Page 239 - 2021_05-Haematologica-web

Letters to the Editor
Figure 2. Distribution of major immune cell types in patients with COVID-19 according to the type of hematological cancer and outcome. Patients were clas- sified according to the pre-malignant vs. malignant stage of the disease, tumor type and outcome. Grey boxes represent the distribution of coronavirus disease 2019 (COVID-19) patients without blood cancer, and dots correspond to hematological patients. Black asterisks indicate significant differences between patients without and with hematological tumor, and red asterisks represent significant differences between alive and deceased patients with hematological can- cer. No significant differences were observed between pre-malignant and malignant stages. *P<0.05; **P<0.01. AML: acute myeloid leukemia; MBL: mono- clonal B-cell lymphocytosis; MDS: myelodysplastic syndrome; MGUS: monoclonal gammopathy of undetermined significance; CLL: chronic lymphocytic leukemia; DLBCL: diffuse large B-cell lymphoma; FL: follicular lymphoma. NK: natural killer.
out blood cancer (Online Supplemental Figure S3B). Genes related to NF-κB and STAT transcription factors as well as genes encoding Toll-like receptors and proinflammatory interleukin receptors, all of which described to be impli- cated in the response and evasion of innate sensing by coronaviruses,11 were differentially expressed in many of these cell types. Although preliminary, these data suggest that myeloid and antigen-presenting cells could be phe- notypically altered in COVID-19 patients with hemato- logical tumors.
Immune impairment in patients with hematological malignancies has been well-documented.12 Moreover, there is a growing body of evidence supporting that immune defects emerge in pre-malignant stages such as monoclonal B-cell lymphocytosis (MBL) and monoclonal gammopathy of undetermined significance (MGUS),13,14 which are present in 3% or more of individuals older than 50 years. Thus, our results unveiling altered immune profiles in COVID-19 patients with benign and malignant hematological cancer could be relevant to a considerable number of elderly adults worldwide. However, while MBL and MGUS cases displayed
immune alterations similar to patients with a malignant tumor (Figure 2), their outcome was favorable compared to patients with malignant disease, in line with recent observations.7 Accordingly, this study should foster fur- ther investigations to clarify if all hematological cases or only those with hematological malignancies are at risk of severe COVID-19.
Catarina Maia,1,2,3,4* Esperanza Martín-Sánchez,1,2,3,4*
Juan José Garcés,1,2,3,4* Ascensión López-Díaz de Cerio,1,3,5* Susana Inogés,1,3,5 Manuel F. Landecho,1
Belén Gil-Alzugaray,6 Cristina Perez,2,3,4 Cirino Botta,7 Aintzane Zabaleta,1,2,3,4 Félix Alegre,1 César Rincón,6
Laura Blanco,3,4 Sarai Sarvide,2,3,4 Amaia Vilas-Zornoza,2,3,5 Diego Alignani,1,2,3,4 Cristina Moreno,1,3,4 Artur Paiva,8
9 8 10 António Martinho, Rui Alves, Enrique Colado,
Covadonga Quirós,10 Mónica Olid,6 Andrés Blanco,1 Josepmaria Argemi,1,3 Bruno Paiva1,2,3,4#
and José Ramón Yuste1,3#
1Clinica Universidad de Navarra, Pamplona, Spain; 2Centro de Investigacion Medica Aplicada (CIMA), Pamplona, Spain; 3Instituto de Investigacion Sanitaria de Navarra (IdiSNA),
haematologica | 2021; 106(5)
1459