Chronic lymphocytic leukemia (CLL) is a disease of the elderly, characterized by immunodeficiency. Hence, patients with CLL might be considered more susceptible to severe complications from COVID-19. We undertook this retrospective international multicenter study to characterize the course of COVID-19 in patients with CLL and identify potential predictors of outcome. Of 190 patients with CLL and confirmed COVID-19 diagnosed between 28/03/2020 and 22/05/2020, 151 (79%) presented with severe COVID-19 (need of oxygen and/or intensive care admission). Severe COVID-19 was associated with more advanced age (≥65 years) (odds ratio 3.72 [95% CI 1.79-7.71]). Only 60 patients (39.7%) with severe COVID-19 were receiving or had recent (≤12 months) treatment for CLL at the time of COVID-19 versus 30/39 (76.9%) patients with mild disease. Hospitalization rate for severe COVID-19 was lower (p < 0.05) for patients on ibrutinib versus those on other regimens or off treatment. Of 151 patients with severe disease, 55 (36.4%) succumbed versus only 1/38 (2.6%) with mild disease; age and comorbidities did not impact on mortality. In CLL, (1) COVID-19 severity increases with age; (2) antileukemic treatment (particularly BTK inhibitors) appears to exert a protective effect; (3) age and comorbidities did not impact on mortality, alluding to a relevant role of CLL and immunodeficiency.

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1st Department of Pathology and Experimental Cancer Research Semmelweis University Budapest Hungary

1st State Pavlov Medical University of Saint Petersburg Raisa Gorbacheva Memorial Institute for Children Oncology Hematology and Transplantation Russia Saint Petersburg Russia

Carlos Haya Málaga Spain

Carol Davila University of Medicine and Pharmacy Hematology Clinic Coltea Clinical Hospital Bucharest Romania

Cattedra di Ematologia Dipartimento di Biomedicina e Prevenzione Università Tor Vergata Roma Rome Italy

Colentina Clinical Hospital Bucharest Bucharest Romania

Dep of Hematology Cancer Center Amsterdam Amsterdam University Medical Centers Amsterdam The Netherlands

Department of Haemato Oncology Royal Marsden Hospital London UK

Department of Haematology St James Hospital and Trinity College Dublin Dublin Ireland

Department of Hematology and Central Hematology Laboratory Inselspital Bern University Hospital University of Bern Bern Switzerland

Department of Hematology Haga Hospital The Hague The Netherlands

Department of Hematology Iuliu Hatieganu University of Medicine and Pharmacy and Ion Chiricuta Oncology Institute Cluj Napoca Romania

Department of Hematology Oncology and Chemotherapy S P Botkin's City Hospital Moscow Russia

Department of Hematology Rigshospitalet Copenhagen University Hospital Copenhagen Denmark

Department of Hematology Shaare Zedek Medical Center Jerusalem Israel

Department of Hematology Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel

Department of Hematology University hospital Dubrava Zagreb Croatia

Department of Internal Medicine Albert Schweitzer Hospital Dordrecht The Netherlands

Department of Internal Medicine Haematology University Hospital and Medical School Hradec Kralove Hradec Kralove Czech Republic

Department of Medicine 3 University Hospital LMU Munich Munich Germany

Department of Medicine Section of Hematology University of Verona Verona Italy

Dept Hematooncology and Bone Marrow Transplantation Medical University in Lublin Lublin Poland

Dept of Hematology Hospital Clinic IDIBAPS Barcelona Spain

Dipartimento Scienze Radiologiche ed Ematologiche Divisione di Ematologia Fondazione Policlinico universitario A Gemelli Roma Italy

Division of Haematology Fondazione IRCCS Policlinico San Matteo Pavia Italy

Division of Hematology 2 San Giovanni Battista Hospital Torino Italy

Division of Hematology and Stem Cell Transplantation Unit Cardarelli Hospital Naples Italy

Division of Hematology Department of Translational Medicine University of Eastern Piedmont Novara Italy

Division of Hematology Fondazione IRCCS Istituto Nazionale dei Tumori Milano Italy

Division of Hematology Oncology Institute of Southern Switzerland Bellinzona Switzerland

Division of Hematology Policlinico Department of Surgery and Medical Specialties University of Catania Catania Italy

Hematology Almazov National Medical Research Centre St Petersburg Russia

Hematology Area Hospital Italiano La Plata La Plata Argentina

Hematology Azienda USL IRCCS di Reggio Emilia Reggio Emilia Italy

Hematology Center after Prof Yeolyan MH RA Yerevan Armenia

Hematology Department and HCT Unit G Papanicolaou Hospital Thessaloniki Greece

Hematology Department Hospital del Mar Barcelona Spain

Hematology Department Hospital Universitario Puerta de Hierro Majadahonda Madrid Spain

Hematology Department Hospital Universitario Ramón y Cajal Madrid Spain

Hematology Department of Translational and Precision Medicine Sapienza University Policlinico Umberto 1 Rome Italy

Hematology Dpt Az Osp SS Antonio e Biagio e Cesare Arrigo Alessandria Italy

Hematology Section Department of Medical Sciences University of Ferrara Ferrara Italy

Hematology Unit 1st Dept of Internal Medicine AUTH AHEPA Hospital Thessaloniki Greece

Hematology Unit Azienda Ospedaliera Ospedali Riuniti Marche Nord Pesaro Italy

Hematology Unit Consorci Sanitari Terrassa Hospital Terrassa Spain

Hematology Unit Department of Medical and Surgical Sciences University of Modena and Reggio Emilia Modena Italy

Hematology Unit Nepal Cancer Hospital and Research Centre Lalitpur Nepal

Hematology Unit University of Padua Padua Italy

Hospital de Clinicas Montevideo Uruguay

Hospital Universitario 12 de Octubre Madrid Spain

Hospital Universitario Infanta Leonor Madrid Universidad Complutense Madrid Spain

Inst J Bordet Brussels Belgium

Institute of Applied Biosciences Centre for Research and Technology Hellas Thessaloniki Greece

Institute of Hematology and Center for Hemato Oncological Research Ospedale S Maria della Misericordia University of Perugia Perugia Italy

Internal Medicine Rijnstate Hospital Arnhem The Netherlands

Laboratory of Experimental Hematology Institute of Oncology Research Bellinzona Switzerland

National Center for Cancer Care and Research Doha Doha Qatar

Norfolk and Norwich University NHS Foundation Trust Norwich UK

Peter MacCallum Cancer Centre and University of Melbourne Victoria Australia

Rabin Medical Center Beilinson Hospital; Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel

S C Ematologia ASST Spedali Civili Brescia Italy

SC Ematologia AO S Croce e Carle Cuneo Italy

Servicio de Hematología del Complejo Asistencial Universitario de Salamanca IBSAL Salamanca Spain

St James's University Hospital Leeds UK

Struttura Semplice Dipartimentale di Ematologia Presidio Ospedaliero Santa Chiara Trento Italy

U O C Ematologia Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico Milan Italy

Università Vita Salute San Raffaele and IRCC Ospedale San Raffaele Milan Italy

Universitaire Ziekenhuizen Leuven Leuven Belgium

University Division of Hematology A O U Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences University of Torino Torino Italy

University Hospital and CEITEC MU Brno Brno Czech Republic

UOC Ematologia AO Cosenza Cosenza Italy

UOC Ematologia PO Vito Fazzi Lecce Lecce Italy

USC Ematologia ASST PAPA GIOVANNI XXIII Bergamo Italy

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