Aurer Igor, Jakšić Ozren, Bašić-Kinda Sandra, Mrđenović Stefan, Ostojić-Kolonić Slobodanka, Lozić Dominik, Holik Hrvoje, Novaković-Coha Sabina, Berneš Petra, Krečak Ivan, Morić-Perić Martina, Narančić Marino, Mitrović Zdravko, Valković Toni
University Hospital Centre Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia.
School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia.
Biomedicines. 2024 Jan 31;12(2):331. doi: 10.3390/biomedicines12020331.
Patients with lymphoid malignancies are at increased risk of death or prolonged infection due to COVID-19. Data on the influence of different antineoplastic treatment modalities on outcomes are conflicting. Anti-CD20 monoclonal antibodies increase the risk of prolonged infection. It is unclear whether this risk is affected by the choice of the antibody (rituximab vs. obinutuzumab). To elucidate the role of antineoplastic therapy on COVID-19 outcomes, KroHem collected data on patients with lymphoid malignancies diagnosed with COVID-19 between October 2020 and April 2021. A total of 314 patients were identified, 75 untreated, 61 off treatment and 178 on treatment. The mortality rate in untreated and off-treatment patients was 15% and 16%; 9% and 10% had prolonged infection. In the on-treatment group, 3% were still prolonged positive at time of data collection, 62% recovered and 35% died; 42% had prolonged infection. Disease type, use of anti-CD20 monoclonal antibodies, prior autologous stem-cell transplantation (ASCT) and line of treatment did not significantly affect mortality. Mortality was higher in older patients ( = 0.0078) and those treated with purine analogues ( = 0.012). Prolonged COVID-19 was significantly more frequent in patients treated with anti-CD20 monoclonal antibodies ( = 0.012), especially obinutuzumab, and purine analogues ( = 0.012). Age, prior ASCT and treatment line did not significantly affect risk of prolonged infection. These data suggest that increased age and use of purine analogues are main risk factors for increased mortality of COVID-19 in patients with lymphoid malignancies. Obinutuzumab further increases the risk of prolonged disease, but not of death, in comparison to rituximab. Epidemiological considerations should be taken into account when choosing the appropriate antineoplastic therapy for patients with lymphoid malignancies.
淋巴系统恶性肿瘤患者因感染新型冠状病毒肺炎（COVID-19）而死亡或感染持续时间延长的风险增加。关于不同抗肿瘤治疗方式对预后影响的数据相互矛盾。抗CD20单克隆抗体增加了感染持续时间延长的风险。目前尚不清楚这种风险是否受抗体选择（利妥昔单抗与奥妥珠单抗）的影响。为了阐明抗肿瘤治疗在COVID-19预后中的作用，KroHem收集了2020年10月至2021年4月期间确诊感染COVID-19的淋巴系统恶性肿瘤患者的数据。共识别出314例患者，75例未接受治疗，61例停止治疗，178例正在接受治疗。未接受治疗和停止治疗患者的死亡率分别为15%和16%；9%和10%的患者感染持续时间延长。在正在接受治疗的组中，3%的患者在数据收集时仍持续呈阳性，62%的患者康复，35%的患者死亡；42%的患者感染持续时间延长。疾病类型、抗CD20单克隆抗体的使用、既往自体干细胞移植（ASCT）和治疗线对死亡率无显著影响。老年患者（P = 0.0078）和接受嘌呤类似物治疗的患者（P = 0.012）死亡率较高。接受抗CD20单克隆抗体治疗的患者（P = 0.012），尤其是奥妥珠单抗，以及接受嘌呤类似物治疗的患者，COVID-19持续时间延长的情况明显更频繁（P = 0.012）。年龄、既往ASCT和治疗线对感染持续时间延长的风险无显著影响。这些数据表明，年龄增加和使用嘌呤类似物是淋巴系统恶性肿瘤患者COVID-19死亡率增加的主要危险因素。与利妥昔单抗相比，奥妥珠单抗进一步增加了疾病持续时间延长的风险，但未增加死亡风险。为淋巴系统恶性肿瘤患者选择合适的抗肿瘤治疗时应考虑流行病学因素。
