Introduction
Materials and methods
Study population
Data collection
Statistical analyses
Results
Patient characteristics
All patients | Haematological malignancy | Connective tissue disease | Demyelinating disorders | Other | Statistical significance | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|
N = 98 | N = 40 | N = 27 | N = 20 | N = 11 | p-value | ||||||
Age, years | 61 | 43.5 – 71.5 | 67.5 | 60—75 | 63 | 54.5 – 71 | 36.5 | 33 – 45 | 54 | 39 – 59 | < 0.001* |
Females | 57/98 | 58.2% | 18/40 | 45.0% | 20/27 | 74.1% | 13/20 | 65.0% | 6/11 | 54.5% | 0.107 |
BMI | 26.7 | 23.7 – 31.2 | 28.0 | 24.6 – 30.65 | 28.9 | 24.2 – 33.6 | 24.8 | 22.7 – 27.3 | 28.2 | 25.1 – 29.0 | 0.55 |
Smoking | 0.579 | ||||||||||
Never | 53/94 | 56.4% | 22/39 | 56.4% | 15/27 | 55.6% | 10/20 | 50.0% | 6/8 | 75.0% | |
Ex-smoker | 34/94 | 36.2% | 15/39 | 38.5% | 8/27 | 29.6% | 9/20 | 45.0% | 2/8 | 25.0% | |
Current smoker | 7/94 | 7.4% | 2/39 | 5.1% | 4/27 | 14.8% | 1/20 | 5.0% | 0/8 | - | |
Anti-CD20 mAb treatment | 0.212 | ||||||||||
Rituximab | 94/98 | 95.9% | 37/40 | 92.5% | 27/27 | 100% | 19/20 | 95.0% | 11/11 | 100% | |
Obinutuzumab | 3/98 | 3.1% | 3/40 | 7.5% | - | - | - | - | - | - | |
Ocrelizumab | 1/98 | 1.0% | - | - | - | - | 1/20 | 5.0% | - | - | |
Last dose, mg | 800 | 500 – 1000 | 800 | 700 – 850 | 1000 | 500 – 1000 | 500 | 500 – 800 | 800 | 665 – 1000 | 0.014* |
Days before COVID-19 | 85.5 | 38.5 – 156.0 | 59.5 | 9.5 – 161.5 | 113 | 70.5—169 | 94 | 49 – 147 | 188 | 80 – 260 | 0.093 |
Vaccinateda | 78/84 | 92.9% | 34/34 | 100% | 23/23 | 100% | 15/19 | 78.9% | 6/8 | 75.0% | 0.03* |
Comorbidities | |||||||||||
Diabetes mellitus | 9/98 | 9.2% | 5/40 | 12.5% | 3/27 | 11.1% | 0/20 | - | 1/11 | 9.1% | 0.445 |
Hypertension | 28/98 | 28.6% | 17/40 | 42.5% | 8/27 | 29.6% | 0/20 | - | 3/11 | 27.3% | 0.008* |
COPD | 2/98 | 2.0% | 0/40 | - | 1/27 | 3.7% | 0/20 | - | 1/11 | 9.1% | 0.225 |
Asthma | 7/98 | 7.1% | 1/40 | 5% | 6/27 | 22.2% | 0/20 | - | 0/11 | - | 0.005* |
Sleep apnoea | 11/98 | 11.2% | 5/40 | 12.5% | 4/27 | 14.8% | 1/20 | 5.0% | 1/11 | 9.1% | 0.743 |
Atrial fibrillation | 8/98 | 8.2% | 4/40 | 10% | 3/27 | 11.1% | 0/20 | - | 1/11 | 9.1% | 0.516 |
Coronary artery disease | 7/98 | 7.1% | 1/40 | 2.5% | 5/27 | 18.5% | 0/20 | - | 1/11 | 9.1% | 0.043* |
Kidney disease | 5/98 | 5.1% | 0/40 | - | 4/27 | 14.8% | 0/20 | - | 1/11 | 9.1% | 0.031* |
Primary indication for anti-CD20 mAb therapy
Condition | % | Number |
---|---|---|
Haematological malignancy | N = 40 | |
Diffuse large B-cell lymphoma | 27.5% | 11 |
Mantle cell lymphoma | 27.5% | 11 |
CLL / SLL | 17.5% | 7 |
Follicular lymphoma | 12.5% | 5 |
Marginal zone lymphoma | 7.5% | 3 |
Unspecified B cell lymphoma | 5% | 2 |
