Anti-CD20 Drugs Tied to Severe COVID in Cancer Patients

CD20-targeting agents such as rituximab (Rituxan) and obinutuzumab (Gazyva) were tied to severe COVID-19 in lymphoma patients, according to data presented at the American Association for Cancer Research (AACR) COVID-19 and Cancer meeting.

In over 100 lymphoma patients hospitalized for COVID-19 in France, those treated with these B-cell-depleting therapies over the previous year were at increased risk for longer hospital stays (HR 1.97, 95% CI 1.24-3.13, P=0.004) and death (HR 2.13, 95% CI 1.03-4.44, P=0.043) after adjusting for age and other factors, reported Sylvain Lamure, MD, of Centre Hospitalier Universitaire Montpellier in France.

Additionally, 29% of patients experienced persistent COVID-19, requiring hospital stays beyond 30 days (either consecutively or cumulatively), with a median symptom duration of 83 days.

“Patients with lymphoma may develop immune deficiency due to particular features of their disease or due to their treatment regimen, which can lead to increased incidence and increased severity of infections,” co-author Caroline Besson, MD, PhD, of Centre Hospitalier de Versailles, France, said in a statement.

Previous studies have demonstrated persistent SARS-CoV-2 infections in immunocompromised cancer patients treated with stem-cell transplants or CAR T-cell therapies, with some shedding virus for stretches longer than 2 months.

The current study included 111 lymphoma patients admitted to 16 French hospitals with COVID-19 from March to April 2020. Overall, 57% of the cohort had been treated with CD20-targeting agents in the prior year.

The 6-month survival rate was 69%. Older age (70 and over) as well as relapsed/refractory disease were both tied to worse survival and prolonged hospital stays. Among the 32 patients with persistent disease, nine died (27%) after a median follow-up of roughly 6 months.

Chemotherapy Not Linked With COVID-19 Infection

Another study from the AACR meeting showed no increased risk of SARS-CoV-2 infection among cancer patients on active chemotherapy treatment in New York City early on in the pandemic.

In a study of over 1,000 cancer patients tested for COVID-19 at two hospitals, those currently on active treatment were in fact less likely to have COVID-19 (odds ratio 0.65, 95% CI 0.44-0.95), according to Monica Chen, MD, of Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Hospital in New York City.

About a quarter of patients had recently been diagnosed with cancer, and 56.7% had received treatment over the prior year, neither of which were associated with testing positive for COVID-19.

“We found that patients on active treatment, including chemotherapy, were not at increased risk for COVID-19, and surprisingly, they were less likely to test positive for COVID-19 than those not on treatment,” Chen said in a statement. “Our study shows that with proper precautions in the clinical setting, disruptions in lifesaving cancer treatment should be minimized during the COVID-19 pandemic.”

The retrospective study examined 1,174 cancer patients tested for COVID-19 at NewYork-Presbyterian Hospital/Columbia University Irving Medical Center from March to June 2020. Patients had a median age of 67 years, and 55.1% were women. About one-third of patients were white and one-third were Hispanic, while 15.2% were Black and 4.0% were Asian.

Overall, 27% tested positive for COVID-19. On multivariate analysis, Black patients (OR 2.21, 95% CI 1.44-3.40) and Hispanic patients were more likely to receive a positive COVID-19 test (OR 2.71, 95% CI 1.91-3.83). Older age and a higher body mass index were also associated with a positive test. Unsurprisingly, mortality rates were higher among those testing positive for COVID-19 (28.4% vs 8.3%, P<0.001).