Lymphoma patients at high risk of persistent COVID-19

Patients with B-cell non-Hodgkin lymphoma hospitalized for COVID-19 are at an increased risk of developing persistent COVID-19 and death, according to a retrospective study presented at EHA 2021.

“Treatment of B-lineage lymphoma with B-cell depleting immunotherapy causes B-cell aplasia and impairs immune response,” explained the researchers led by Dr Caroline Besson from Université Versailles Saint-Quentin en Yvelines in Versailles, France.

There are also case reports of persistent COVID-19 in lymphoma patients treated with anti-CD20 therapy, she pointed out, thus bringing on the table the issue of whether to withhold this treatment in patients with lymphoma. 

In the retrospective multicentre study, 111 adults with lymphoma were followed 30 days after being admitted for COVID-19. Persistent COVID-19 refers to persisting severe COVID-19 symptoms entailing a hospital stay of >30 days, or recurrent severe COVID-19 symptoms after initial improvement requiring repeated hospitalization, resulting in total hospital stay of >30 days. [EHA 2021, abstract S215]

“Patients with B-cell non-Hodgkin lymphoma hospitalized for COVID-19 have a high incidence of prolonged evolution of SARS-CoV-2 infection,” reported Besson.

In the entire cohort, 24 had died within 30 days of hospitalization, 55 had been discharged from hospital, and 31 remained hospitalized beyond 30 days. There was one recurrent COVID-19 case who was later rehospitalized. This yields an incidence of 29 percent for persistent COVID-19.

Among the 32 patients classified as having persistent COVID-19 (median age 64 years, 63 percent male), 22 of them (69 percent) had ≥1 significant comorbidity. The time of hospitalization lasted for a median of 58 days, with their COVID-19 symptoms persisting for a median duration of 83 days.

In particular, prior use of anti-CD20 monoclonal antibody therapy within 12 months preceding COVID-19 hospitalization was associated with significantly increased risk of death (hazard ratio [HR], 2.13; p=0.043) and longer length of hospital stay (HR, 1.97; p=0.004).

Two other factors that were associated with significant excess risk of both death and prolonged hospital stay were older age ≥70 years (HRs, 2.34; p=0.004 and 4.73; p<0.001, respectively) and relapsed or refractory lymphoma (HRs, 3.12; p=0.028 and 3.34; p=0.002).

“These findings may contribute to guide the management of lymphoma patients during the COVID-19 pandemic,” said Besson.

Nonetheless, experts noted that the question of whether to withhold anti-CD20 therapy in these patients is a challenging one to address — entailing balance of risk vs benefit of doing so.

In the entire cohort of lymphoma patients, 69 percent were still alive at 6 months, after a median follow-up period of 191 days. Of note, none of the patients with classical Hodgkin’s disease or T-cell lymphoma had persistent COVID-19.

With regard to treatment, eight of the patients with persistent COVID-19 were given corticosteroids and nine received convalescent plasma — of which all eventually recovered, except one. Overall, nine patients with persistent COVID-19 died, translating to a death rate of 27 percent in this subgroup.