Waldenström macroglobulinemia | 2.5% | 1 |
Stem cell transplantation | 25.0% | 10 |
Time between SCT and COVID-19, months (median, Q1–Q3) | 36.5 | 19 – 54 |
Connective tissue disease | N = 27 | |
Rheumatic arthritis | 48.1% | 13 |
Granulomatosis with polyangiitis | 14.8% | 4 |
EGPA | 3.7% | 1 |
MPA | 14.8% | 4 |
Sjögren’s syndrome | 11.1% | 3 |
Systemic sclerosis | 7.4% | 2 |
CTD-associated ILD | 44.4% | 12 |
Demyelinating disease | N = 20 | |
Multiple sclerosis | 95.0% | 19 |
Unspecified demyelinating disease of the central nervous system | 5.0% | 1 |
Other | N = 11 | |
ITP | 27.3% | 3a |
AIHA | 18.2% | 2 |
CVID with GL-ILD | 18.2% | 2a |
Chronic nephritic syndrome with mesangiocapillary glomerulonephritis | 9.1% | 1 |
Autoimmune hepatitis | 9.1% | 1 |
Pemphigus vulgaris | 9.1% | 1 |
Minimal change glomerulonephritis | 9.1% | 1 |
Neuromyelitis optica spectrum disorder | 9.1% | 1 |
Clinical course and treatment characteristics of COVID-19
All patients | Haematological malignancy | Connective tissue disease | Demyelinating disorders | Other | Statistical significance | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|
N = 98 | N = 40 | N = 27 | N = 20 | N = 11 | p-value | ||||||
Health care consumptiona | < 0.001* | ||||||||||
No consultation | 7/93 | 7.5% | 1/37 | 2.7% | 2/25 | 8.0% | 2/20 | 10.0% | 2/11 | 18.2% | |
Only distant consultation | 27/93 | 29.0% | 6/37 | 16.2% | 2/25 | 8.0% | 14/20 | 70.0% | 5/11 | 45.5% | |
Ambulant (ED or OPD) | 15/93 | 16.1% | 8/37 | 21.6% | 5/25 | 20.0% | 2/20 | 10.0% | 0/11 | - | |
Hospitalized for COVID-19 | 44/93 | 47.3% | 22/37 | 59.5% | 16/25 | 64.0% | 2/20 | 10.0% | 4/11 | 36.4% | |
Requiring ICU | 7/93 | 7.5% | 2/37 | 5.4% | 3/25 | 12.0% | 1/20 | 5.0% | 1/11 | 9.1% | |
Hospitalized for other indication | 5/98 | 5.1% | 3/40 | 7.5% | 2/27 | 7.4% | 0/20 | - | 0/11 | - | |
Maximal respiratory support | 0.102 | ||||||||||
No respiratory support | 66/98 | 67.3% | 25/40 | 62.5% | 15/27 | 55.6% | 19/20 | 95.0% | 7/11 | 63.6% | |
Low-flow supplemental oxygen | 19/98 | 19.4% | 10/40 | 25.0% | 6/27 | 22.2% | 1/20 | 5.0% | 2/11 | 18.2% | |
HFNC | 3/98 | 3.1% | 2/40 | 5.0% | 0/27 | - | 0/20 | - | 1/11 | 9.1% | |
NIV | 7/98 | 7.1% | 2/40 | 5.0% | 5/27 | 18.5% | 0/20 | - | 0/11 | - | |
MV | 3/98 | 3.1% | 1/40 | 2.5% | 1/27 | 3.7% | 0/20 | - | 1/11 | 9.1% | |
COVID-19 medical treatment | |||||||||||
Systemic corticosteroids | 31/98 | 31.6% | 14/40 | 35.0% | 13/27 | 48.1% | 1/20 | 5.0% | 3/11 | 27.3% | 0.016* |
Tocilizumab | 4/98 | 4.1% | 2/40 | 5.0% | 1/27 | 3.7% | 0/20 | - | 1/11 | 9.1% | 0.648 |
Remdesivir | 12/98 | 12.2% | 7/40 | 17.5% | 4/27 | 14.8% | 0/20 | - | 1/11 | 9.1% | 0.252 |
Nirmatrelvir-ritonavir | 18/98 | 18.4% | 10/40 | 25.0% | 5/27 | 18.5% | 3/20 | 15.0% | 0/11 | - | 0.284 |
