A prognostic model for patients with lymphoma and COVID-19: a multicentre cohort study

Visco, Carlo; Marcheselli, Luigi; Mina, Roberto; Sassone, Marianna; Guidetti, Anna; Penna, Domenico; Cattaneo, Chiara; Bonuomo, Valentina; Busca, Alessandro; Ferreri, Andrés José María; Bruna, Riccardo; Petrucci, Luigi; Cairoli, Roberto; Salvini, Marco; Bertù, Lorenza; Ladetto, Marco; Pilerci, Sofia; Pinto, Antonello; Ramadan, Safaa; Marchesi, Francesco; Cavo, Michele; Arcaini, Luca; Coviello, Elisa; Romano, Alessandra; Musto, Pellegrino; Massaia, Massimo; Fracchiolla, Nicola; Marchetti, Monia; Scattolin, Annamaria; Tisi, Maria Chiara; Cuneo, Antonio; Porta, Matteo Della; Trentin, Livio; Turrini, Marco; Gherlinzoni, Filippo; Tafuri, Agostino; Galimberti, Sara; Bocchia, Monica; Cardinali, Valeria; Cilloni, Daniela; Corso, Alessandro; Armiento, Daniele; Luigi, Rigacci; Barbera, Elettra Ortu La; Gambacorti-Passerini, Carlo; Visani, Giuseppe; Vallisa, Daniele; Venditti, Adriano; Selleri, Carmine; Conconi, Annarita; Tosi, Patrizia; Lanza, Francesco; Candoni, Anna; Krampera, Mauro; Corradini, Paolo; Passamonti, Francesco; Merli, Francesco

Lymphoma represents a heterogeneous hematological malignancy (HM), which is characterized by severe immunosuppression. Patients diagnosed of coronavirus disease (COVID-19) during the course of HM have been described to have poor outcome, with only few reports specifically addressing lymphoma patients. Here, we investigated the clinical behaviour and clinical parameters of a large multicenter cohort of adult patients with different lymphoma subtypes, with the aim of identifying predictors of death. The study included 856 patients, of whom 619 were enrolled prospectively in a 1-year frame and were followed-up for a median of 66 days (range 1-395). Patients were managed as outpatient (not admitted cohort, n=388), or required hospitalization (n=468), and median age was 63 years (range 19-94). Overall, the 30- and 100-days mortality was 13% (95%CI 11-15%) and 23% (95%CI 20-27%), respectively. Anti-lymphoma treatment, including anti-CD20 containing regimens, did not impact on survival. Patients with Hodgkin's lymphoma had the more favourable survival, but this was partly related to significantly younger age. The time interval between lymphoma diagnosis and COVID-19 was inversely related to mortality. Multivariable analysis recognized 4 easy-to-use factors (age, gender, lymphocyte, and platelet count) that were associated with risk of death, both in the admitted and in the not-admitted cohort (HR 3.79 and 8.85 for the intermediate and high-risk group, respectively). Overall, our study shows that patients should not be deprived of the best available treatment for their underlying disease, and indicates which patients are at higher risk of death. This study was registered with ClinicalTrials.gov, NCT04352556.