COVID-19 IN CHRONIC MYELOID LEUKEMIA PATIENTS – BRAZILIAN EXPERIENCE

Abstract

Aims: To collect data about COVID-19 in CML patients from Brazilian centers and their outcomes. Methods: Observational, multicentric, ongoing register study. Hematologists from private and public CML reference centers from different regions of Brazil were invited to report their cases of COVID-19 in CML patients. Those centers are responsible for the care of approximately 3030 CML patients. Results: Between March 2020 and July 2021, 16 institutions contributed to this analysis, and reported 73 COVID-19 cases in CML patients (pts). Eight-five % were from the South and Southeast regions, 11% from Northeast. The median age was 50 years (22-79), with 33% of the pts older than 60. Male patients were predominant (60%). The median time of CML diagnosis was 9 years (0-29). Most of the pts were in first line therapy (57.5%), 27% in second line and 11% in third line. Current CML treatment at COVID-19 was: imatinib (46,5%), nilotinib (22%), dasatinib (16%), post-transplant (4%), asciminib (1%), ponatinib (1%), treatment-free remission (2%), no treatment (7%). COVID-19 grade: asymptomatic (4%), mild (66%), moderate (12%), severe/critical (16%). CML status at COVID: AP/BC (3%), CP (12,4%), hematologic response (11%), complete cytogenetic response (4%), MMR (34%), MR4.0 (8%), MR4.5 (27%). Eleven patients interrupted treatment temporarily during COVID. COVID-19 was confirmed by RT-PCR of oral and nasal swab collection (68%) or rapid/serologic test (32%). Comorbidities were present in 34 pts, most common were: hypertension (33%), diabetes (14%), chronic renal failure (4%), chronic obstructive pulmonary disease/emphysema (5.5%), pulmonary hypertension (1). Hospitalization occurred in 30% of the cases, 18% in an intensive care unit, 8% with mechanical ventilation. Treatment received for COVID-19: antibiotics (31%), steroids (16%), chloroquine (5.5%), oseltamivir (4%); ivermectin (8%): heparin (3%). Sixty-nine patients recovered, 4 died from COVID-19 (5,4%): one 42 year old newly diagnosed male patient with high leukocytes counts and with a simultaneous bacterial infection, two 70-year old patients treated with imatinib, both in MR4.5, and one 31-year old male patient treated with nilotinib, after imatinib and dasatinib failure, with hematologic response. A fifth patient in the accelerated phase died 2 months after discharge, from disease progression and pulmonary infection. All cases occurred before vaccination. There was one case of re-infection, in a patient treated with imatinib.Discussion: Conclusions: the majority of COVID-19 cases in the CML population was mild, but there were 2 deaths of young patients with active disease and two deaths in elderly patients, one of them with comorbidities. The mortality in CML was lower than observed in other hematologic cancers.