The clinical management of patients with chronic lymphocytic leukemia (CLL) was altered across Italy in response to the COVID-19 pandemic, according to a survey study published in Blood.

“What is starting to emerge is an impact on the routine work-up of patients, on treatment choices, and the enrollment and adherence to clinical trials,” the authors wrote.

The authors sent a survey to 33 hematology centers across Italy in early April that included questions about testing strategies for COVID-19; the effect of the pandemic on diagnosis, management, and the outcomes of patients with CLL; and the adherence to clinical protocols. The survey data was based on 9930 patients with CLL, which represents approximately one-third of all patients with CLL in Italy.

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Although the minimum testing requirements mandated by law were followed by all centers, only 30% of centers tested asymptomatic patients without any known contact with a COVID-19 case prior to initiating CLL treatment. The authors said that this “reflects the higher capacity of some regional health systems to performed analyze nasopharyngeal swabs.”

Of the 9330 patients with CLL, 47 (0.5%) patients were symptomatic and tested positive for COVID-19.

Most centers reported a decrease in the number of newly diagnosed CLL cases, likely due to a decrease in the use of peripheral laboratories for diagnostic work-up, the authors said. In addition, 15.2% of centers reported that delays and difficulties in an accurate diagnostic work-up has occurred due to a reduction in personnel.

New treatment initiation was delayed in 79% of centers, and 24% of centers reported a delay in ongoing therapy. Delayed post-treatment restaging also occurred in 30.3% of centers.

The sample size was not large enough to characterize patient outcomes due to COVID-19 or the effect of anti-CLL treatments. However, there was a mix of patients who were receiving active first-line or salvage treatment vs no active treatment.

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The mortality rate in this cohort was 30.4%. “The mortality rate for symptomatic COVID-19 patients amongst the general population was 13.4% and 25.5% in the 70- to 79-year-old population,” the authors noted.

Clinical trial enrollment and follow-up of patients on a clinical trial protocol was reduced in two-thirds of the centers.

The authors concluded that this survey has revealed that COVID-19 “has started to impact on the number of new cases, on the adequate follow-up of treated patients, on the number of patients enrolled in clinical trials, and on the monitoring of such patients.”


Cuneo A, Scarfo L, Reda G, et al. Chronic lymphocytic leukemia management in Italy during the COVID-19 pandemic. A Campus CLL report [published online June 19, 2020]. Blood. doi: 10.1182/blood.2020006854