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New Study Shows COVID-19 Severity in CLL Patients

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Published on August 13, 2020

How Well do CLL Patients Who Get COVID-19 Recover?

A recent study published in the medical journals Nature and Blood analyzed the effects of COVID-19 positive CLL patients who were hospitalized during the early days of the pandemic. Dr. Anthony Mato from Sloan Kettering, NYC joined Patient Power Co-founder, Andrew Schorr to report on the findings of this study. An international effort that includes information from cancer centers around the world, this retrospective study is being used to inform treatment decisions moving forward. Watch to hear the full report.

Program 1 of 6 from Answers Now Live Program: CLL and Covid 19: What's My Risk? recorded July 31, 2020.

This is a Patient Power program. We thank AbbVie Inc. and Genentech, Inc. for their support. These organizations have no editorial control, and Patient Power is solely responsible for program content.

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Transcript | New Study Shows COVID-19 Severity in CLL Patients

Andrew Schorr:

Dr. Mato, thank you for joining us from Memorial Sloan Kettering in New York. Tell us about this study. You had cooperation from doctors around the world, right? CLL specialists, based on data of people who've been hospitalized, correct?

Dr. Mato:

Thanks so much for having me. Literally the minute that we heard about this oncoming crisis, we started to gather some partners from around the world to examine the outcomes for patients with CLL who were diagnosed with COVID-19, recognizing that our patients are somewhat different than everybody else, they could be immunocompromised, they may be on active continuous therapy. So we have many centers from Europe, the US, even South America participate to put together a very large population of patients who were symptomatic and hospitalized. So I do want to emphasize that this is not all patients with CLL who've had COVID-19, but these were the sickest of the sick early on who required hospital or ICU admission.

And we tried to ask some really simple questions to begin with, what was the mortality for those patients? Were there any therapies that seem to help or hurt patients? And then also, were there any differences between patients on active therapy or active observation? And could we identify any particular risk factors for having a poor outcome, death largely, in this group of patients? And so that's what we did. We identified approximately 30 to 35% mortality rate, depending on how you look at it across the cohort, approximately 33%. We found that age, particularly age greater than 75 and patients who had multiple medical comorbidities measured by something called a SEAR score were at a higher risk for dying from COVID-19.

And then we also found, interestingly, that the outcomes were similar on patients, on observation or patients who were on active continuous therapy. And so watch and wait didn't appear to be different from someone who had chemo or someone who was on a continuous therapy like ibrutinib (Imbruvica) or venetoclax (Venclexta), for example.

Andrew Schorr:

Okay. So I think the number of patients you have data on is 198?

Dr. Mato:

Correct.

Andrew Schorr:

And of those, from February to the end of April, which was the study period, 66 of those patients passed away?

Dr. Mato:

That is correct. Yes.

Andrew Schorr:

That's a scary percentage for us, and we'll discuss that. So of these people, what symptoms did they present that led to them being in the hospital?

Dr. Mato:

Probably the number one symptom that led to hospitalization was shortness of breath and need for oxygen support. So if a patient was seen in the doctor's office or in an emergency department with the complaint of fever, if their oxygen levels were lower, for example, than they should be, less than 90% for example, they were automatically admitted. Most patients who were admitted had shortness of breath, fever and an oxygen requirement. And then of course, there were patients who were sicker than that who required mechanical ventilation and so on and so forth.

Andrew Schorr:

Comorbidities, so we've heard about that a lot. Sometimes on the news, they talk about cancer being a risk factor, but they often talk about asthma, diabetes. So what would be the conditions that a CLL patient would have besides age that would be a risk factor?

Dr. Mato:

The ones that stand out to me are the obvious. So if you have underlying lung disease, for example, asthma, COPD, those are ones where you would be particularly concerned. Underlying renal insufficiency, so your kidneys are not able to work at full capacity, and underlying comorbidities like diabetes were the ones that were the most obvious particular red flags in this particular group of patients.

Andrew Schorr:

And age in and of itself?

Dr. Mato:

Age by itself was also a predictor. And so when you do these types of analyses, you look at things called univariable analysis, so each thing by itself, and then you put them together to see whether or not they remain independent predictors. And by my analysis and some others who've done similar work, age was probably the most important predictor, even more so than having underlying comorbidities. And that's been shown not only in CLL, but several other studies looking at patients with COVID-19.

Andrew Schorr:

So there were 66 people who passed away. Do we know anything about the people who were hospitalized or maybe hopefully were able to go home? Is there any follow up or what else do we know about them?

