persistent COVID-19. Among the 32 patients with persistent COVID-19, the median time between first admission and final discharge was 58 days (range = 31–235), and the median duration of COVID-19 symptoms was 83 days (range = 32–237).
Eight patients received corticosteroids, and nine received convalescent plasma; all patients recovered from their symptoms except one. Overall, nine patients with persistent COVID-19 died (27%). After a median follow-up of 191 days (range = 3–260), the 6-month overall survival rate was 69% (95% confidence interval [CI] = 60%–78%) for the whole cohort.
In multivariate analysis, administration of an anti-CD20 monoclonal antibody within 12 months before admission to the hospital for COVID-19 was associated with decreased overall survival (hazard ratio [HR] = 2.13, 95% CI = 1.03–4.44, P = .043) as well as prolonged hospital stay (HR = 1.97, 95% CI = 1.24–3.13, P = .004). The two other significant factors associated with decreased overall survival and prolonged hospital stay were age ≥ 70 years and refractory or relapsed disease.
Clinical Significance
“Patients with B-cell non-Hodgkin lymphoma hospitalized for COVID-19 have a high incidence of prolonged evolution of SARS-CoV-2 infection. Administration of anti-CD20 therapy within the last 12 months is one of the main risk factors for longer in-hospital stay and death [from] COVID-19. The risk of persistent COVID-19 was also higher in patients older than 70 years or with refractory or relapsed disease. These findings may contribute to guide the management of [patients with] lymphoma during the COVID-19 pandemic,” concluded the study authors.
“Our findings regarding the impact of anti–CD20 therapy on the course of COVID-19 can contribute to the guidelines for managing patients with lymphoma during the pandemic,” said Caroline Besson, MD, PhD, a hematologist at Centre Hospitalier de Versailles and Université de Versailles Saint-Quentin-en-Yvelines in France, and senior author of this study, in a statement. “Our results also highlight the need for specific therapies for patients with COVID-19 who are B-cell depleted, and for the evaluation of the efficacy and timing of vaccination in this particular population. Patients who recently received B-cell–depleting therapies and have COVID-19 should refer to their physician and should be closely monitored.”
Disclosure: Funding for this study was provided by Roche Pharmaceuticals.
