Experience of a supra-regional cutaneous lymphoma centre during the COVID-19 pandemic

INTRODUCTION: Prioritisation of National Health Service (NHS) resources to cope with the COVID-19 pandemic has had a major impact on dermatology services. The consequences of the pandemic on the care of patients with primary cutaneous lymphoma (CL) in the U.K. is unknown. OBJECTIVE: To examine the impact of the Covid-19 pandemic on patients enrolled in the prospective registration and data collection study for newly diagnosed patients with all stages of MF/SS ‘PROCLIPI (PROspective Cutaneous Lymphoma International Prognostic Index) Study’. METHODS: The impact of the COVID-19 pandemic was assessed by comparing the pre-COVID clinical stage (TNMB stage, mSWAT score, global response assessment) and health-related quality of life (HRQoL (Skindex-29) prior to and 4.5 (4.0-5.6) months after the onset of the COVID-19 pandemic. A specific COVID-19 dataset was used to capture the impact of the pandemic on study participants. RESULTS: PROCLIPI study visit data was analysed in 75 patients with a mean (±SD) age of 65.19 (±14.31) years with a male: female ratio of 1.4:1. 61 patients had early stage (IA, n=41; IB, n=17 and IIA, n=3) and 14 had late-stage disease (IIB, n=3; IIIA, n=4; IIIB, n=1; IVA1, n=3 and IVA2, n=3) of whom 70 had MF and five SS. Global response assessment was possible in 40 patients. 17.1% (n=7) had an overall response (CR=1; PR=6), 43.9% (n=18) stable disease and 39% (n=16) progressive disease. The mean (±SEM) time to disease progression was 13.82 (±1.22) months and the median (IQR) mSWAT score increased from 7.25 (0.85–30.25) to 26.4 (2.6–41.78), p=0.08. 12 patients had missed/delayed treatments (phototherapy, n=5; radiotherapy, n=1; topical skin direct therapy, n=3; extracorporeal photopheresis, n=1; investigational medicinal product, n=2). We found no quantitative differences in health-related quality of life (HRQoL) using Skindex-29 (n=75) however 40.6% of patients rated the pandemic as having a moderate to severe impact on their QoL. COVID-19 risk group stratification identified 16.7% of patients with high risk and 54.5% of patients with moderate risk features for severe illness from the virus. Five patients developed COVID-19 illness and one with advanced disease (SS, Stage IVA2) in a high-risk COVID-19 group died. CONCLUSION: The COVID-19 pandemic has significantly impacted the care of patients with CL. From March 2020 all CL clinics were cancelled, clinical trials were suspended and only emergency appointments permitted. Further work comparing progression status in a matched cohort from 2015 and 2016 will further assess the impact of the COVID-19 pandemic in CL.