A prognostic index predicting survival in transformed Waldenström macroglobulinemia

Histological transformation into diffuse large B-cell lymphoma is a rare complication in patients with Waldenström macroglobulinemia (WM) usually associated with a poor prognosis. The objective of this study was to develop and validate a prognostic index for survival in transformed WM patients. Through this multicenter, international collaborative effort, we developed a scoring system based on data from 133 patients with transformed WM who were evaluated between 1995 and 2016 (training cohort). Univariate and multivariate analyses were used to propose a prognostic index with 2-year survival after transformation as an end-point. For external validation, a data set of 67 patients was used to evaluate the performance of the model (validation cohort). By multivariate analysis, three adverse covariates were identified as independent predictors of 2-year survival after transformation: elevated serum LDH (2 points), platelet count < 100 x 109/L (1 point) and any previous treatment for WM (1 point). Three risk groups were defined: low-risk (0-1 point, 24% of patients), intermediate-risk (2-3 points, 59%, hazard ratio (HR) = 3.4) and high-risk (4 points, 17%, HR = 7.5). Two-year survival rates were 81%, 47%, and 21%, respectively (P < 0.0001). This model appeared to be a better discriminant than the International Prognostic Index (IPI) and the revised IPI (R-IPI). We validated this model in an independent cohort. This easy-to-compute scoring index is a robust tool that may allow identification of groups of transformed WM patients with different outcomes and could be used for improving the development of risk-adapted treatment strategies

COVID-19 severity and mortality in patients with chronic lymphocytic leukemia: a joint study by ERIC, the European Research Initiative on CLL, and CLL Campus

Chronic lymphocytic leukemia (CLL) is a disease of the elderly, characterized by immunodeficiency. Hence, patients with CLL might be considered more susceptible to severe complications from COVID-19. We undertook this retrospective international multicenter study to characterize the course of COVID-19 in patients with CLL and identify potential predictors of outcome. Of 190 patients with CLL and confirmed COVID-19 diagnosed between 28/03/2020 and 22/05/2020, 151 (79%) presented with severe COVID-19 (need of oxygen and/or intensive care admission). Severe COVID-19 was associated with more advanced age (≥65 years) (odds ratio 3.72 [95% CI 1.79–7.71]). Only 60 patients (39.7%) with severe COVID-19 were receiving or had recent (≤12 months) treatment for CLL at the time of COVID-19 versus 30/39 (76.9%) patients with mild disease. Hospitalization rate for severe COVID-19 was lower (p &lt; 0.05) for patients on ibrutinib versus those on other regimens or off treatment. Of 151 patients with severe disease, 55 (36.4%) succumbed versus only 1/38 (2.6%) with mild disease; age and comorbidities did not impact on mortality. In CLL, (1) COVID-19 severity increases with age; (2) antileukemic treatment (particularly BTK inhibitors) appears to exert a protective effect; (3) age and comorbidities did not impact on mortality, alluding to a relevant role of CLL and immunodeficiency

ABCL-298 Diffuse Large B-Cell Lymphoma During the Covid-19 Pandemic in Two Tertiary Centers: The Israeli/Italian Study

Introduction: The COVID-19 pandemic posed a major challenge in cancer care worldwide, which might have an impact on the management of hematologic malignancies. Aims: To compare the characteristics, management, and outcomes of diffuse large B-cell lymphoma (DLBCL) patients diagnosed during the first year of the COVID-19 pandemic compared to the previous year. Methods: This retrospective study compared DLBCL patients diagnosed from 1/3/2020 to 28/2/2021 and those diagnosed between 1/3/2019 and 28/2/2020 in two tertiary centers in Italy and Israel. Results: A total of 182 patients were diagnosed with DLBCL during the study period in both centers. More patients were diagnosed during the pandemic in both centers compared to the year before (60 vs. 29 and 54 vs. 39 in Italy and in Israel, respectively). Only in the Italian cohort was there a trend towards older age at diagnosis during the pandemic (68 vs. 61 years; P=0.13). The interval between the initiation of symptoms and diagnosis was longer during the pandemic for both cohorts. Five and four patients were diagnosed with COVID-19 during treatment in Italy and Israel, respectively. For both cohorts, there was no difference in dose density or intensity before or during the pandemic. Although in the Italian cohort there was a trend towards lower estimated 1-year PFS (73.7% vs. 89.7%; P=0.06) during the pandemic compared to the year before, there was no such difference in the Israeli cohort. In a univariate analysis for PFS in the Italian cohort, diagnosis during the pandemic was associated with 2.6-fold increased risk for progression (95% CI 0.9–7.2; P=0.07). In multivariate analysis, age was the only independent prognostic factor (HR 1.08, 95% CI 1.03–1.14; P&lt;0.001). Conclusions: In both cohorts, patients' characteristics were comparable between the periods. Yet, more patients were diagnosed with DLBCL during the pandemic, and the interval between symptoms and diagnosis was longer compared to the year before. Still, there was no change in treatment in terms of dose density and intensity. The trend towards a shorter PFS during the outbreak in the Italian cohort can be explained by the older age of the patients treated during this period

SARS‐COV‐2 INFECTION IN 50 PATIENTS WITH PRIMARY CNS LYMPHOMA: PRESENTATION, EFFECTS ON TUMOR TREATMENT AND OUTCOME IN A SERIES OF THE INTERNATIONAL PCNSL COLLABORATIVE GROUP

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