key: cord-0707935-3d9ijfuf
authors: Sánchez‐Velázquez, A.; Bauer‐Alonso, A.; Estrach, T.; Vega‐Díez, D.; Garcia‐Muret, P.; Haya, L.; Peñate, Y.; Acebo, E.; Fernández de Misa, R.; Blanes, M.; Suh‐Oh, HJ.; Izu, R.; Silva‐Díaz, E.; Sarriugarte, J.; Román‐Curto, C.; Botella‐Estrada, R.; Mateu‐Puchades, A.; Prieto‐Torres, L.; Morillas, V.; Morillo, Me.; Sanchez‐Caminero, P.; Calzado, L.; Pérez‐Ferriols, A.; Pérez, A.; Domínguez, JD.; Navedo, M.; Muniesa, C.; Combalia, A.; Arroyo‐Andrés, J.; Descalzo, MA.; García‐Doval, I.; Ortiz‐Romero, PL.
title: Patients with Primary Cutaneous Lymphoma are at risk for severe COVID‐19. Data from the Spanish Primary Cutaneous Lymphoma Registry
date: 2021-06-01
journal: J Eur Acad Dermatol Venereol
DOI: 10.1111/jdv.17430
sha: bd686ca658c2ba02b7b6bda4964e1b43886786bd
doc_id: 707935
cord_uid: 3d9ijfuf

While some papers report an increased risk of COVID‐19 and worse outcomes(1) in oncological patients, others have found no differences(2). We are not aware of studies assessing risk for COVID‐19 and clinical outcomes of patients with Primary Cutaneous Lymphomas (PCL).

This article is protected by copyright. All rights reserved While some papers report an increased risk of COVID-19 and worse outcomes 1 in oncological patients, others have found no differences 2 .

We are not aware of studies assessing risk for COVID-19 and clinical outcomes of patients with Primary Cutaneous Lymphomas (PCL).

The objectives of our study were to evaluate the incidence of COVID-19 and severe outcomes in a cohort of PCL patients, compare it to the general population, and describe changes in lymphoma staging eight weeks after COVID-19.

Registro Español de Linfomas Cutaneos (RELC) is a prospective cohort recruiting all patients with PCL referred to the 27 participating dermatology departments. In May 2020, we collected all patients with COVID-19 and described their clinical data and evolution. We defined COVID-19 cases, according to the European Centre for Disease Prevention and Control 3 , as possible, probable or confirmed. COVID-19 outcomes included asymptomatic or mild, hospitalized, intensive care unit (ICU) and deaths.

We estimated cumulative incidences, 95% Confidence Intervals (CI), and standardized incidence ratios (SIR) by age, sex and geographical area, corresponding to the same period (January-November 2020) of Spanish figures published by the Spanish Ministry of Health 4 . This study was approved by the ethics committee of Hospital 12 de Octubre (CEIM 20/297).

RELC included 1542 patients (56% Mycosis fungoides/Sézary (MF/SS), 44% non-MF/SS primary cutaneous lymphomas). 20% were in T3 and T4 stages. 60 patients (3.9 %) suffered from COVID-19, median age of 59.1 years (SD=13.1); 50% of them MF/SS, and 50% non-MF/SS. 42 patients had a microbiologically confirmed infection (70%), 7 of them being probable cases (12%) and 11 possible cases (18%). Most patients (65%) experienced mild disease, 25% required hospitalization, 5% needed ICU and 5% died. 82% of patients reported stability of their PCLs, 9% improvement and 9% worsening. 

This article is protected by copyright. All rights reserved 9.12)) and need for intensive care (SIR: 12.41 (95%CI: 1.5-45)). In patients surviving, the oncological disease remains stable.

There were limited data regarding PCL and COVID-19. The United States CL Consortium and the EORTC CLTF established some general recommendations for the treatment of PCLs during the COVID-19 pandemic 5,6 while some authors suggested that PCL does not increase the risk of SARS-CoV-2 7 . As far as we know, this study is the first to describe the incidence and severity of COVID-19 among PCL patients.

Strengths of our study are that it's based on a previously defined and closely followed prospective cohort, and has comparable data for the general population. Few cases remained unnoticed because it is unlikely that COVID-19 were diagnosed in a different setting.

Nevertheless, our study couldn't reach high statistical power, because the number of COVID-19 outcomes was relatively low, especially for severe outcomes and death, and the elderly were less represented in RELC, probably due to reduced survival after disease.

We could not detect increased risks in all PCL patients compared to the general population, especially for rare outcomes such as mortality. However, we found an augmented risk of severe disease compared to general population among those of 60 to 69 years of age (this group included more patients and outcomes, thus, offering more statistical power). The insufficient number of total cases didn't allow us further subdivision of the PCL group.

Our study suggests that PCL patients should be considered at risk for severe COVID-19, requiring reinforced preventive measures and prioritization in vaccination strategies.

This article is protected by copyright. All rights reserved 

Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China

COVID-19 Severity and Outcomes in Patients With Cancer: A Matched Cohort Study

Case definition for coronavirus disease 2019 (COVID-19), as of 3

COVID-19 en España

United States Cutaneous Lymphoma Consortium recommendations for treatment of cutaneous lymphomas during the COVID-19 pandemic

Management of primary cutaneous lymphoma patients during COVID-19 pandemic: EORTC CLTF guidelines

Cutaneous lymphomas and COVID-19: What is known so far?

We would like to thank Marina Pollán and National Centre for Epidemiology for helping with access to the data and all participants in the Spanish Primary Cutaneous Lymphoma Registry and reviewing the manuscript.

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