Newly Diagnosed Chronic Lymphocytic Leukemia During Symptomatic COVID-19: Two Cases.

Q2 Medicine Electronic Journal of the International Federation of Clinical Chemistry and Laboratory Medicine Pub Date : 2022-08-08 eCollection Date: 2022-08-01
Enikő Papp, Szabolcs Tasnády, Katalin Tisza, Ágnes Király, Gabriella Bekő
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Abstract

Patients suffering from malignant diseases have a high risk of developing severe or critical forms of COVID-19 (Coronavirus Disease 2019). Chronic lymphocytic leukaemia (CLL) is characterized by dysregulated adaptive and innate immune responses, because both T and B cells, the function of phagocytes and the activity of the complement system may be affected. Severe SARS-CoV-2 infection also influences the immunological functions mainly via causing the depletion of CD4+ and CD8+ T cells. We present the cases of two patients, whose de novo CLL were observed during severe COVID-19 pneumonia. A 43-year-old man with IDDM (Insulin dependent diabetes mellitus) was sent to hospital in February 2021. He had a bilateral severe COVID-19 pneumonia. There was a suspected sign of malignancy on a thoracic vertebra in his chest CT, and haematological consultation was requested. In parallel, a 53-year-old man was hospitalized in March of 2021 because of severe COVID-19 pneumonia. CLL was suspected based on his haematology test results (WBC: 123 G/L, lymphocytes: 91%, haemoglobin: 107 g/L). Flow cytometric analysis revealed CLL in both cases. Based on the result of the molecular genetic tests, the first patient had a good prognosis in Rai 0 stage, while the other patient suffered from Rai I stage with a worse prognosis. Both patients recovered from bilateral COVID-19 pneumonia without the need for intensive care unit treatment. The follow-up of these CLL patients that manifested during symptomatic COVID-19 disease further enriched our knowledge on such clinical conditions where the immune system is dysfunctional due to different simultaneous causes.

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COVID-19症状期新诊断慢性淋巴细胞白血病2例
患有恶性疾病的患者患COVID-19(2019冠状病毒病)严重或危重型的风险很高。慢性淋巴细胞白血病(CLL)的特点是适应性和先天免疫反应失调,因为T细胞和B细胞、吞噬细胞的功能和补体系统的活性都可能受到影响。严重的SARS-CoV-2感染也主要通过引起CD4+和CD8+ T细胞的耗竭来影响免疫功能。我们报告了两例在重症COVID-19肺炎期间观察到新生CLL的患者。一名患有胰岛素依赖型糖尿病(IDDM)的43岁男性于2021年2月被送往医院。他患有双侧严重的COVID-19肺炎。胸部CT显示疑似胸椎恶性肿瘤,要求进行血液学会诊。与此同时,2021年3月,一名53岁的男子因严重的COVID-19肺炎住院。根据他的血液学检查结果(白细胞:123 G/L,淋巴细胞:91%,血红蛋白:107 G/L),怀疑CLL。流式细胞术分析显示两例均为慢性淋巴细胞白血病。分子遗传学检测结果显示,第1例患者Rai 0期预后较好,另1例患者Rai期预后较差。两名患者均从双侧COVID-19肺炎中康复,无需重症监护病房治疗。对这些在COVID-19症状期出现的CLL患者的随访,进一步丰富了我们对这种由不同原因同时引起的免疫系统功能失调的临床情况的认识。
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