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216 ACUTE Lymphoblastic Leukemia (ALL) and COVID-19 Infection. a Campus ALL ReportClinically Relevant Abstract

Program: Oral and Poster Abstracts
Type: Oral
Session: 612. Acute Lymphoblastic Leukemias: Clinical and Epidemiological: Clinical, genetic and societal risk factors impacting ALL outcomes
Hematology Disease Topics & Pathways:
Lymphoid Leukemias, ALL, Diseases, Lymphoid Malignancies, Clinical Practice (e.g. Guidelines, Health Outcomes and Services, and Survivorship, Value; etc.)
Saturday, December 11, 2021: 3:15 PM

Sabina Chiaretti, MD, PhD1, Massimiliano Bonifacio, MD2*, Roberta Agrippino1*, Mario Annunziata, MD3*, Anna Candoni, MD4*, Cerrano Marco, MD5*, Michele Cedrone, MD6*, Maria Ciccone7*, Patrizia Chiusolo8*, Antonio Curti, MD, PhD9, Michelina Dargenio, MD10*, Marzia Defina11*, Mario Delia, MD, PhD12*, Maria Ilaria Del Principe, MD13*, Mauro Endri14*, Carmen Fava, M.D.15, Fabio Forghieri, MD16*, Alessandro Fiorentini17*, Fabio Giglio, MD18*, Francesco Grimaldi, MD19*, Fabio Guolo, MD20*, Michela Lamanda21*, Monia Lunghi, MD22*, Federico Lussana, MD23*, Valentina Mancini24*, Carla Mazzone, MD25*, Antonino Mulè, MD26*, Crescenza Pasciolla, MD27*, Matteo Piccini, MD28*, Giovanna Rege Cambrin, MD, PhD29*, Prassede Salutari, MD30*, Lidia Santoro31*, Anna Maria Scattolin, MD32*, Mariarita Sciumè, MD33*, Elisabetta Todisco, MD, PhD34*, Felicetto Ferrara, MD3*, Giovanni Pizzolo, MD2 and Robin Foà1*

1Department of Translational and Precision Medicine, Division of Hematology, Rome, Italy
2Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
3Hematology Unit, Azienda Ospedaliera Cardarelli, Naples, Italy
4Division of Hematology and Bone Marrow Transplantation, Clinica Di Ematologia E Unità Di Terapie Cellulari 'carlo Melzi'-Azienda, Udine, Italy
5Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
6San Giovanni - Addolorata Hospital, ROMA CAPITALE, ITA
7Azienda Ospedaliero-Universitaria di Ferrara, ferrara, Italy
8Department of Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, NA, Italy
9IRCCS Azienda ospedaliero-universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, Bologna, Italy
10Hematology and Stem Cell Transplantation Unit, Vito Fazzi Hospital, Lecce, Italy, Lecce, Italy
11Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, ITA
12Hematology and Stem Cell Transplantation Unit - A.O.U. Consorziale Policlinico di Bari, Bari, Italy
13Ematologia, Dipartimento di Biomedicina e Prevenzione, Università   degli studi di Roma Tor Vergata, Roma, Italy
14UOC Ematologia – Ospedale Ca’ Foncello – Treviso, treviso, Italy
15Department of Clinical and Biological Sciences, University of Turin, Orbassano, To, Italy
16Section of Hematology, Department of Surgical and Medical Sciences,, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
17Ospedali Riuniti Marche nord, Ancona, Italy
18Haematology and BMT Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
19University of Naples Federico II, Naples, Italy, Napoli, ITA
20Clinic of Hematology, Department of Internal Medicine (DiMI), IRCCS Ospedale Policlinico San Martino, Genova, Italy
21Hematology, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
22Division of Hematology Department of Translational Medicine , AOU Maggiore della Carità, Università del Piemonte Orientale, Novara, ITA
23Hematology and Bone Marrow Transplant Unit, ASST Papa Giovanni XXIII, Bergamo, Please Choose A State, Italy
24ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
25Hematology, S. Eugenio Hospital, Tor Vergata University, ASL Roma2, Rome, Italy
26Division of Hematology and Bone Marrow Transplantation, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
27Istituto Tumori Bari "Giovanni Paolo" IRCCS, Bari, Italy
28Azienda ospedaliero-universitaria Careggi, Department of Hematology, Florence, Italy
29University of Turin, ORBASSANO TORINO, Italy
30Dipartimento Oncologia Ematologia, Ospedale Civile Spirito Santo, Pescara, Italy
31Struttura Complessa di Ematologia e Trapianto Emopoietico, A.O. S.G.Moscati., Avellino, ITA
32Complex Operative Unit of Haematology, dell’Angelo Hospital and Santissimi Giovanni and Paolo Hospital, Venezia Mestre, Italy
33Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
34IEO, European Institute of Oncology IRCCS, Milan, Milan, Italy

Introduction. The recent spread of the COVID-19 infection has represented an important challenge in the management of acute lymphoblastic leukemia (ALL) patients.

