Thrombotic and bleeding complications in patients with chronic lymphocytic leukemia and severe COVID-19: a study of ERIC, the European Research Initiative on CLL.

Autor: Antic D; Lymphoma Center, Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia. darko.antic1510976@gmail.com.; Faculty of Medicine, University of Belgrade, Belgrade, Serbia. darko.antic1510976@gmail.com., Milic N; Department of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia., Chatzikonstantinou T; Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece.; Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece., Scarfò L; Università Vita-Salute San Raffaele and IRCC Ospedale San Raffaele, Milan, Italy., Otasevic V; Lymphoma Center, Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia., Rajovic N; Department of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia., Allsup D; Centre for Atherothrombosis and Metabolic Disease, Hull York Medical School, Hull, UK., Alonso Cabrero A; Haematology Department, Hospital Universitario de La Princesa, Madrid, Spain., Andres M; Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland., Baile Gonzales M; Hematology Department, University Hospital of Salamanca-IBSAL, Salamanca, Spain., Capasso A; IRCSS Ospedale San Raffaele, Milan, Italy., Collado R; Department of Hematology, Hospital General Universitario, Valencia, Spain.; Fundación de Investigación del Hospital General Universitario, Valencia, Spain., Cordoba R; Department of Hematology, Health Research Institute IIS-FJD, Fundacion Jimenez Diaz University Hospital, Madrid, Spain., Cuéllar-García C; Hematology Unit Terrassa Hospital, Terrassa, Spain., Correa JG; Hospital Clínic de Barcelona, Barcelona, Spain., De Paoli L; Division of Internal Medicine, Hematology Unit, ASL Vercelli, Vercelli, Italy., De Paolis MR; UOC Ematologia PO Vito Fazzi Lecce, Lecce, Italy., Del Poeta G; Department of Biomedicine and Prevention Hematology, University Tor Vergata, Rome, Italy., Dimou M; 1st Internal Medicine Department, Propaedeutic, Hematology Clinical Trial Unit, National and Kapodistrian University of Athens, Athens, Greece., Doubek M; Department of Internal Medicine - Hematology and Oncology, University Hospital, Brno, Czechia.; Department of Medical Genetics and Genomics, Faculty of Medicine, Masaryk University, Brno, Czechia., Efstathopoulou M; Department of Haematology Athens Medical Center-Psychikon Branch, Athens, Greece., El-Ashwah S; Clinical Hematology Unit, Oncology Center, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt., Enrico A; Hospital Italiano La Plata, La Plata, Argentina., Espinet B; Department of Hematology, Hospital del Mar, Barcelona, Spain., Farina L; Hematology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy., Ferrari A; Hematology Unit, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy., Foglietta M; SC Ematologia, AO S. Croce e Carle, Cuneo, Italy., Lopez-Garcia A; Department of Hematology, Health Research Institute IIS-FJD, Fundacion Jimenez Diaz University Hospital, Madrid, Spain., García-Marco JA; Hematology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain., García-Serra R; Department of Hematology, Hospital General Universitario, Valencia, Spain.; Fundación de Investigación del Hospital General Universitario, Valencia, Spain., Gentile M; Hematology Unit AO Cosenza, Cosenza, Italy., Gimeno E; Department of Hematology, Hospital del Mar, Barcelona, Spain., da Silva MG; Hematology Department, Portuguese Institute of Oncology Lisbon, Lisbon, Portugal., Gutwein O; Department of Hematology, Shamir Medical Center, Zerifin, Israel.; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel., Hakobyan YK; Hematology Center after Prof. Yeolyan MH RA, Yerevan, Armenia., Herishanu Y; Department of Hematology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel., Hernández-Rivas JÁ; Department of Hematology, Infanta Leonor University Hospital, Madrid, Spain., Herold T; Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany., Itchaki G; Division of Hematology, Rabin Medical Center, Petah Tikva, and the Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel., Jaksic O; Department of Hematology, University Hospital Dubrava, Zagreb, Croatia., Janssens A; Department of Hematology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium., Kalashnikova OB; Federal State Budgetary Educational Institution of Higher Education Academician I.P. Pavlov, First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia., Kalicińska