Patients with CLL have a lower risk of death from COVID-19 in the Omicron era

Abstract

Previous studies have shown that patients with chronic lymphocytic leukemia (CLL) and coronavirus disease 2019 (COVID-19) have high mortality rates. Infection with the Omicron variant has been described as a milder disease course in the general population. However, the outcome for immunocompromised patients has not previously been reported. In a cohort of patients with CLL tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at hospital test sites in the time periods before and after dominance of the Omicron variant, rates of hospitalizations and intensive care unit admissions declined significantly, whereas 30-day mortality remained as high as 23% in the period with dominance of the Omicron sublineage BA.2 variant. However, for a larger population-based cohort of patients with CLL (including the hospital cohort), 30-day mortality was 2%. Thus, patients with CLL with close hospital contacts and, in particular, those >70 years of age with 1 or more comorbidities should be considered for closer monitoring and preemptive antiviral therapy upon a positive SARS-CoV-2 test.

Graphical abstract

Figure 1.

Admission to hospital, admission to ICU, and overall survival upon COVID-19 in CLL. Kaplan-Meier curves for (A) admission to hospital, (B) admission to ICU, (C) overall survival (OS) for the EHR cohort, (D) OS for the population cohort, and (E) OS for the combined cohort. Data are stratified for the following time periods: period 1: 12 March and 16 September 2020 for EHR and population cohorts, respectively, to December 2020; period 2: January 2021 to 25 November 2021; period 3: 26 November 2021 to December 2021; and period 4: 1 January 2022 to 28 January 2022 and 7 March 2022 for EHR and population cohorts, respectively. Patients represented within the EHR cohort (A-C) are excluded from the population cohort (D). P values were calculated using log-rank test for differences across the 4 subgroups.