Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jul 8;9(13):3170-3181.
doi: 10.1182/bloodadvances.2024015260.

Outcomes of the COVID-19 pandemic in chronic lymphocytic leukemia: focus on the very early period and Omicron era

Pontus Hedberg  1 , Lisa Blixt  2   3 , Sandra Eketorp Sylvan  3 , Isabela Killander Möller  1 , Hannes Lindahl  4   5 , Fredrik Kahn  6   7 , Åsa Nilsdotter-Augustinsson  8 , Mats Fredrikson  9 , Sofia Nyström  9   10 , Peter Bergman  4   11 , Christina Carlander  1   12   13 , Soo Aleman  1   12 , Pontus Nauclér  12   14 , Anders Österborg  2   3 , Lotta Hansson  2   3
Affiliations

Outcomes of the COVID-19 pandemic in chronic lymphocytic leukemia: focus on the very early period and Omicron era

Pontus Hedberg et al. Blood Adv. .

Abstract

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.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest disclosure: F.K. reports funding grants from CSL Behring. P.B. reports receiving speaking and lecture fees from CSL Behring and Takeda. C.C. reports funding grants from Gilead Sciences Inc; serving as a consultant or in an advisory role for Gilead Sciences Inc and ViiV Healthcare; and speaking and lecture fees from Gilead Sciences Inc and ViiV Healthcare. S.A. reports funding grants from AbbVie and Gilead Sciences Inc, and speaking and lecture fees from AbbVie, Biogen Inc, Gilead Sciences Inc, and Merck Sharp & Dohme. A.Ö. reports funding grants from BeiGene Ltd, Lilly/Loxo Inc, and Merck Sharp & Dohme. L.H. reports funding grants from IQVIA. The remaining authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Study flowchart.aIf >90 days had passed between 2 positive consecutive PCR tests, these were classified as 2 different infection episodes.
Figure 2.
Figure 2.
The 90-day all-cause mortality rates, COVID-19 hospitalization rates, and COVID-19 ICU admission rates in individuals with and those without CLL.
Figure 3.
Figure 3.
Forest plot of fully adjusted RRs for 90-day all-cause mortality, COVID-19 hospitalization, and COVID-19 ICU admission in individuals with CLL compared with those without CLL.
Figure 4.
Figure 4.
Cumulative incidence of all-cause mortality from 2017 through 2022 in individuals with and those without CLL in Stockholm County.
See this image and copyright information in PMC

Comment in

Similar articles

  • Physical interventions to interrupt or reduce the spread of respiratory viruses.
    Jefferson T, Dooley L, Ferroni E, Al-Ansary LA, van Driel ML, Bawazeer GA, Jones MA, Hoffmann TC, Clark J, Beller EM, Glasziou PP, Conly JM. Jefferson T, et al. Cochrane Database Syst Rev. 2023 Jan 30;1(1):CD006207. doi: 10.1002/14651858.CD006207.pub6. Cochrane Database Syst Rev. 2023. PMID: 36715243 Free PMC article.
  • Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID-19.
    Struyf T, Deeks JJ, Dinnes J, Takwoingi Y, Davenport C, Leeflang MM, Spijker R, Hooft L, Emperador D, Domen J, Tans A, Janssens S, Wickramasinghe D, Lannoy V, Horn SRA, Van den Bruel A; Cochrane COVID-19 Diagnostic Test Accuracy Group. Struyf T, et al. Cochrane Database Syst Rev. 2022 May 20;5(5):CD013665. doi: 10.1002/14651858.CD013665.pub3. Cochrane Database Syst Rev. 2022. PMID: 35593186 Free PMC article.
  • Accuracy of routine laboratory tests to predict mortality and deterioration to severe or critical COVID-19 in people with SARS-CoV-2.
    De Rop L, Bos DA, Stegeman I, Holtman G, Ochodo EA, Spijker R, Otieno JA, Alkhlaileh F, Deeks JJ, Dinnes J, Van den Bruel A, McInnes MD, Leeflang MM; Cochrane COVID-19 Diagnostic Test Accuracy Group; Verbakel JY. De Rop L, et al. Cochrane Database Syst Rev. 2024 Aug 6;8(8):CD015050. doi: 10.1002/14651858.CD015050.pub2. Cochrane Database Syst Rev. 2024. PMID: 39105481 Free PMC article.
  • Antibody tests for identification of current and past infection with SARS-CoV-2.
    Fox T, Geppert J, Dinnes J, Scandrett K, Bigio J, Sulis G, Hettiarachchi D, Mathangasinghe Y, Weeratunga P, Wickramasinghe D, Bergman H, Buckley BS, Probyn K, Sguassero Y, Davenport C, Cunningham J, Dittrich S, Emperador D, Hooft L, Leeflang MM, McInnes MD, Spijker R, Struyf T, Van den Bruel A, Verbakel JY, Takwoingi Y, Taylor-Phillips S, Deeks JJ; Cochrane COVID-19 Diagnostic Test Accuracy Group. Fox T, et al. Cochrane Database Syst Rev. 2022 Nov 17;11(11):CD013652. doi: 10.1002/14651858.CD013652.pub2. Cochrane Database Syst Rev. 2022. PMID: 36394900 Free PMC article.
  • The effect of sample site and collection procedure on identification of SARS-CoV-2 infection.
    Davenport C, Arevalo-Rodriguez I, Mateos-Haro M, Berhane S, Dinnes J, Spijker R, Buitrago-Garcia D, Ciapponi A, Takwoingi Y, Deeks JJ, Emperador D, Leeflang MMG, Van den Bruel A; Cochrane COVID-19 Diagnostic Test Accuracy Group. Davenport C, et al. Cochrane Database Syst Rev. 2024 Dec 16;12(12):CD014780. doi: 10.1002/14651858.CD014780. Cochrane Database Syst Rev. 2024. PMID: 39679851 Free PMC article.
See all similar articles

Cited by

References

    1. Hamblin AD, Hamblin TJ. The immunodeficiency of chronic lymphocytic leukaemia. Br Med Bull. 2008;87:49–62. - PubMed
    1. Andersen MA, Eriksen CT, Brieghel C, et al. Incidence and predictors of infection among patients prior to treatment of chronic lymphocytic leukemia: a Danish nationwide cohort study. Haematologica. 2018;103(7):e300–e303. - PMC - PubMed
    1. Mauro FR, Giannarelli D, Galluzzo CM, et al. Response to the conjugate pneumococcal vaccine (PCV13) in patients with chronic lymphocytic leukemia (CLL) Leukemia. 2021;35(3):737–746. - PubMed
    1. Muchtar E, Koehler AB, Johnson MJ, et al. Humoral and cellular immune responses to recombinant herpes zoster vaccine in patients with chronic lymphocytic leukemia and monoclonal B cell lymphocytosis. Am J Hematol. 2022;97(1):90–98. - PMC - PubMed
    1. Shen Y, Freeman JA, Holland J, et al. Multiple COVID-19 vaccine doses in CLL and MBL improve immune responses with progressive and high seroconversion. Blood. 2022;140(25):2709–2721. - PMC - PubMed