Publication date: Sep 20, 2023

Hairy cell leukemia (HCL), like its variant HCLv, is a B-cell malignancy associated with decreased humoral immunity. We prospectively monitored the largest cohort of HCL/HCLv patients to date (n=503) for COVID-19 by symptoms, antibody, PCR and/or antigen-positivity. Fifty percent (253 of 503) of the HCL/HCLv patients (238 HCL, 15 HCLv) had evidence of COVID-19, with 210 (83%) of 253 testing positive by PCR or rapid-antigen. Of 43 without positive tests, all had nucleocapsid antibodies indicating COVID-19 exposure, 7 recalled no symptoms, and 36 had mild symptoms but without a positive test. Of the 210 testing positive, 23, 46, 129 and 12 occurred in 2020, 2021, 2022 and 2023, respectively. Of 210 testing positive, 175 began treatment for HCL/HCLv 0. 4-429 (median 66) months before, and 132 had their last dose of anti-CD20 Mab 0. 2-229 (median 63) months before. Two patients died, including a young woman beginning rituximab 2 months after 1st-line cladribine before vaccine availability. Nearly all HCL/HCLv patients recovered uneventfully from COVID-19 including those without vaccination or those with significant immunosuppression and recent treatment. However, decreased normal B-cells from HCL or treatment was associated with lower spike antibody levels as a response to COVID-19 (p=0. 0094) and longer recovery time (p=0. 0036). Thus, in a large cohort of HCL/HCLv and the first to determine relationships between COVID-19 outcome and immune markers, mortality was relatively low (~1%), sequelae were uncommon, and recovery from COVID-19 was longer if normal B-cells were low after recent treatment.

Semantics

Original Article