Table 1.

Immune pathophysiology and clinical presentation of COVID-19 by the type of HM

Type of HM	Mechanism of impaired immunity	Clinical presentation of COVID-19	COVID-19 persistence	References
Acute myeloid leukemia MDS	Myelosuppression and severe prolonged neutropenia secondary to underlying disease and its treatment In MDS impaired neutrophil and T-cell function and baseline elevated IL-1, IL-6, TNF, and other cytokines. Immune impairment associated with older age	More severe disease Higher risk of mortality Prolonged LOS	Prolonged viral shedding	[3, 4, 6, 23, 24, 25, 26, 137]
Acute lymphoblastic leukemia	Myelosuppression secondary to underlying disease and treatment Hypogammaglobulinemia Treatment-related B-cell dysfunction	Higher risk of mortality		[6, 27]
CLL	Hypogammaglobulinemia, B- and T-cell defects, CD4+ lymphopenia, innate immune dysfunction, and neutropenia	More severe disease and hospitalization Higher risk of mortality Possibly better outcomes with BTK inhibitors	Prolonged viral shedding Lack of seroconversion	[6, 28, 29, 30, 31, 123]
Lymphoma	Hypogammaglobulinemia, neutropenia, and lymphopenia Treatment causing cellular and humoral immune deficiency	Higher risk of mortality in NHL and in patients with relapsed/refractory disease Prolonged LOS Outcome better for Hodgkin lymphoma	Lack of seroconversion	[3, 6, 19, 33, 138]
Anti-CD20 treatments	Depleted circulating B cells and significantly impaired IgG and IgM responses	Prolonged LOS Probably associated with increased mortality and disease severity	Prolonged viral shedding Lack of seroconversion	[33, 34, 35, 36, 61]
Multiple myeloma	B-cell dysfunction leading to hypogammaglobulinemia, T-cell, dendritic cell, and NK cell abnormalities	Higher risk of mortality Elevation of inflammatory markers and severe hypogammaglobulinemia associated with higher mortality	Prolonged viral shedding median time to negative PCR 43 days Lack of seroconversion	[6, 32, 139]
Chronic myeloid leukemia		Relatively lower mortality compared to other HM		[23, 118]
Myeloproliferative neoplasms		Higher mortality (mainly PMF) Possible protective effect of JAK inhibitors High risk for VTE (mainly ET)		[3, 22, 37]
HCT	Neutropenia (pre-engraftment period) Impaired humoral and cellular immunity with prolonged reconstitution immune suppression (allogeneic > autologous HCT)	More moderate to severe COVID-19 Higher mortality Mortality higher when COVID-19 occurs within 12 months of transplantation	Prolonged viral shedding (median time to negative PCR 7.7 weeks) Lack of seroconversion	[3, 38, 39, 40, 133]
CART-cell therapy	High risk of CRS, long-term B-cell depletion, hypogammaglobulinemia, and cytopenia	Increased risk of moderate-severe COVID-19 pneumonia and higher mortality	Prolonged viral shedding Lack of seroconversion	[1, 39, 40, 140]

MDS, myelodysplastic syndrome; TNF, tumor necrosis factor; BTK, Bruton tyrosine kinase; NHL, non-Hodgkin lymphoma; LOS, length of stay; NK, natural killer cells; PCR, polymerase chain reaction; HM, hematologic malignancy; PMF, primary myelofibrosis; JAK, Janus kinase; VTE, venous thromboembolism; ET, essential thrombocytosis; HCT, hematopoietic cell transplantation; CRS, cytokine release syndrome.