Prolonged in-hospital stay and higher mortality after Covid-19 among patients with non-Hodgkin lymphoma treated with B-cell depleting immunotherapy
Prolonged in-hospital stay and higher mortality after Covid-19 among patients with non-Hodgkin lymphoma treated with B-cell depleting immunotherapy
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DOI：
10.1002/ajh.26209
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发表时间：
2021-05-12
影响因子：
12.8
通讯作者：
Besson, Caroline
中科院分区：
文献类型：
--
作者：
Dulery, Remy;Lamure, Sylvain;Besson, Caroline
对于淋巴瘤或免疫缺陷患者来说，持续的COVID-19是一个新出现的问题。我们旨在研究淋巴瘤患者因Covid-19导致的住院时间延长（LOS），并评估其决定因素和结局。纳入了2020年3月和4月因新冠肺炎入院的16家法国医院的淋巴瘤成人患者。将住院时间作为竞争药物vs死亡进行分析。该研究包括111名患者。中位年龄为65岁（范围：19-92岁）。94例患者（85%）患有B细胞非霍奇金淋巴瘤。在因Covid-19住院前的12个月内，79名患者（71%）接受了淋巴瘤治疗。其中，63例（57%）接受了抗CD 20治疗。14例患者（12%）患有复发性/难治性疾病。中位LOS为14天（范围，1-235）。中位随访191天（3-260天）后，6个月总生存率为69%。在多变量分析中，近期抗CD 20治疗与LOS延长（子分布风险比2.26，95%置信区间1.42-3.6，p < 0.001）和死亡风险较高（风险比2.17，95%置信区间1.04-4.52，p = 0.039）相关。年龄≥ 70岁和复发/难治性淋巴瘤也与LOS延长和总生存率降低相关。总之，年龄≥ 70岁、复发/难治性淋巴瘤和近期接受抗CD 20治疗是因Covid-19住院的淋巴瘤患者LOS延长和死亡的风险因素。这些发现可能有助于指导大流行期间淋巴瘤的管理，支持评估特定的治疗方法，并提出关于该特定人群疫苗接种的有效性和时机的问题。
Prolonged Covid-19 is an emerging issue for patients with lymphoma or immune deficiency. We aimed to examine prolonged length of in-hospital stay (LOS) due to Covid-19 among patients with lymphoma and assess its determinants and outcomes. Adult patients with lymphoma admitted for Covid-19 to 16 French hospitals in March and April, 2020 were included. Length of in-hospital stay was analyzed as a competitor vs death. The study included 111 patients. The median age was 65 years (range, 19-92). Ninety-four patients (85%) had B-cell non-Hodgkin lymphoma. Within the 12 months prior to hospitalization for Covid-19, 79 patients (71%) were treated for their lymphoma. Among them, 63 (57%) received an anti-CD20 therapy. Fourteen patients (12%) had relapsed/refractory disease. The median LOS was 14 days (range, 1-235). After a median follow-up of 191 days (3-260), the 6-month overall survival was 69%. In multivariable analyses, recent administration of anti-CD20 therapy was associated with prolonged LOS (subdistribution hazard ratio 2.26, 95% confidence interval 1.42-3.6, p < 0.001) and higher risk of death (hazard ratio 2.17, 95% confidence interval 1.04-4.52, p = 0.039). An age >= 70 years and relapsed/refractory lymphoma were also associated with prolonged LOS and decreased overall survival. In conclusion, an age >= 70 years, a relapsed/refractory lymphoma and recent administration of anti-CD20 therapy are risk factors for prolonged LOS and death for lymphoma patients hospitalized for Covid-19. These findings may contribute to guide the management of lymphoma during the pandemic, support evaluating specific therapeutic approaches, and raise questions on the efficacy and timing of vaccination of this particular population.