B-Cell Depletion Linked to Prolonged COVID-19 in Lymphoma

A study of patients with B-cell non-Hodgkin lymphoma hospitalized for COVID-19 has found that these patients had a higher incidence of prolonged evolution of the SARS-CoV-2 infection. Caroline Besson, MD, PhD, of Centre Hospitalier de Versailles in Le Chesnay, France, presented results from this retrospective multicenter study at EHA2021 Virtual, the annual congress of the European Hematology Association.

The study showed that administration of an anti-CD20 monoclonal antibody within 12 months of hospital admission for COVID-19 was associated with a doubling of the risk of death (hazard ratio [HR] = 2.17; 95% CI 1.04-4.52; p=0.039) and prolonged in-hospital stay (HR=2.26; 95% CI 2.42-3.60; p<0.001).

“These results are the first – to my knowledge – that show a higher risk of death and a longer length of hospitalization in patients with non-Hodgkin lymphoma who recently – within one year – received B-cell depletion,” Dr. Besson told ASH Clinical News. “They also confirm the pejorative impact of comorbidities, older age, and relapsed/refractory status of lymphoma.”

The study included 111 patients with lymphoma admitted for COVID-19 to 16 hospitals in France between March and April 2020. Thirty days after admission, 24 patients had died, 55 had been discharged, 31 were still hospitalized, and one was later rehospitalized for COVID-19 recurrence.

Almost 40% of the study population were aged 70 or older. Additionally, 57% of patients were treated with an anti-CD20 monoclonal antibody within 12 months of positive COVID-19 diagnosis, and 12% of the population had relapsed or refractory disease.

Nearly one-third of patients (29%) had persistent COVID-19, defined as persistent or recurrent symptoms requiring in-hospital stay for longer than 30 days. The majority of these patients (69%) had at least one significant comorbidity. No persistent COVID-19 was documented in the patients with T-cell lymphoma or classical Hodgkin lymphoma.

Among patients with persistent disease, the median time from first admission to discharge was 58 days. The median duration of COVID-19 symptoms was 83 days, and 27% of patients with persistent COVID-19 died.

With a median follow-up of 191 days, the six-month overall survival was 69%. In addition to receipt of an anti-CD20 monoclonal antibody, age ≥70 was associated with increased risk of death (HR=4.73; p<0.001) and prolonged hospital stay (HR=2.34; p=0.004). The multivariate analysis also showed that refractory or relapsed lymphoma was associated with decreased overall survival (HR=3.34; p=0.002) and prolonged hospital stay (HR=3.12; p=0.028).

According to Dr. Besson, these results should encourage the practice of providing early COVID-19 vaccination to all patients with a suspected or confirmed diagnosis of lymphoma, before initiation of B-cell–directed therapy.

“Patients under B-cell therapy should be careful to avoid infection and have their proxies vaccinated,” Dr. Besson said. “Our findings also question the role of maintenance with B-cell–depleting agents in patients in complete remission in periods of pandemic peak.”

Finally, Dr. Besson said that studies are needed to evaluate the efficacy of vaccination in these patients.

Study authors report no relevant conflicts of interest.


Duléry R, Lamure S, Delord M, et al. High incidence of prolonged COVID-19 among patients with lymphoma treated with B-cell depleting immunotherapy. Abstract #S215. Presented at the EHA2021 Virtual Congress, June 9-17, 2021.