Impact of COVID-19 on short- and long-term outcomes in patients with diffuse large B-cell lymphoma: A real-world analysis.

Abstract

e19066 Background: Patients with diffuse large B-cell lymphoma (DLBCL) are highly vulnerable to infectious complications due to disease-related immune dysfunction and immunosuppressive therapies. The impact of coronavirus disease 2019 (COVID-19) on short- and long-term outcomes in patients with DLBCL remains incompletely characterized in large real-world populations. Methods: We conducted a retrospective cohort study using the TriNetX Global Collaborative Network, including adult patients (≥18 years) with a diagnosis of DLBCL. Patients were stratified into two cohorts based on the presence or absence of COVID-19 infection. Propensity score matching (1:1) was performed for demographics and major comorbidities. The primary outcome was all-cause mortality. Secondary outcomes included acute respiratory failure, mechanical ventilation, and other COVID-related complications. Outcomes were assessed at 30 days, 90 days, and up to 3 years following the index event using risk ratios and Kaplan–Meier survival analyses. Results: After propensity score matching, 33,026 patients were included in each cohort. Patients with DLBCL and COVID-19 demonstrated significantly higher 30-day mortality compared with those without COVID-19 (22.4% vs 18.5%; risk ratio [RR] 1.21, 95% CI 1.18–1.25; p <0.0001). Over long-term follow-up, COVID-19 infection was associated with worse overall survival, with a significantly increased hazard of mortality on Kaplan–Meier analysis (hazard ratio [HR] 1.97, 95% CI 1.86–2.09; p <0.0001). Additionally, patients with COVID-19 had a markedly higher incidence of acute respiratory failure at 3 years compared with those without COVID-19 (12.9% vs 5.1%; RR 2.52, 95% CI 2.39–2.67; p <0.0001). Conclusions: In this large real-world cohort, COVID-19 infection in patients with DLBCL was associated with significantly increased short-term mortality, worse long-term survival, and substantially higher rates of acute respiratory failure. These findings highlight the profound impact of COVID-19 on outcomes in patients with aggressive lymphoma and underscore the importance of preventive strategies and close monitoring in this high-risk population.