Dr. Mato:

So right now, we're in the process of updating the study data set and we're collecting follow up data, particularly for the patients who remained in the hospital at the time that we finished this particular paper. So it was a fair number of patients who were still hospitalized, so we're collecting that data now and we're collecting longer term follow up. The median follow up here was less than 20 days for the cohort, and so it was a very quick look at what happens during a hospitalization for patients with COVID-19. Certainly, with two or three months follow up, it'll be more valuable.

Andrew Schorr:

That said though, this is the first study of its kind in a hematologic malignancy bringing with the cooperation, the volunteer cooperation of you and your colleagues around the world, so it's a foundational study, if you will?

Dr. Mato:

To me, it serves as a baseline. As we have new therapies or vaccines, we have at least the mortality for these hospitalized patients for comparison to as a historical control. Yeah.

Andrew Schorr:

And the theory is then that we with CLL have a cancer of the immune system so that you wouldn't be surprised if we had a worst go of it. So is the study bearing that out?

Dr. Mato:

People who do research are very hesitant to make what we call cross-trial or cross-study comparisons. My personal feeling is that there should be more caution for patients with CLL, and that the numbers do look, at least quantitatively, slightly worse, although there's no statistical testing here to tell us for sure that the CLL patients are doing worse than anyone else.

Andrew Schorr:

Okay. I want to get back to something you mentioned earlier. CLL is not one disease. I mean, we have different journeys. So we have many people who are on watch and wait. You mentioned that earlier, and other people who were on very active therapies, even all the way to big guns, like CAR T. So depending upon what treatment you're in or watch and wait, was there any difference in the people who were studied?

Dr. Mato:

At least in the symptomatic patients who required hospitalization, it seemed like once you got to the point that you needed to be in the hospital, we didn't see a difference between the watch and wait or the treated patients. Of course, therapies like CAR T, ALLO transplant, very active, heavy duty chemotherapy are all very underrepresented in this patient population. Most of the treated patients were those on the targeted therapies.

Andrew Schorr:

Okay. And people are asking here about their lymphocyte count, anything that we know about what your lymphocyte count was going into this, whether that seems to make a difference?

Dr. Mato:

No obvious signal or strong signal that lymphocytosis, a lymphocyte count or lymphopenia was an important predictor here. We're also now delving into whether patients with CLL are making antibodies to COVID-19 at the same rate as others are doing, other non-cancer or non CLL patients. And we're also retrospectively delving into some of therapies and whether there's benefit or not.

It should be noted that all of these approaches are retrospective, so they are not prospective randomized trials that the FDA would consider good enough to lead to approvals for drugs, but it does give us some insight into how our particular patients might benefit from some of the drugs or vaccines that are being studied in the larger patient populations.

Andrew Schorr:

Dr. Mato, what happens now? You have this data, was the first published data of hospitalized, hematologic malignancy patients, CLL in this case, where do we go from here so we get more hard data, if you will.

Dr. Mato:

Well, one of the things to do is what we're doing by continuing to expand our partnerships, getting longer term, strongly encouraging that therapies and the vaccines are tested in patients with CLL so we have patient or disease specific data. And then participating in all of the registries that are starting around the country, ASH has one now, the American Society of Hematology, where they're gathering data on heme malignancies to try to put our experiences together. And then also further developing studies that test the immune systems of patients with cancer and immunodeficiencies, to try to understand if these vaccines are not working, how can we augment them to allow them to work for patients? And we have studies like that are underway at our center as well.

Andrew Schorr:

Okay. I want to underscore something for our audience, and you mentioned it earlier, you are a CLL specialist and there are many around the US and in other countries as well. Not all of us go to CLL specialists, but we have access to certainly have a consultation or have them weigh in with our community doctor if they're more of a generalist. And so as this data comes out or published for everyone, your article in Blood, just from a few days ago, this is a moving target, we're living with it, we want to know. So I would just say, you said it earlier, consult with a CLL specialist, make sure you're getting the updated data.

Dr. Mato:

And if you're not seeing a CLL specialist, I can't think of anyone that I work with who focuses on CLL who's not willing to talk to your physician to provide guidance or to work with other professional organizations to educate either providers or patients to share whatever it is we know. It's a very open community and certainly, not everyone may have access to a large cancer center based on where they live, but they shouldn't feel isolated from the most up-to-date information.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

 


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