Department of Hematology, Karolinska University Hospital Solna, Stockholm, Sweden.
Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
Leukemia. 2022 Feb;36(2):476-481. doi: 10.1038/s41375-021-01424-w. Epub 2021 Sep 25.
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.
我们研究了在大流行的第 1-13 个月期间，来自一个明确界定地区的连续 CLL 患者的新冠病毒感染的临床和免疫学结果。确定了 60 名患者（中位年龄 71 岁，范围 43-97 岁）。中位 CIRS 为 8（4-20）。患者患有惰性 CLL（n=38），已完成（n=12）或正在进行治疗（n=10）。46 名患者（77%）因严重新冠病毒感染住院，11 名患者入住 ICU。无论年龄、性别、BMI、CLL 状态如何，严重新冠病毒感染在各组之间的分布均相等，除 CIRS 外（p<0.05）。14 名患者（23%）死亡；年龄≥75 岁是唯一的显著危险因素（p<0.05，具有有限效力的多变量分析）。与大流行的第 1-6 个月相比，第 7-13 个月的死亡人数从 32%减少到 18%，ICU 入院人数从 37%减少到 15%，而住院人数仍然很高（86%对 71%）。33/40 名患者（82%）发生血清转化，17/22 名和 8/11 名患者分别在 6 个月和 12 个月时可检测到抗 SARS-CoV-2 抗体。大多数（13/17）患者具有中和抗体，19/28 名患者在唾液中具有抗体。17 名患者中的 14 名（82%）检测到 SARS-CoV-2 特异性 T 细胞（ELISpot）。即使在连续和年轻的早期 CLL 患者中，新冠病毒感染仍导致高入院率。大多数康复者观察到强大而持久的 B 和/或 T 细胞免疫。
