Impact of the first covid-19 lockdown in Germany on the rate of acute infections during intensive chemotherapy for hodgkin lymphoma

Background: Acute infections and fever under chemotherapy are an important cause for morbidity and mortality in hematologic malignancies such as Hodgkin lymphoma (HL). Prophylactic anti-infective concomitant medication is prescribed frequently. Another protective measure could be self-protection via social distancing and wearing facemasks. However, evidence on the effect of self-protection on infections during chemotherapy is currently not available. Aims: We asked if the frequency of acute infections during chemotherapy for advanced-stage HL decreased when Corona Virus Disease 2019 (COVID-19) protection measures were in effect. Methods: We analyzed the occurrence of infections during all documented eBEACOPP cycles that started between 01 March and 30 June of 2017-2020 among patients treated within the GHSG HD21 study in Germany. We compared cycles starting between March and June 2020 with cycles starting between March and June of 2017-2019 regarding infection rates and infection characteristics by logistic regression models and means of descriptive statistics. Results: We analyzed 911 cycles of 313 adult patients treated with 4 to 6 cycles of eBEACOPP. We found a significant decrease in the frequency of infections during chemotherapy for HL during COVID-19 lockdown from131 (19.6%) of 670 cycles in the years 2017-2019 to 30 (12.6%) of 239 cycles during COVID-19 lockdown (OR 0.574 (95% CI 0.354- 0.930), P = 0.024). Correspondingly, 20 (24.1%) of 83 patients had an infection during the COVID-19 lockdown versus 99 (43.2%) of 229 patients in the years 2017-2019 (P = 0.0023). The strongest effect was observed for unspecified infections (unknown type of etiologic agent), occurring in 39 cycles (5.8%) during 2017-2019 in comparison to 5 cycles (2.1%) during COVID-19 lockdown. There was also a strong trend towards fewer minor infections: during the COVID-19 lockdown period there were 8 cycles (3.3%) with a minor infection compared to 66 cycles (9.9%) with an infection during the reference period. Summary/Conclusion: The significant and relevant decrease observed in acute infections while receiving chemotherapy for HL during the COVID-19 lockdown demonstrates the potential of protective measures to shield patients from transmissible pathogens. We conclude that these measures may be recommended for cancer patients at risk for infections during chemotherapy.