Aims and methods. To investigate the incidence, features, source of contagion and outcome of patients with ALL who developed a COVID-19 infection, a survey was conducted among 34 hematology centers throughout Italy within the Campus ALL network. The period covered by the survey spanned from February 2020 to April 2021 and included 756 adult ALL patients actively followed during this time period.

Results. Sixty-three of the 756 ALL patients (8.3%) developed a COVID-19 infection, with an equal distribution among the various regions. The majority of cases (90.5%) was recorded during the second wave of the pandemic, between September 2020 and April 2021. The source of the infection was nosocomial in 26 cases (41.3%), familial in 23 (36.5%), unknown in 13 (20.6%) and work-related in 1 (1.6%).

The infected patients were prevalently male (n=43, 68.2%) with a similar distribution among age groups: 21 patients aged 18-35 years, 17 35-50, 15 50-65 and 10 older than 65. Seventeen patients (27%) had a diagnosis of T-ALL, 28 (44.4%) of Ph- B-ALL and 18 (28.6%) of Ph+ ALL. Thirty-six (57.1%) of the infected patients had no concomitant comorbidities, whereas 27 (42.9%) had one or more comorbidities.

The infection was documented at the onset of the disease in 4 patients (6.3%), during induction in 10 (15.9%), consolidation in 13 (20.6%), chemotherapy maintenance in 11 (17.5%), after allogenic transplant in 15 (23.8%), during maintenance with tyrosine kinase inhibitors (TKI) treatment or off-treatment in 8 (12.7%) and at relapse in 2 (3.2%). Of the infected patients, 9 were asymptomatic, 10 had only isolated fever, 36 had respiratory symptoms and 8 presented other symptoms, including - but not limited to - ageusia and anosmia. As a consequence, management of the infection was variable: 29 (46%) patients did not require hospitalization, 28 (44.4%) were hospitalized in a COVID ward and 13 of them required respiratory assistance; finally, 6 (9.5%) patients were transferred to an ICU. Importantly, in 54 patients (85.7%) there were no sequelae, in 1 patient a pulmonary fibrosis was documented and in 1 patient the delay in treatment led to a relapse of the disease, while 7 (11.1%) succumbed to the infection. Finally, in 6 cases (9.5%) the infection was still ongoing at the time of the survey, and at the last update (July 2021) it had resolved in all. Since a key aspect in the management of ALL is the adherence to the timing of treatment, we also investigated if COVID-19+ patients stopped treatment during the infection. Out of the 42 evaluable patients (patients who had undergone an allogeneic transplant or were off-treatment were excluded from this analysis), ALL treatment was suspended in 28 (66.6%). Importantly, while in Ph+ ALL only very few patients stopped treatment (3/12), in Ph- B-ALL the majority did interrupt it (18/22, p<0.001); likewise, also in T-ALL most patients suspended treatment (7/8).

Conclusions. The incidence of SARS-CoV-2 infection in adult ALL patients in Italy over a 15 month period has been similar to that observed in the general population and has been recorded mostly during the second wave of the pandemic. The contagion was mainly nosocomial, suggesting that outward care should be pursued as much as possible in ALL. The infection was manageable, with 46% of patients not requiring any medical intervention and an overall death rate of 11%. Strikingly, in line with previous reports1, it appears that Ph+ ALL patients were more manageable, with less treatment interruptions. These findings underline the advantage of the TKI-based induction/consolidation strategy without systemic chemotherapy in Ph+ ALL used in the GIMEMA (Gruppo Italiano Malattie EMatologiche dell'Adulto) protocols and further point to a possible protective role of TKIs in COVID-19-infected patients.

  1. Foà R et al, Br J Haematol. 2020;190(1):e3-e5

Disclosures: Chiaretti: Incyte: Consultancy; novartis: Consultancy; pfizer: Consultancy; amgen: Consultancy. Bonifacio: Bristol Myers Squibb: Honoraria; Pfizer: Honoraria; Novartis: Honoraria; Amgen: Honoraria. Marco: Jazz: Consultancy; Insight,: Consultancy; Janssen: Consultancy. Curti: Novartis: Membership on an entity's Board of Directors or advisory committees; Abbvie: Membership on an entity's Board of Directors or advisory committees; Pfizer: Membership on an entity's Board of Directors or advisory committees; Jazz Pharma: Membership on an entity's Board of Directors or advisory committees. Delia: Gilead: Consultancy; Amgen: Consultancy; abbvie: Consultancy; Jazz pharmaceuticals: Consultancy. Forghieri: Jannsen: Membership on an entity's Board of Directors or advisory committees; Novartis: Speakers Bureau; Jazz: Honoraria. Lussana: Amgen: Honoraria; Astellas Pharma: Honoraria; Pfizer: Honoraria; Incyte: Honoraria.

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