Bacterial Coinfection Associated With Poor COVID-19 Outcomes in Chronic Lymphocytic Leukemia


The case fatality rate was high among patients with chronic lymphocytic leukemia (CLL) who were infected with SARs-CoV-2, with poor outcomes associated with bacterial coinfection, according to the results of a retrospective study that was presented at the EHA 2022 Hybrid Congress.

Previous studies suggest that patients with CLL are particularly vulnerable to COVID-19, with a reported case fatality rate of up to 40%. The aim of this study was to characterize potential risk factors for poor outcomes associated with COVID-19 in this population.

The retrospective study evaluated clinical records of 81 patients with CLL and SARS-CoV-2 infection who were treated for COVID-19 at 3 university centers in Serbia between March 2020 and December 2021.

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The median age of the cohort was 68 years and 75% of patients were male. Comorbid conditions were common, with 72.3% of patients having at least 1. There were 13.6% of patients in remission, 35.8% receiving active treatment, and 54.3% who were treatment-naïve.

The majority of patients required oxygen supplementation at 71.6%, including 43.2% of patients with severe COVID-19 and 23.5% who were considered critical. There were 30.9% of patients who were admitted to the intensive care unit, with 76% requiring mechanical ventilation. The case fatality rate was 32.1%.

Case fatality was significantly associated with Charlson comorbidity index greater than 4, with a rate of 38% compared with 9.5% among patients with a lower index (P =.025).

Documented or highly suspected bacterial infection was present among 53.1% and treated with antibiotics, which was significantly associated with case fatality with a rate of 51.2% compared with 10.2% among patients without a bacterial coinfection (P <.001). This association remained significant in a multivariate analysis (P =.012).

Some elevated laboratory parameters were associated with fatality, including C-reactive protein (P <.001), D-dimer (P =.039), and lactate dehydrogenase (P =.002). Supplemental oxygen use (P <.001) and intensive care unit admission (P <.001) were also associated with fatality.

Age, sex, and CLL treatment history were not associated with case fatality rate.

The authors concluded that the poor outcomes associated with COVID-19 among patients in their cohort was “mainly attributed to the high proportion of bacterial coinfections reflecting the frailty and susceptibility to both viral and bacterial infections.”

Disclosures are not available for this presentation.


Cvetkkovic Z, Markovic O, Markovic K, et al. Risk factors for unfavorable outcome of hospitalized patients with concurrent chronic lymphocytic leukemia and COVID-19 – experience of three Serbian University Centers. Presented at EHA 2022; June 9-12, 2022. Abstract P643.

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