Outcomes in Patients with Hematological Malignancies Receiving Anti-CD20 Therapy in the Setting of COVID-19 Infection

Objective: The global COVID-19 pandemic has posed a major challenge for patients with hematological malignancies undergoing treatment. For patients with acute leukemia and aggressive lymphomas, delaying curative chemotherapy treatments has historically been associated with adverse outcomes. In the absence of any quality prospective data, expert recommendation has been to treat when possible. Though earlier studies have reported that cancer patients are at an increased risk for mortality due to COVID-19 when compared to the general population, questions remain unanswered as to how specific agents used to treat malignancies affect the natural history of COVID-19. In particular, the effect of anti-CD20 therapy in patients with lymphoid malignancies remains unexplored in patients who contract COVID-19 during their treatment.

Methods: We conducted a retrospective chart review of patients at our New York-based institution to identify any COVID-19 positive patients that required inpatient treatment for their lymphoid malignancy from December 31st, 2019 to July 31st, 2020. Only patients that had received anti-CD20 therapy (rituximab or obinutuzumab) were included in this study. COVID-19 positivity was determined via a positive PCR-based test (either nasopharyngeal swab or bronchoalveolar lavage).

Results: A total of 13 patients were identified, with primary hematological diagnoses including DLBCL (6), ALL (1), MALT lymphoma (1), follicular lymphoma (2), and chronic lymphocytic leukemia (1). The COVID-19 related mortality rate in this cohort was 46% (6), with the remainder recovering from COVID-19. Of the 7 patients who survived, 2 patients had persistently positive COVID-19 PCR-based testing after clinical recovery, 2 failed to develop detectable IgG anti-COVID-19 antibodies, 1 had not had antibody testing, and 2 had detectable antibodies. Of the 2 patients that developed antibodies after recovery, 1 had undetectable anti-COVID-19 IgG levels 55 days later on subsequent testing.

Conclusions: Patients who are hospitalized with lymphoid malignancies and are requiring anti-CD20 therapy seem to be at increased risk of COVID-19-related mortality. Furthermore, anti-CD20 therapy appears to adversely impact the development of IgG antibodies and appears to be associated with delayed clearance of the virus on PCR-based testing.