Patients with lymphoma treated with B-cell-depleting therapies may have worse outcomes from COVID-19 infection
Among patients with lymphoma admitted to the hospital for severe COVID-19, those treated with B-cell-depleting therapies within the previous 12 months had an increased risk of prolonged hospital stay and death, according to results presented at the AACR Virtual Meeting: COVID-19 and Cancer, held Feb. 3-5.
"Patients with lymphoma may develop immune deficiency due to particular features of their disease or due to their treatment regimen, which can lead to increased incidence and increased severity of infections," said study senior author Caroline Besson, MD, Ph.D., a hematologist at Centre Hospitalier de Versailles and Université de Versailles Saint-Quentin-en-Yvelines (UVSQ) in France. "In the context of the COVID-19 pandemic, it appeared necessary to analyze the clinical course of this infection in our patients and to characterize the determinants of worse outcomes."
Patients with lymphoma are often treated with B-cell-depleting antibodies, such as rituximab (Rituxan) or obinutuzumab (Gazyva). These drugs target CD20, a protein found on the surface of B cells. "More than 20 years ago, anti-CD20 monoclonal antibodies were shown to improve survival among patients with B-cell non-Hodgkin lymphoma, the most frequent subtype of the disease," said presenting author Sylvain Lamure, MD, a hematologist at Centre Hospitalier Universitaire (CHU) Montpellier in France. "However, these treatments induce rapid B-cell depletion, which alters the generation of antibody responses to new pathogens, which may impact the clinical course of COVID-19," he added.
To better elucidate factors associated with worse outcomes from COVID-19 in this patient population, the researchers evaluated data from 111 patients with lymphoma who were admitted to one of 16 French hospitals for severe COVID-19 during March and April of 2020. The researchers specifically focused on identifying factors associated with prolonged hospital stay (longer than 30 days) and death from any cause.
Of the 111 patients, 63 (57 percent) had previously received B-cell-depleting therapy; 29 percent of all patients required a prolonged hospital stay due to severe COVID-19 symptoms. After a median follow-up of 191 days, the six-month overall survival in this patient population was 69 percent.
After adjusting for age, comorbidities, and the presence of relapsed/refractory disease, the authors found that receipt of B-cell-depleting treatment within the previous 12 months nearly doubled the likelihood of a prolonged hospital stay and more than doubled the risk of death. Other factors that were significantly associated with decreased overall survival and prolonged hospital stay were having relapsed/refractory lymphoma or being at least 70 years of age.
"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 Besson. "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," she said.
"Patients who recently received B-cell-depleting therapies and have COVID-19 should refer to their physician and should be closely monitored," Lamure added.
Limitations of this study include its retrospective nature.