Clinical outcome of classical Hodgkin Lymphoma patients receiving systemic anti-lymphoma treatment during SARS-COV-2 positivity: Results from the chemo-covid study on behalf of fondazione italiana linfomi
Patients (pts) affected by classical Hodgkin Lymphoma (cHL) infected by SARS-CoV-2 are at risk of protracted positivity due to immunodeficiency, and consequent delay of anti-lymphoma treatment may worsen cHL prognosis. Feasibility of chemo-therapy (CT) administration during SARS-CoV-2 infection in cHL pts has not been investigated so far. We collected data of cHL pts enrolled in Haematocovid observational trial and treated with CT while positive for SARS-CoV-2, with the aim to describe CT feasibility and to assess the risk of infection worsening. Thirteen cHL pts treated since May 2020 to May 2022 were included: median age was 39 years (17-68), 6 pts (46%) presented with advanced stage, 8 pts (62%) with B symptoms and 5 pts (38%) with bulky. Seven pts (54%) were treatment-naïve and waiting for ABVD start at time of COVID diagnosis, while in 6 pre-treated pts (46%) SARS-CoV-2 infection occurred after a median time of 18 days (1-42) from administration of the last CT cycle and the median number of prior therapeutic lines was 1 (1-4). Eight pts (62%) previously received m-RNA vaccines, while 5 pts (38%) were infected in the pre-vaccine era. At COVID onset, 6 (46%) pts were asymptomatic and 7 (54%) pauci-symptomatic, being fever (n=5) the most reported symptom; pneumonia was documented in 2 pts, but no case of respiratory failure was described. Viral variant was identified in 7 pts: 1 alpha, 1 delta and 5 omicron, while in 6 pts the presumed variant was derived from pandemic wave (3 pts alpha, 1 pt delta and 3 pts omicron). Four pts (31%) received antiviral treatment, consisting in monoclonal antibodies (n=3) and remdesivir (n=1). A median of 1 cycle of CT (1-2) after a median time of 25 days (1-45) from the first SARS-CoV-2 positivity was delivered. Ten pts (77%) received ABVD, in two cases with bleomycine omission, 1 pt (8%) received escBEACOPP and 2 pts (15%) brentuximab-vedotin. None of the pts experienced COVID worsening following CT administration. Median duration of SARS-CoV-2 positivity was 21 days (9-60). After a median follow-up of 11 months (1-61), one pt died due to cHL progressive disease while positive but asymptomatic for SARS-CoV-2. All the remaining pts were alive and negative for SARS-CoV-2 infection, and 8 pts (62%) achieved cHL complete response. In conclusion, in this preliminary analysis CT administration to high-risk cHL pts positive but asymptomatic for SARS-CoV-2 seems feasible and did not induce clinical worsening of viral infection.