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Outcomes of the COVID-19 pandemic in chronic lymphocytic leukemia : focus on the very early period and Omicron era

Hedberg, Pontus ; Blixt, Lisa ; Eketorp Sylvan, Sandra ; Killander Möller, Isabela ; Lindahl, Hannes ; Kahn, Fredrik LU ; Nilsdotter-Augustinsson, Åsa ; Fredrikson, Mats ; Nyström, Sofia and Bergman, Peter , et al. (2025) In Blood Advances 9(13). p.3170-3181
Abstract

Individuals with chronic lymphocytic leukemia (CLL) face an increased risk for severe COVID-19. This study from Sweden, a country that only had a few mandatory restrictions at the onset of the pandemic, used 10 nationwide registers to compare the risks for severe COVID-19 outcomes of polymerase chain reaction-verified severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections through February 2023 in individuals with and those without CLL. From a population of 8 275 839 (6653 CLL) individuals born between 1930 and 2003, 2 088 163 first infections (1289 CLL) were included. The 90-day all-cause mortality rate and adjusted relative risk (aRR; 95% confidence interval) for individuals with CLL vs the general population was 24.8%... (More)

Individuals with chronic lymphocytic leukemia (CLL) face an increased risk for severe COVID-19. This study from Sweden, a country that only had a few mandatory restrictions at the onset of the pandemic, used 10 nationwide registers to compare the risks for severe COVID-19 outcomes of polymerase chain reaction-verified severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections through February 2023 in individuals with and those without CLL. From a population of 8 275 839 (6653 CLL) individuals born between 1930 and 2003, 2 088 163 first infections (1289 CLL) were included. The 90-day all-cause mortality rate and adjusted relative risk (aRR; 95% confidence interval) for individuals with CLL vs the general population was 24.8% (1.95; 1.58-2.41) during wild-type, 17.2% (2.38; 1.58-3.57) during Alpha, 4.1% (0.71; 0.24-2.08) during Delta, and 12.6% (1.49; 1.24-1.78) during Omicron infections. Their mortality during Omicron was 0.6% (<65 years), 5.4% (65-74 years), and 19.7% (≥75 years). Small molecule inhibitors (1.56; 1.03-2.37) and corticosteroid usage (1.45; 1.04-2.02) was associated with increased mortality. Next, we analyzed the all-cause mortality in the capital (Stockholm), widely affected by SARS-CoV-2 at the onset of the pandemic. Mortality in individuals with CLL increased by 55% during the first 6 months of 2020 vs 2019, and the age- and sex-aRR by 30 June was 1.53 (1.09-2.15) for individuals with CLL (P = .02) and 1.29 (1.25-1.33) for the general population (P < .001). Collectively, a significantly increased risk for severe COVID-19 and death was observed among individuals with CLL in Sweden, particularly at the onset of the pandemic when few national protective measures were introduced and also after Omicron emerged, emphasizing the need for a more pro-active pandemic strategy for CLL.

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publication status
published
subject
keywords
Humans, COVID-19/epidemiology, Leukemia, Lymphocytic, Chronic, B-Cell/complications, Female, Male, Aged, Sweden/epidemiology, Middle Aged, SARS-CoV-2/isolation & purification, Aged, 80 and over, Registries, Adult, Risk Factors, Pandemics
in
Blood Advances
volume
9
issue
13
pages
3170 - 3181
publisher
American Society of Hematology
external identifiers
  • scopus:105009614250
  • pmid:39983071
ISSN
2473-9529
DOI
10.1182/bloodadvances.2024015260
language
English
LU publication?
yes
additional info
© 2025 American Society of Hematology. Published by Elsevier Inc. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.
id
9b9a42ac-6ee9-4b2f-8563-26a076af8080
date added to LUP
2025-09-22 09:10:17
date last changed
2025-11-18 02:53:30
@article{9b9a42ac-6ee9-4b2f-8563-26a076af8080,
  abstract     = {{<p>Individuals with chronic lymphocytic leukemia (CLL) face an increased risk for severe COVID-19. This study from Sweden, a country that only had a few mandatory restrictions at the onset of the pandemic, used 10 nationwide registers to compare the risks for severe COVID-19 outcomes of polymerase chain reaction-verified severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections through February 2023 in individuals with and those without CLL. From a population of 8 275 839 (6653 CLL) individuals born between 1930 and 2003, 2 088 163 first infections (1289 CLL) were included. The 90-day all-cause mortality rate and adjusted relative risk (aRR; 95% confidence interval) for individuals with CLL vs the general population was 24.8% (1.95; 1.58-2.41) during wild-type, 17.2% (2.38; 1.58-3.57) during Alpha, 4.1% (0.71; 0.24-2.08) during Delta, and 12.6% (1.49; 1.24-1.78) during Omicron infections. Their mortality during Omicron was 0.6% (&lt;65 years), 5.4% (65-74 years), and 19.7% (≥75 years). Small molecule inhibitors (1.56; 1.03-2.37) and corticosteroid usage (1.45; 1.04-2.02) was associated with increased mortality. Next, we analyzed the all-cause mortality in the capital (Stockholm), widely affected by SARS-CoV-2 at the onset of the pandemic. Mortality in individuals with CLL increased by 55% during the first 6 months of 2020 vs 2019, and the age- and sex-aRR by 30 June was 1.53 (1.09-2.15) for individuals with CLL (P = .02) and 1.29 (1.25-1.33) for the general population (P &lt; .001). Collectively, a significantly increased risk for severe COVID-19 and death was observed among individuals with CLL in Sweden, particularly at the onset of the pandemic when few national protective measures were introduced and also after Omicron emerged, emphasizing the need for a more pro-active pandemic strategy for CLL.</p>}},
  author       = {{Hedberg, Pontus and Blixt, Lisa and Eketorp Sylvan, Sandra and Killander Möller, Isabela and Lindahl, Hannes and Kahn, Fredrik and Nilsdotter-Augustinsson, Åsa and Fredrikson, Mats and Nyström, Sofia and Bergman, Peter and Carlander, Christina and Aleman, Soo and Nauclér, Pontus and Österborg, Anders and Hansson, Lotta}},
  issn         = {{2473-9529}},
  keywords     = {{Humans; COVID-19/epidemiology; Leukemia, Lymphocytic, Chronic, B-Cell/complications; Female; Male; Aged; Sweden/epidemiology; Middle Aged; SARS-CoV-2/isolation & purification; Aged, 80 and over; Registries; Adult; Risk Factors; Pandemics}},
  language     = {{eng}},
  month        = {{07}},
  number       = {{13}},
  pages        = {{3170--3181}},
  publisher    = {{American Society of Hematology}},
  series       = {{Blood Advances}},
  title        = {{Outcomes of the COVID-19 pandemic in chronic lymphocytic leukemia : focus on the very early period and Omicron era}},
  url          = {{http://dx.doi.org/10.1182/bloodadvances.2024015260}},
  doi          = {{10.1182/bloodadvances.2024015260}},
  volume       = {{9}},
  year         = {{2025}},
}