E; Department and Clinic of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Pasteura Street 4, 50-367, Wrocław, Poland., Kater AP; Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands., Kersting S; Department of Hematology, Haga Teaching Hospital, The Hague, The Netherlands., Koren-Michowitz M; Department of Hematology, Shamir Medical Center, Zerifin, Israel.; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel., Labrador J; Hematology Department, Unit Research, Complejo Asistencial Universitario de Burgos, Burgos, Spain., Lad D; Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India., Laurenti L; Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy.; Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy., Fresa A; Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy.; Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy., Levin MD; Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands., Mayor Bastida C; Haematology Department, Hospital Universitario de La Princesa, Madrid, Spain.; Spanish Society of Haematology and Hemotherapy (SEHH: Sociedad Española de Hematología y Hemoterapia), Madrid, Spain., Malerba L; Hematology and Stem Cell Transplant Center Marche Nord Hospital, Pesaro, Italy., Marasca R; Section of Hematology, Department of Medical Sciences, University of Modena and Reggio E., Modena, Italy., Marchetti M; Hematology Unit & TMO Center, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy., Marquet J; Hematology Department, Ramón y Cajal University Hospital, Madrid, Spain., Mihaljevic B; Lymphoma Center, Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia.; Faculty of Medicine, University of Belgrade, Belgrade, Serbia., Milosevic I; Clinical Centre of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia., Mirás F; Hematology Department, Hospital Universitario 12de Octubre, Madrid, Spain., Morawska M; Experimental Hematooncology Department, Medical University of Lublin, Lublin, Poland.; Hematology Department, St. John's Cancer Center, Lublin, Poland., Motta M; S.C. Ematologia ASST Spedali Civili Brescia, Brescia, Italy., Munir T; Consultant Haematologist, St James's Hospital, Leeds, LS9 7TF, UK., Murru R; Hematology and Stem Cell Transplantation Unit, Ospedale Oncologico A. Businco, ARNAS 'G. Brotzu', Cagliari, Italy., Nunes R; Hematology Department, Portuguese Institute of Oncology Lisbon, Lisbon, Portugal., Olivieri J; Hematology Clinic, ASUFC, Udine, Italy., Pavlovsky MA; FUNDALEU, Clinical Research Center Buenos Aires, Buenos Aires, Argentina., Piskunova I; Consultative Hematology Department with a Day Hospital for Intensive High-Dose Chemotherapy, National Research Center for Hematology, Moscow, Russia., Popov VM; Hematology Department, Colentina Clinical Hospital, Bucharest, Romania., Quaglia FM; Department of Medicine, Section of Hematology, University of Verona, Verona, Italy., Quaresmini G; Hematology, ASST Papa Giovanni XXIII, Bergamo, Italy., Reda G; Hematology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan, Milan, Italy., Rigolin GM; St. Anna University Hospital, Ferrara, Italy., Shrestha A; Hematology Unit, Nepal Cancer Hospital and Research Center, Lalitpur, Nepal., Šimkovič M; 4th Department of Internal Medicine - Haematology, Faculty of Medicine in Hradec Králové, University Hospital and Charles University in Prague, Hradec Kralove, Czech Republic., Smirnova S; Consultative Hematology Department with a Day Hospital for Intensive High-Dose Chemotherapy, National Research Center for Hematology, Moscow, Russia., Špaček M; 1st Department of Medicine - Hematology, First Faculty of Medicine, Charles University and General Hospital in Prague, Prague, Czech Republic., Sportoletti P; Department of Medicine and Surgery, Institute of Hematology and Center for Hemato-Oncological Research, Ospedale S. Maria della Misericordia, Perugia, Italy., Stanca O; Hematology Department from Coltea Clinical Hospital, 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania., Stavroyianni N; Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece., Te Raa D; Department of Hematology, Gelderse Vallei Ede, Ede, The Netherlands., Tomic K; Lymphoma Center, Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia., Tonino S; Department of Hematology, Lymmcare, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands., Trentin L; Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padua, Italy., Van Der Spek E; Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands., van Gelder M; Department Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands., Varettoni M; Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy., Visentin A; Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padua, Italy., Vitale C; Division of Hematology, A.O.U. Cittàdella Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy., Vukovic V; Lymphoma Center, Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia., Wasik-Szczepanek E; Department Hematooncology and Bone Marrow Transplantation, Medical University in Lublin, Lublin, Poland., Wróbel T; Department and Clinic of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Pasteura Street 4, 50-367, Wrocław, Poland., Segundo LYS; University Hospital and Research Institute of Marqués de Valdecilla (IDIVAL), Santander, Spain., Yassin M; Hematology Section, Department of Medical Oncology, National Center for Cancer Care and Research, Doha, Qatar., Coscia M; Division of Hematology, A.O.U. Cittàdella Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy., Rambaldi A; Hematology, ASST Papa Giovanni XXIII, Bergamo, Italy., Montserrat E; Hospital Clínic de Barcelona, Barcelona, Spain., Foà R; Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy., Cuneo A; St. Anna University Hospital, Ferrara, Italy., Carrier M; Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, K1H 8L6, Canada., Ghia P; Università Vita-Salute San Raffaele and IRCC Ospedale San Raffaele, Milan, Italy., Stamatopoulos K; Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece.
Jazyk: angličtina
Zdroj: Journal of hematology & oncology [J Hematol Oncol] 2022 Aug 26; Vol. 15 (1), pp. 116. Date of Electronic Publication: 2022 Aug 26.
DOI: 10.1186/s13045-022-01333-0
Abstrakt: Background: Patients with chronic lymphocytic leukemia (CLL) may be more susceptible to COVID-19 related poor outcomes, including thrombosis and death, due to the advanced age, the presence of comorbidities, and the disease and treatment-related immune deficiency. The aim of this study was to assess the risk of thrombosis and bleeding in patients with CLL affected by severe COVID-19.
Methods: This is a retrospective multicenter study conducted by ERIC, the European Research Initiative on CLL, including patients from 79 centers across 22 countries. Data collection was conducted between April and May 2021. The COVID-19 diagnosis was confirmed by the real-time polymerase chain reaction (RT-PCR) assay for SARS-CoV-2 on nasal or pharyngeal swabs. Severe cases of COVID-19 were defined by hospitalization and the need of oxygen or admission into ICU. Development and type of thrombotic events, presence and severity of bleeding complications were reported during treatment for COVID-19. Bleeding events were classified using ISTH definition. STROBE recommendations were used in order to enhance reporting.
Results: A total of 793 patients from 79 centers were included in the study with 593 being hospitalized (74.8%). Among these, 511 were defined as having severe COVID: 162 were admitted to the ICU while 349 received oxygen supplementation outside the ICU. Most patients (90.5%) were receiving thromboprophylaxis. During COVID-19 treatment, 11.1% developed a thromboembolic event, while 5.0% experienced bleeding. Thrombosis developed in 21.6% of patients who were not receiving thromboprophylaxis, in contrast to 10.6% of patients who were on thromboprophylaxis. Bleeding episodes were more frequent in patients receiving intermediate/therapeutic versus prophylactic doses of low-molecular-weight heparin (LWMH) (8.1% vs. 3.8%, respectively) and in elderly. In multivariate analysis, peak D-dimer level and C-reactive protein to albumin ratio were poor prognostic factors for thrombosis occurrence (OR = 1.022, 95%CI 1.007‒1.038 and OR = 1.025, 95%CI 1.001‒1.051, respectively), while thromboprophylaxis use was protective (OR = 0.199, 95%CI 0.061‒0.645). Age and LMWH intermediate/therapeutic dose administration were prognostic factors in multivariate model for bleeding (OR = 1.062, 95%CI 1.017-1.109 and OR = 2.438, 95%CI 1.023-5.813, respectively).
Conclusions: Patients with CLL affected by severe COVID-19 are at a high risk of thrombosis if thromboprophylaxis is not used, but also at increased risk of bleeding under the LMWH intermediate/therapeutic dose administration.
(© 2022. The Author(s).)
Databáze: MEDLINE
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