Hedberg Pontus, Blixt Lisa, Eketorp Sylvan Sandra, Killander Möller Isabela, Lindahl Hannes, Kahn Fredrik, Nilsdotter-Augustinsson Åsa, Fredrikson Mats, Nyström Sofia, Bergman Peter, Carlander Christina, Aleman Soo, Nauclér Pontus, Österborg Anders, Hansson Lotta
Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
Department of Hematology, Karolinska University Hospital, Stockholm, Sweden.
Blood Adv. 2025 Jul 8;9(13):3170-3181. doi: 10.1182/bloodadvances.2024015260.
Individuals with chronic lymphocytic leukemia (CLL) face an increased risk for severe COVID-19. This study from Sweden, a country that only had a few mandatory restrictions at the onset of the pandemic, used 10 nationwide registers to compare the risks for severe COVID-19 outcomes of polymerase chain reaction-verified severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections through February 2023 in individuals with and those without CLL. From a population of 8 275 839 (6653 CLL) individuals born between 1930 and 2003, 2 088 163 first infections (1289 CLL) were included. The 90-day all-cause mortality rate and adjusted relative risk (aRR; 95% confidence interval) for individuals with CLL vs the general population was 24.8% (1.95; 1.58-2.41) during wild-type, 17.2% (2.38; 1.58-3.57) during Alpha, 4.1% (0.71; 0.24-2.08) during Delta, and 12.6% (1.49; 1.24-1.78) during Omicron infections. Their mortality during Omicron was 0.6% (<65 years), 5.4% (65-74 years), and 19.7% (≥75 years). Small molecule inhibitors (1.56; 1.03-2.37) and corticosteroid usage (1.45; 1.04-2.02) was associated with increased mortality. Next, we analyzed the all-cause mortality in the capital (Stockholm), widely affected by SARS-CoV-2 at the onset of the pandemic. Mortality in individuals with CLL increased by 55% during the first 6 months of 2020 vs 2019, and the age- and sex-aRR by 30 June was 1.53 (1.09-2.15) for individuals with CLL (P = .02) and 1.29 (1.25-1.33) for the general population (P < .001). Collectively, a significantly increased risk for severe COVID-19 and death was observed among individuals with CLL in Sweden, particularly at the onset of the pandemic when few national protective measures were introduced and also after Omicron emerged, emphasizing the need for a more pro-active pandemic strategy for CLL.
慢性淋巴细胞白血病（CLL）患者患重症 COVID-19 的风险增加。这项来自瑞典的研究，该国在疫情初期仅有少数强制性限制措施，利用 10 个全国性登记册，比较了截至 2023 年 2 月经聚合酶链反应验证的严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染在有和没有 CLL 的个体中出现重症 COVID-19 结局的风险。在 1930 年至 2003 年出生的 8275839 人（6653 例 CLL）中，纳入了 2088163 例首次感染（1289 例 CLL）。CLL 患者与普通人群相比，在野生型期间 90 天全因死亡率和调整后相对风险（aRR；95%置信区间）为 24.8%（1.95；1.58 - 2.41），在 Alpha 变异株期间为 17.2%（2.38；1.58 - 3.57），在 Delta 变异株期间为 4.1%（0.71；0.24 - 2.08），在 Omicron 变异株感染期间为 12.6%（1.49；1.24 - 1.78）。他们在 Omicron 变异株感染期间的死亡率在年龄<65 岁者中为 0.6%，65 - 74 岁者中为 5.4%，≥75 岁者中为 19.7%。小分子抑制剂使用（1.56；1.03 - 2.37）和皮质类固醇使用（1.45；1.04 - 2.02）与死亡率增加相关。接下来，我们分析了在疫情初期受 SARS-CoV-2 广泛影响的首都（斯德哥尔摩）的全因死亡率。2020 年的前 6 个月，CLL 患者的死亡率相较于 2019 年增加了 55%，到 6 月 30 日，CLL 患者的年龄和性别调整后相对风险为 1.53（1.09 - 2.15）（P = 0.02），普通人群为 1.29（1.25 - 1.33）（P < 0.001）。总体而言，在瑞典，CLL 患者中观察到患重症 COVID-19 和死亡的风险显著增加，特别是在疫情初期国家防护措施很少的时候以及 Omicron 变异株出现之后，这强调了对 CLL 需要采取更积极的疫情应对策略。
