International Cutaneous Lymphomas Pandemic Section (ICLYPS) analysis of CTCL outcomes during COVID-19

At the onset of the COVID-19 pandemic, the United States Cutaneous Lymphoma Consortium (USCLC) and the European Organisation for Research and Treatment of Cancer Cutaneous Lymphoma Task Force (EORTC-CLTF) developed emergency guidelines for the management of patients with cutaneous lymphomas (CLs) during the pandemic. These emergency protocols were intended to ensure patient safety and called for dose modifications, treatment delays and treatment interruptions as necessary to minimize exposure risks to COVID-19. Because there are no established maintenance protocols for CLs, the impact of such delays or interruptions on disease outcomes was not known. The ISCL created an International Cutaneous Lymphomas Pandemic Section (ICLYPS) to collect data from the institutions around the world to assess the impact of these changes on patients’ outcomes and to determine if these measures were effective in preventing infection. We summarize the outcomes from a preliminary cohort of patients from Brazil, Greece, Italy, Spain, Switzerland, the UK and the US. Actively managed patients with an established diagnosis of CL from March to October 2020 were included according to the Institutional Protection of Human Subjects guidelines at the respective centers. We included 149 patients in this retrospective review. The average age was 61.88 years (range: 22–95). 2 patients (1.3%) had diagnoses of CD30+ lymphoproliferative disorders (LyP and pcALCL), 112 (75.2%) had mycosis fungoides (MF), and 35 (23.5%) had Sézary syndrome (SS). 77 patients (68.7%) had stages IA–IIA MF, 23 (20.5%) had Stage IIB MF, 6 (5.4%) had stage III MF, and 41 (27.5%) had Stage IV disease, of which 6 had Stage IV MF (5.4%) and 35 had SS (23.5%). Treatment was delayed for more than half (53.0%) of the patients for a mean of 3.2 months (range: 10 days to 10 months). Treatment delay was associated with a significant risk of disease relapse or progression across all stages (65.8% vs 32.9%, p<0.00001). During follow up, 6 patients (4%) died due to disease progression, including 3 patients with Stage IIB MF, one with Stage IVB MF, and two with SS. Twenty-eight patients (18.8%) had a confirmed COVID-19 infection during the capture period. Two of these cases were definitive hospital-acquired infections following prolonged hospital admission, while the remaining contracted the virus through community exposures. There were no outpatient office-acquired infections. Three of the 26 patients who contracted COVID-19 died of the infection (2 SS and 1 LyP, mean age: 80, range: 66–89). The ICLYPS analysis has revealed that treatment interruptions and delays during the COVID-19 pandemic resulted in significantly worse outcomes in patients with CLs as compared to those who did not experience treatment interruptions. No outpatient office-acquired infections were reported in this extensive review, and patients with CLs who developed COVID-19 did not do worse than expected according to their risk factors. Effective safety measures and protocols can prevent transmission of COVID-19 at physicians’ offices. Interruption of therapy leads to negative clinical outcomes and should be avoided, especially in the setting of advanced disease, as the risk of contracting COVID-19 in the outpatient setting did not outweigh the risk of morbidity and mortality due to disease progression. Ensuring continuity of treatment and maintenance therapy appears to be critical to avoiding life-threatening disease progression.