Anti-CD20 Therapy For Lymphoma Tied To Worse COVID-19 Outcomes

Lymphoma patients treated with B-cell-depleting anti-CD20 monoclonal antibodies, such as rituximab or obinutuzumab, may have worse outcomes from COVID-19 infection, according to a study from France.

"More than 20 years ago, anti-CD20 monoclonal antibodies were shown to improve survival among patients with B-cell non-Hodgkin lymphoma, the most frequent subtype of the disease. However, these treatments induce rapid B-cell depletion, which alters the generation of antibody responses to new pathogens, which may impact the clinical course of COVID-19," Dr. Sylvain Lamure, with Centre Hospitalier Universitaire (CHU) Montpellier, said in a statement.

Dr. Lamure and colleagues evaluated the clinical course of 111 lymphoma patients hospitalized with severe COVID-19 in France, including 63 (57%) who had been treated with B-cell-depleting therapy in the year before COVID-19 hospitalization.

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One month after admission for COVID-19, 24 patients had died, 55 had been discharged, 31 remained in the hospital and one was later rehospitalized for COVID-19 recurrence. Thirty-two patients (29%) suffered persistent ongoing severe symptoms requiring hospital care for more than 30 days.

During a median follow-up of 191 days (range, 3 to 260 days), the six-month overall survival rate was 69%.

In multivariate analysis adjusting for age and other factors, patients who were treated with B-cell-depleting therapies within 12 months before COVID-19 hospital admission were at increased risk for a prolonged hospital stay (>30 days, hazard ratio, 1.97; 95% confidence interval: 1.24 to 3.13; P=0.004) and death (HR 2.13; 95% CI: 1.03-4.44; P=0.043).

"Administration of anti-CD20 therapy within the last 12 months was one of the main risk factors for longer in-hospital stay and death from COVID-19," said Dr. Lamure in reporting the findings at the American Association for Cancer Research (AACR) virtual COVID-19 and Cancer meeting.

Age over 70 and relapsed/refractory lymphoma were also significantly associated with worse survival and prolonged hospital stay, he noted.

These findings may help guide the management of lymphoma patients during the COVID-19 pandemic, Dr. Lamure said.

Related research presented at the AACR COVID-19 and Cancer meeting found no increased risk for SARS-CoV-2 infection in cancer patients receiving chemotherapy.

"Given the concern that patients with cancer are at increased risk for COVID-19, there have been widespread changes to the practice of clinical oncology since the start of the pandemic last year," Dr. Monica Chen of Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Hospital in New York City, said in a statement.

Among 1,1740 cancer patients tested for SARS-CoV-2 between March 1 and June 2, 2020, 317 (27%) tested positive.

About 27% of these patients had a recent cancer diagnosis, 56.7% had active disease and were on active cancer treatment within the past year.

However, neither a recent cancer diagnosis nor active disease/treatment were associated with a positive SARS-CoV-2 test. In fact, cancer patients on active treatment were less likely to test positive (odds ratio 0.65, 95% confidence interval: 0.44 to 0.95), Dr. Chen reported.

"We found that patients on active treatment, including chemotherapy, were not at increased risk for COVID-19, and surprisingly, they were less likely to test positive for COVID-19 than those not on treatment," Dr. Chen said in the statement.

"Our study shows that with proper precautions in the clinical setting, disruptions in lifesaving cancer treatment should be minimized during the COVID-19 pandemic," Dr. Chen added.

However, consistent with prior studies, cancer patients with COVID-19 had higher death rates than COVID-free peers (28.4% vs. 8.3%, P<0.001).

—Megan Brooks

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