Duléry Rémy, Lamure Sylvain, Delord Marc, Di Blasi Roberta, Chauchet Adrien, Hueso Thomas, Rossi Cédric, Drenou Bernard, Deau Fischer Bénédicte, Soussain Carole, Feugier Pierre, Noël Nicolas, Choquet Sylvain, Bologna Serge, Joly Bertrand, Philippe Laure, Kohn Milena, Malak Sandra, Fouquet Guillemette, Daguindau Etienne, Taoufik Yassine, Lacombe Karine, Cartron Guillaume, Thiéblemont Catherine, Besson Caroline
Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Inserm UMRs, Paris, France.
Département d'Hématologie Clinique, CHU de Montpellier, UMR-CNRS 5535, Université de Montpellier, Montpellier, France.
Am J Hematol. 2021 Aug 1;96(8):934-944. doi: 10.1002/ajh.26209. Epub 2021 May 12.
Prolonged Covid-19 is an emerging issue for patients with lymphoma or immune deficiency. We aimed to examine prolonged length of in-hospital stay (LOS) due to Covid-19 among patients with lymphoma and assess its determinants and outcomes. Adult patients with lymphoma admitted for Covid-19 to 16 French hospitals in March and April, 2020 were included. Length of in-hospital stay was analyzed as a competitor vs death. The study included 111 patients. The median age was 65 years (range, 19-92). Ninety-four patients (85%) had B-cell non-Hodgkin lymphoma. Within the 12 months prior to hospitalization for Covid-19, 79 patients (71%) were treated for their lymphoma. Among them, 63 (57%) received an anti-CD20 therapy. Fourteen patients (12%) had relapsed/refractory disease. The median LOS was 14 days (range, 1-235). After a median follow-up of 191 days (3-260), the 6-month overall survival was 69%. In multivariable analyses, recent administration of anti-CD20 therapy was associated with prolonged LOS (subdistribution hazard ratio 2.26, 95% confidence interval 1.42-3.6, p < 0.001) and higher risk of death (hazard ratio 2.17, 95% confidence interval 1.04-4.52, p = 0.039). An age ≥ 70 years and relapsed/refractory lymphoma were also associated with prolonged LOS and decreased overall survival. In conclusion, an age ≥ 70 years, a relapsed/refractory lymphoma and recent administration of anti-CD20 therapy are risk factors for prolonged LOS and death for lymphoma patients hospitalized for Covid-19. These findings may contribute to guide the management of lymphoma during the pandemic, support evaluating specific therapeutic approaches, and raise questions on the efficacy and timing of vaccination of this particular population.
新冠长期症状是淋巴瘤或免疫缺陷患者面临的一个新问题。我们旨在研究淋巴瘤患者因新冠病毒感染导致的住院时间延长情况，并评估其决定因素和预后。纳入了2020年3月和4月因新冠病毒感染入住法国16家医院的成年淋巴瘤患者。将住院时间作为与死亡竞争的指标进行分析。该研究共纳入111例患者。中位年龄为65岁（范围19 - 92岁）。94例患者（85%）患有B细胞非霍奇金淋巴瘤。在因新冠病毒感染住院前的12个月内，79例患者（71%）接受了淋巴瘤治疗。其中，63例（57%）接受了抗CD20治疗。14例患者（12%）患有复发/难治性疾病。中位住院时间为14天（范围1 - 235天）。中位随访191天（3 - 260天）后，6个月总生存率为69%。在多变量分析中，近期接受抗CD20治疗与住院时间延长相关（亚分布风险比2.26，95%置信区间1.42 - 3.6，p < 0.001）以及死亡风险更高（风险比2.17，95%置信区间1.04 - 4.52，p = 0.039）。年龄≥70岁和复发/难治性淋巴瘤也与住院时间延长和总生存率降低相关。总之，年龄≥70岁、复发/难治性淋巴瘤以及近期接受抗CD20治疗是因新冠病毒感染住院的淋巴瘤患者住院时间延长和死亡的危险因素。这些发现可能有助于指导疫情期间淋巴瘤的管理，支持评估特定治疗方法，并引发对这一特定人群疫苗接种效果和时机的质疑。
