Impact of COVID-19 in patients with lymphoid malignancies

Abstract

The first cases of coronavirus disease 2019 (COVID-19) were detected in Wuhan, China, in December 2019. Since this time a concerted global effort of research and observational data gathering has meant that a great deal has been learnt about the impact of COVID-19 in patients with lymphoid malignancies. Approximately one-third of patients with lymphoid malignancies who acquire COVID-19 and have it severely enough to require hospital assessment will die from this infection. Major risk factors for a poor outcome are age and co-morbidities, but when these are taken into account lymphoma patients have a slightly greater than 2-fold increased risk compared to the general population. Notably, despite early concerns regarding the particular vulnerability of lymphoma patients due to the immunosuppressive effects of therapy, active treatment, including B-cell depleting agents such as rituximab, do not appear to be associated with an increased risk of a poorer outcome. Indeed, some treatments such as ibrutinib may be beneficial due to their modulation of the potential fatal hyperinflammatory phase of infection. There are risks associated with hemopoietic stem cell transplantation, but the collective experience is that these can be minimized by preventive strategies and that the majority of transplant recipients with COVID-19 infection will survive. Many questions remain including those regarding the outcome of COVID-19 infection in the rarer lymphoid malignancies and the efficacy of COVID-19 vaccines in lymphoma patients. This review aims to discuss these issues and present a summary of the current knowledge of the impact of COVID-19 in lymphoid malignancies.

Keywords: COVID-19; Lymphoma; Leukemia; Chemoimmunotherapy; Hemopoietic stem cell transplantation; Vaccination

Core Tip: Patients with lymphoid malignancies who have coronavirus disease 2019 (COVID-19) severely enough to require hospital assessment have an approximately one-third chance of dying from the infection, representing a slightly greater than 2-fold increased risk compared to the general population. Despite initial concerns, treatment for lymphoma is not associated with increased risk for poor outcome. Current evidence for the efficacy of COVID-19 vaccines in patients with lymphoid malignancies is extremely limited, so it will be crucial to conduct studies to address this issue over the coming months.