Lu X, Gao L, Qian S J, Dai L M J, Zhou Z Y, Qiu T L, Xia Y, Miao Y, Qin S C, Fan L, Xu W, Li J Y, Zhu H Y
Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China.
Department of Hematology, The Affiliate Suqian First People's Hospital of Nanjing Medical University, Suqian Branch of Jiangsu Provincial People's Hospital, Suqian 223999, China.
Zhonghua Xue Ye Xue Za Zhi. 2024 Oct 14;45(10):923-930. doi: 10.3760/cma.j.cn121090-20240621-00230.
To investigate the vaccination status, characteristics and prognosis of patients suffering from a combination of COVID-19 and chronic lymphocytic anemia (CLL) in China. Clinical data of 328 patients with chronic lymphocytic leukemia (CLL) who were first diagnosed with COVID-19 and treated in the Department of Hematology of Jiangsu Provincial People's Hospital between November 2022 and February 2023 were retrospectively analyzed. Univariate and multivariate analysis of data of patients with severe/critical COVID-19 were conducted by applying the binary logistic regression model. The median age of the CLL patients was 60 (24-87) years. 23.5% (77/328) of these patients suffered from severe/critical COVID-19 infection. Univariate analysis of the data demonstrated that a combination of factors including age >67 years (=2.15, 95% 1.24- 3.73, =0.006), diabetes (=2.09, 95% 1.05-4.20, =0.037), chronic hepatitis B (=2.91, 95% 1.30-6.51, =0.010), CLL progressive (=3.79, 95% 1.57-9.15, =0.003) and CD20 antibody-based treatments within three months prior to the COVID-19 infection (=2.79, 95% 1.35-5.77, =0.006) were the risk factors for severe/critical COVID-19. According to the multivariate analysis, CLL progressive (=2.98, 95% 1.10-8.10, =0.033) was an independent risk factor for severe/critical COVID-19 and administration of the BTK (Bruton tyrosine kinase) inhibitor monotherapy might exert a protective effect and influence a positive outcome of the COVID-19 infection (=0.38, 95% 0.16-0.90, =0.028). Among the 242 patients who were followed up until October 2023, 9.1% (22/242) had multiple subsequent COVID-19 infections (≥3), and 2.1% (5/242) had persistent COVID-19 infections (patients with persistent positive test for the SARS-CoV-2 antigen testing until missing follow-up for any reason). The peak value of the anti-SARS-CoV-2-IgG titres was observed between three and four months post symptom onset (median: 3.511 S/CO 1.047 S/CO, <0.05). The levels of immunoglobulin A gradually decreased following infection with COVID-19, and its trough levels were attained between two to four weeks post infection (median: 0.30 g/L 0.74 g/L, <0.05). According to this study the mortality of patients suffering from a combination of COVID-19 infection and CLL was 2.7% (9/328), and the main reason for their death was respiratory failure and heart failure. A low rate of COVID-19 vaccination and a high rate of severe/critical COVID-19 infection was observed in the CLL patients. CLL progressive was associated with severe/critical COVID-19. Anti-CD20-based treatments received within the past three months might be a risk factor for exacerbation of COVID-19 infection, whereas a monotherapy with BTK inhibitors exert a protective effect and improve outcome of COVID-19 infection.
调查中国新冠病毒病（COVID-19）合并慢性淋巴细胞白血病（CLL）患者的疫苗接种状况、特征及预后。回顾性分析2022年11月至2023年2月期间在江苏省人民医院血液科首次诊断为COVID-19并接受治疗的328例慢性淋巴细胞白血病（CLL）患者的临床资料。采用二元逻辑回归模型对重症/危重症COVID-19患者的数据进行单因素和多因素分析。CLL患者的中位年龄为60（24 - 87）岁。这些患者中有23.5%（77/328）发生了重症/危重症COVID-19感染。数据的单因素分析表明，年龄>67岁（比值比=2.15，95%置信区间1.24 - 3.73，P = 0.006）、糖尿病（比值比=2.09，95%置信区间1.05 - 4.20，P = 0.037）、慢性乙型肝炎（比值比=2.91，95%置信区间1.30 - 6.51，P = 0.010）、CLL病情进展（比值比=3.79，95%置信区间1.57 - 9.15，P = 0.003）以及在COVID-19感染前三个月内接受基于CD20抗体的治疗（比值比=2.79，95%置信区间1.35 - 5.77，P = 0.006）等因素组合是重症/危重症COVID-19的危险因素。根据多因素分析，CLL病情进展（比值比=2.98，95%置信区间1.10 - 8.10，P = 0.033）是重症/危重症COVID-19的独立危险因素，而给予布鲁顿酪氨酸激酶（BTK）抑制剂单药治疗可能发挥保护作用并影响COVID-19感染的良好转归（比值比=0.38，95%置信区间0.16 - 0.90，P = 0.028）。在随访至2023年10月的242例患者中，9.1%（22/242）有多次后续COVID-19感染（≥3次），2.1%（5/242）有持续性COVID-19感染（SARS-CoV-2抗原检测持续阳性直至因任何原因失访的患者）。抗SARS-CoV-2-IgG滴度峰值在症状出现后三至四个月观察到（中位数：3.511 S/CO 1.047 S/CO，P<0.05）。COVID-19感染后免疫球蛋白A水平逐渐下降，其谷值在感染后两至四周达到（中位数：0.30 g/L 0.74 g/L，P<0.05）。根据本研究，COVID-19感染合并CLL患者的死亡率为2.7%（9/328），其主要死亡原因是呼吸衰竭和心力衰竭。CLL患者中COVID-19疫苗接种率低，重症/危重症COVID-19感染率高。CLL病情进展与重症/危重症COVID-19相关。过去三个月内接受的基于抗CD20的治疗可能是COVID-19感染加重的危险因素，而BTK抑制剂单药治疗发挥保护作用并改善COVID-19感染的转归。
