COVID-19 in patients with lymphoma : special features of the clinical picture and treatment

Cilj istraživanja: Prikupiti podatke o broju hospitaliziranih od COVID-19-a i limfoma u Kliničkom bolničkom centru (KBC) Split u razdoblju od ožujka 2020. godine do lipnja 2022. godine, razvrstati bolesnike po spolu, dobnim skupinama i hematološkoj dijagnozi. Odrediti broj hospitalizacija i utjecaj spola, dobi, hematološke dijagnoze i aktivnosti bolesti na broj hospitalizacija, primjenu oksigenoterapije i ishod bolesti. Procijeniti učinak terapije, naročito rituksimaba na kliničku sliku, broj hospitalizacija i ishod COVID-19-a. Prikazati utjecaj vrijednosti laboratorijskih parametara na ishod COVID-19 bolesti. Ispitanici i metode: Podatci potrebni za rad su prikupljeni iz povijesti bolesti pacijenata koji su pohranjeni u arhivskim prostorijama Klinike za infektologiju, KBC Split. Prikupljeni podaci su uneseni u Microsoft Excel za obradu podataka i prikazani u programu za obradu teksta Microsoft Word. Rezultati: U istraživanje je bio uključen 51 bolesnik s ukupno 74 hospitalizacije zbog SARS-CoV-2 infekcije. Pokazano je da 58,82% oboljelih čine muškarci, a najčešća prosječna dob hospitaliziranih je bila 67,77 godina. Najučestalija dijagnoza među oboljelima s limfomom i COVID-om je bio velikostanični difuzni B limfom (45,10%). Prosječan broj hospitalizacija je iznosio 1,877, a najveći broj hospitalizacija je dokazan u dobnoj skupini od 51 do 60 godina. Kod 81,69% je uslijedio oporavak, a čak 11,27% slučajeva je rezultiralo smrtnim ishodom. Bolesnici s dijagnozom ostalih indolentnih limfoma su imali najlošiju prognozu, njihov prosječan broj hospitalizacija je bio 2,286. Također, kod bolesnika pod anti-CD20 terapijom održavanja je dokazan veći broj hospitalizacija u toku liječenja COVID-19. Oksigenoterapija je najčešće primijenjena kod bolesnika starosti od 71 do 80 godina, dok kod onih mlađih od 60 godina nije bila potrebna. Bolesnici s visokim i vrlo visokim 4C-mortality score-om su češće liječeni kisikom. Dokazan je značajno veći broj smrtnih slučajeva u skupini bolesnika koji su prethodno liječeni rituksimabom. Primjena terapije koja uključuje kortikosteroide, remdesivir i rekonvalescentnu plazmu nije utjecala na ishod bolesti u odnosu na skupinu koje nisu primile navedenu terapiju, točnije u obje skupine najviše je zabilježeno oporavaka od SARS-CoV-2 infekcije. Zaključak: Bolesnici s potvrđenom dijagnozom SARS-CoV-2 infekcije i dijagnozom indolentnih limfoma i limfomi pod terapijom održavanja imaju veći rizik od relapsa COVID-19 te stoga imaju veći broj hospitalizacija. Prethodno liječenje monoklonalnim anti-CD20 protutijelom rezultiralo je višom stopom smrtnosti u oboljelih od COVID-19. Oksigenoterapija je najčešće bila primijenjena u dobnoj skupini od 71 do 80 godina, osobito kod bolesnika s visokim i vrlo visokim 4C-mortality score-om.Objectives: Collect data on the number of people hospitalized for COVID-19 and lymphoma in the Clinical Hospital Center (KBC) Split in the period from March 2020 to June 2022, classify patients by gender, age group and hematological diagnosis. To determine the number of hospitalizations and the influence of sex, age, hematological diagnosis and disease activity on the number of hospitalizations, the use of oxygen therapy and the outcome of the disease. To assess the effect of therapy, especially rituximab, on the clinical picture, the number of hospitalizations and the outcome of COVID-19. Show the influence of laboratory parameter values on the outcome of the COVID-19 disease. Subjects and methods: The data required for the work were collected from the medical history of the patients, which are stored in the archives of the Infectious Diseases Clinic, KBC Split. The collected data were entered into Microsoft Excel for data processing and presented in the word processing program Microsoft Word. Results: The study included 51 patients with a total of 74 hospitalizations due to SARS-CoV-2 infection. It was shown that 58.82% of patients were men, and the most common average age of those hospitalized was 67.77 years. The most common diagnosis among patients with lymphoma and COVID was large cell diffuse B lymphoma (45.10%). The average number of hospitalizations was 1.877, and the highest number of hospitalizations was found in the age group of 51 to 60 years. Recovery followed in 81.69%, and as many as 11.27% of cases resulted in death. Patients diagnosed with other indolent lymphomas had the worst prognosis, their average number of hospitalizations was 2.286. Also, in patients under anti-CD20 maintenance therapy, a higher number of hospitalizations during the treatment of COVID-19 has been demonstrated. Oxygen therapy was most often used in patients aged 71 to 80 years, while it was not necessary in those younger than 60 years. Patients with a high and very high 4C-mortality score were more often treated with oxygen. A significantly higher number of deaths was demonstrated in the group of patients previously treated with rituximab. The use of therapy that includes corticosteroids, remdesivir and convalescent plasma did not affect the outcome of the disease compared to the group that did not receive the specified therapy, more precisely in both groups the highest number of recoveries from SARS-CoV-2 infection was recorded. Conclusion: Patients with a confirmed diagnosis of SARS-CoV-2 infection and a diagnosis of indolent lymphomas and lymphomas under maintenance therapy have a higher risk of relapse of COVID-19 and therefore have a higher number of hospitalizations. Prior treatment with a monoclonal anti-CD20 antibody resulted in a higher mortality rate in patients with COVID-19. Oxygen therapy was most often used in the age group of 71 to 80 years, especially in patients with a high and very high 4C-mortality score