Tixagevimab-cilgavimab | 9/98 | 9.2% | 5/40 | 12.5% | 4/27 | 14.8% | 0/20 | - | 0/11 | - | 0.196 |
LMWH | 34/98 | 34.7% | 17/40 | 42.5% | 13/27 | 48.1% | 1/20 | 5.0% | 3/11 | 27.3% | 0.010* |
COVID-19 related death | 13/98 | 13.3% | 7/40 | 17.5% | 4/27 | 14.8% | 0/20 | - | 2/11 | 18.2% | 0.265 |
COVID-19 related mortality
Deatha (n = 13) | Survived (n = 85) | p-value | |||
---|---|---|---|---|---|
Females | 2/13 | 15.4% | 55/85 | 64.7% | < 0.001* |
Age, years | 69 | 55─77.5 | 58 | 42─69 | 0.025* |
BMI (kg/m2) | 25.8 | 24.6─31.0 | 27.7 | 23.8─30.9 | 0.921 |
Days between anti-CD20 mAb and symptoms | 82 | 39─146 | 100 | 39─177 | 0.543 |
Duration of symptoms at time of arrival (days) | 18 | 5─22 | 6 | 2─16 | 0.124 |
Dose of anti-CD20 mAb (mg) | 800 | 700─1000 | 700 | 500─1000 | 0.132 |
Charlson comorbidity index (points) | 4 | 2.5─5.5 | 3 | 0.5─4 | 0.033* |
COVID-19 medication | |||||
Systemic corticosteroids | 11 | 84.6% | 20 | 23.5% | < 0.001* |
Tocilizumab | 2 | 15.4% | 2 | 2.4% | 0.027* |
Remdesivir | 6 | 46.2% | 6 | 7.1% | < 0.001* |
Nirmatrelvir-ritonavir | 1 | 7.7% | 17 | 20.0% | 0.286 |
Tixagevimab-cilgavimab | 2 | 15.4% | 7 | 8.2% | 0.406 |
LMWH | 10 | 76.9% | 24 | 28.2% | < 0.001* |
Features of prolonged pneumonia
All patients | Haematological malignancy | Connective tissue disease | Demyelinating disorder | Other | Statistical significance | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|
N = 98 | N = 40 | N = 27 | N = 20 | N = 11 | p-value | ||||||
30 days from start of symptoms (N = 94) | |||||||||||
Respiratory symptoms | 30/94 | 31.9% | 18/40 | 45.0% | 11/24 | 45.8% | 0/20 | - | 1/10 | 10.0% | < 0.001* |
Fever | 26/94 | 27.7% | 18/40 | 45.0% | 7/24 | 29.2% | 0/20 | - | 1/10 | 10.0% | 0.002 |
Radiologic findingsa | 30/39 | 76.9% | 18/24 | 75.0% | 10/12 | 83.3% | 1/1 | 1/2 | |||
Positive PCRb | 21/28 | 75.0% | 14/16 | 87.5% | 5/9 | 55.6% | 0/0 | 2/3 | |||
60 days from start of symptoms (N = 89) | |||||||||||
Respiratory symptoms | 19/89 | 21.3% | 12/38 | 31.6% | 7/22 | 31.8% | 0/20 | - | 0/9 | - | 0.009* |
Fever | 16/89 | 18.0% | 11/38 | 28.9% | 5/22 | 22.7% | 0/20 | 0/9 | 0.020* | ||
Radiologic findingsa | 19/32 | 59.4% | 12/21 | 57.1% | 6/9 | 66.7% | 1/1 | 0/1 | |||
Positive PCRb | 15/23 | 65.2% | 10/14 | 71.4% | 4/7 | 57.1% | 0/0 | 1/2 | |||
90 days from start of symptoms (N = 85) | |||||||||||
Respiratory symptoms | 15/85 | 17.6% | 9/34 | 26.5% | 6/22 | 27.3% | 0/20 | - | 0/9 | - | 0.024* |
Fever | 9/85 | 10.6% | 5/34 | 14.7% | 4/22 | 18.2% | 0/20 | - | 0/9 | - | 0.146 |
Radiologic findingsa | 17/33 | 51.5% | 9/19 | 47.4% | 7/11 | 63.6% | 1/2 | 0/1 | |||
Positive PCRb | 9/21 | 42.9% | 5/10 | 50.0% | 4/8 | 50.0% | 0/1 | 0/2 |