Determinants of outcome in Covid-19 hospitalized patients with lymphoma: A retrospective multicentric cohort study

Sylvain Lamure, Rémy Duléry, Roberta Di Blasi, Adrien Chauchet, Cécile Laureana, Bénédicte Deau-Fischer, Bernard Drenou, Carole Soussain, Cédric Rossi, Nicolas Noël, Sylvain Choquet, Serge Bologna, Bertrand Joly, Milena Kohn, Sandra Malak, Guillemette Fouquet, Etienne Daguindau, Sophie Bernard, Catherine Thiéblemont, Guillaume Cartron, Karine Lacombe, Caroline Besson, Sylvain Lamure, Rémy Duléry, Roberta Di Blasi, Adrien Chauchet, Cécile Laureana, Bénédicte Deau-Fischer, Bernard Drenou, Carole Soussain, Cédric Rossi, Nicolas Noël, Sylvain Choquet, Serge Bologna, Bertrand Joly, Milena Kohn, Sandra Malak, Guillemette Fouquet, Etienne Daguindau, Sophie Bernard, Catherine Thiéblemont, Guillaume Cartron, Karine Lacombe, Caroline Besson

Abstract

Background: Patients with lymphoma are immunocompromised because of the disease per se and its treatments. We aimed to describe the characteristics of patients with lymphoma hospitalized for Coronavirus Disease 2019 (Covid-19) and to analyze pre-Covid-19 determinants of mortality.

Methods: This retrospective multicentric cohort study used the Programme de Médicalisation des Systèmes d'Information database to identify all adult patients with lymphoma, hospitalized for Covid-19 in March and April 2020, in 12 hospitals of three French regions with pandemic outbreaks. The characteristics of lymphoma and Covid-19 were collected from medical charts.

Findings: Eighty-nine patients were included. The median age was 67 years (range, 19-92), 66% were male and 72% had a comorbidity. Most patients had B-cell non-Hodgkin lymphoma (86%) and had received a lymphoma treatment within one year (70%). With a median follow-up of 33 days from admission, 30-day overall survival was 71%, (95% confidence interval, 62-81%). In multivariable analysis, having an age ≥ 70 years (hazard ratio 2·87, 1·20-6·85, p = 0·02) and relapsed/refractory lymphoma (hazard ratio 2·54, 1·14-5·66, p = 0·02) were associated with mortality. Recent bendamustine treatment (n = 9) was also pejorative (hazard ratio 3·20, 1·33-7·72, p = 0·01), but was strongly associated with relapsed/refractory lymphoma. Remarkably, 30-day overall survival for patients < 70 years of age without relapsed/refractory lymphoma was 88% (78% - 99%).

Interpretation: Thirty-day mortality was associated with being older and relapsed/refractory lymphoma. Survival of patients younger than 70 years without relapsed/refractory lymphoma was comparable to that of the general population.

Funding: There have been no specific funds to run this study.

Conflict of interest statement

The authors certify that there is no conflict of interest with any organization regarding the material presented in this manuscript. Rémy Duléry reports personal fees from Takeda, non-financial support from Gilead, personal fees from Novartis, outside the submitted work. Roberta Di Blasi reports personal fees from Gilead, personal fees from Novartis, outside the submitted work. Sylvain Choquet reports personal fees from Sanofi, personal fees from Celgene, personal fees from Roche, personal fees from Abbvie, personal fees from Sandoz, personal fees from Janssen, personal fees from Takeda, personal fees from Sandoz, outside the submitted work. Serge Bologna reports personal fees from Janssen, personal fees from Roche, outside the submitted work. Sophie Bernard reports non-financial support from Janssen, outside the submitted work. Guillaume Cartron reports personal fees from Roche, Celgene, Sanofi, Gilead, Janssen, and Abbvie, outside the submitted work. Karine Lacombe reports personal fees and non-financial support from Gilead, personal fees and non-financial support from MSD, personal fees and non-financial support from Abbvie, personal fees and non-financial support from ViiV Healthcare, personal fees and non-financial support from Janssen, outside the submitted work. Caroline Besson reports non-financial support from Takeda, outside the submitted work. All other authors have nothing to disclose.

© 2020 The Author(s).

Figures

Fig. 1
Fig. 1
Overall survival of patients with Covid-19 and lymphoma in (A) the whole population (N  =  89), (B) according to lymphoma subtype, (C) to age group, and (D) lymphoma status. A) 30-day OS, 71% (95% CI, 62–81%). B) 30-day OS of five patients with Hodgkin lymphoma, 80% (95% CI, 45–100%); of 77 patients with B-cell non-Hodgkin lymphoma, 71% (95% CI, 61–82%); and of seven patients with T-cell non-Hodgkin lymphoma, 71% (95% CI, 38–100%). C) 30-day OS of 51 patients aged 

Fig. 2

Overall survival of patients with…

Fig. 2

Overall survival of patients with Covid-19 and lymphoma ( N = 89), according…

Fig. 2
Overall survival of patients with Covid-19 and lymphoma (N =  89), according to age group and refractory/relapsed lymphoma status. - 30-day OS for 13 patients with refractory/relapsed lymphoma, 61% (95% CI, 35–88%). - 30-day OS for 31 patients aged ≥ 70 years with non-refractory/relapsed lymphoma, 52% (95% CI, 34–70%). - 30-day OS for 45 patients aged 
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Fig. 2
Fig. 2
Overall survival of patients with Covid-19 and lymphoma (N =  89), according to age group and refractory/relapsed lymphoma status. - 30-day OS for 13 patients with refractory/relapsed lymphoma, 61% (95% CI, 35–88%). - 30-day OS for 31 patients aged ≥ 70 years with non-refractory/relapsed lymphoma, 52% (95% CI, 34–70%). - 30-day OS for 45 patients aged 

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