1
|
Beck KS, Yoon JH, Yoon SH. Radiologic Abnormalities in Prolonged SARS-CoV-2 Infection: A Systematic Review. Korean J Radiol 2024; 25:473-480. [PMID: 38685737 PMCID: PMC11058427 DOI: 10.3348/kjr.2023.1149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/06/2024] [Accepted: 02/24/2024] [Indexed: 05/02/2024] Open
Abstract
We systematically reviewed radiological abnormalities in patients with prolonged SARS-CoV-2 infection, defined as persistently positive polymerase chain reaction (PCR) results for SARS-CoV-2 for > 21 days, with either persistent or relapsed symptoms. We extracted data from 24 patients (median age, 54.5 [interquartile range, 44-64 years]) reported in the literature and analyzed their representative CT images based on the timing of the CT scan relative to the initial PCR positivity. Our analysis focused on the patterns and distribution of CT findings, severity scores of lung involvement on a scale of 0-4, and the presence of migration. All patients were immunocompromised, including 62.5% (15/24) with underlying lymphoma and 83.3% (20/24) who had received anti-CD20 therapy within one year. Median duration of infection was 90 days. Most patients exhibited typical CT appearance of coronavirus disease 19 (COVID-19), including ground-glass opacities with or without consolidation, throughout the follow-up period. Notably, CT severity scores were significantly lower during ≤ 21 days than during > 21 days (P < 0.001). Migration was observed on CT in 22.7% (5/22) of patients at ≤ 21 days and in 68.2% (15/22) to 87.5% (14/16) of patients at > 21 days, with rare instances of parenchymal bands in previously affected areas. Prolonged SARS-CoV-2 infection usually presents as migrating typical COVID-19 pneumonia in immunocompromised patients, especially those with impaired B-cell immunity.
Collapse
Affiliation(s)
- Kyongmin Sarah Beck
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong-Hwa Yoon
- Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Republic of Korea
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University Hospital, Seoul National College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
2
|
Feuth E, Nieminen V, Palomäki A, Ranti J, Sucksdorff M, Finnilä T, Oksi J, Vuorinen T, Feuth T. Prolonged viral pneumonia and high mortality in COVID-19 patients on anti-CD20 monoclonal antibody therapy. Eur J Clin Microbiol Infect Dis 2024; 43:723-734. [PMID: 38358552 DOI: 10.1007/s10096-024-04776-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/05/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE In clinical practice, we observed an apparent overrepresentation of COVID-19 patients on anti-CD20 monoclonal antibody therapy. The aim of this study was to characterize the clinical picture of COVID-19 in these patients. METHODS All adult patients from Turku University Hospital, Turku, Finland, with COVID-19 diagnosis and/or positive SARS-CoV-2 PCR test result up to March 2023, and with anti-CD20 therapy within 12 months before COVID-19 were included. Data was retrospectively obtained from electronic patient records. RESULTS Ninety-eight patients were identified. 44/93 patients (47.3%) were hospitalized due to COVID-19. Patients with demyelinating disorder (n = 20) were youngest (median age 36.5 years, interquartile range 33-45 years), had less comorbidities, and were least likely to be hospitalized (2/20; 10.0%) or die (n = 0). COVID-19 mortality was 13.3% in the whole group, with age and male sex as independent risk factors. Persistent symptoms were documented in 33/94 patients (35.1%) alive by day 30, in 21/89 patients (23.6%) after 60 days, and in 15/85 after 90 days (17.6%), mostly in patients with haematological malignancy or connective tissue disease. Prolonged symptoms after 60 days predisposed to persistent radiological findings (odds ratio 64.0; 95% confidence interval 6.3-711; p < 0.0001) and persistently positive PCR (odds ratio 45.5, 95% confidence interval 4.0-535; p < 0.0001). Several patients displayed rapid response to late antiviral therapy. CONCLUSION Anti-CD20 monoclonal antibody therapy is associated with high COVID-19 mortality and with a phenotype consistent with prolonged viral pneumonia. Our study provides rationale for retesting of immunocompromised patients with prolonged COVID-19 symptoms and considering antiviral therapy.
Collapse
Affiliation(s)
- Eeva Feuth
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Valtteri Nieminen
- Department of Pulmonary Diseases and Clinical Allergology, Turku University Hospital and University of Turku, Turku, Finland
| | - Antti Palomäki
- Centre for Rheumatology and Clinical Immunology, and Department of Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Juha Ranti
- Department of Haematology, Turku University Hospital, Turku, Finland
| | - Marcus Sucksdorff
- Turku PET Centre, and Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | - Taru Finnilä
- Department of Hospital Hygiene & Infection Control, Turku University Hospital, Turku, Finland
| | - Jarmo Oksi
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Tytti Vuorinen
- Department of Clinical Microbiology, Turku University Hospital and Institute of Biomedicine, University of Turku, Turku, Finland
| | - Thijs Feuth
- Department of Pulmonary Diseases and Clinical Allergology, Turku University Hospital and University of Turku, Turku, Finland.
| |
Collapse
|
3
|
Maino A, Amen A, Plumas J, Bouquet L, Deschamps M, Saas P, Chaperot L, Manches O. Development of a New Off-the-Shelf Plasmacytoid Dendritic Cell-Based Approach for the Expansion and Characterization of SARS-CoV-2-Specific T Cells. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2024; 212:825-833. [PMID: 38214610 DOI: 10.4049/jimmunol.2300704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/20/2023] [Indexed: 01/13/2024]
Abstract
Global vaccination against COVID-19 has been widely successful; however, there is a need for complementary immunotherapies in severe forms of the disease and in immunocompromised patients. Cytotoxic CD8+ T cells have a crucial role in disease control, but their function can be dysregulated in severe forms of the disease. We report here a cell-based approach using a plasmacytoid dendritic cell line (PDC*line) to expand in vitro specific CD8+ responses against COVID-19 Ags. We tested the immunogenicity of eight HLA-A*02:01 restricted peptides derived from diverse SARS-Cov-2 proteins, selected by bioinformatics analyses in unexposed and convalescent donors. Higher ex vivo frequencies of specific T cells against these peptides were found in convalescent donors compared with unexposed donors, suggesting in situ T cell expansion upon viral infection. The peptide-loaded PDC*line induced robust CD8+ responses with total amplification rates that led up to a 198-fold increase in peptide-specific CD8+ T cell frequencies for a single donor. Of note, six of eight selected peptides provided significant amplifications, all of which were conserved between SARS-CoV variants and derived from the membrane, the spike protein, the nucleoprotein, and the ORF1ab. Amplified and cloned antiviral CD8+ T cells secreted IFN-γ upon peptide-specific activation. Furthermore, specific TCR sequences were identified for two highly immunogenic Ags. Hence, PDC*line represents an efficient platform to identify immunogenic viral targets for future immunotherapies.
Collapse
Affiliation(s)
- Anthony Maino
- Etablissement Français du Sang, Recherche et Développement, Grenoble, France
- Université Grenoble Alpes, INSERM U 1209, CNRS UMR 5309, Institute for Advanced Biosciences, Grenoble, France
| | - Axelle Amen
- Laboratoire d'Immunologie, Centre Hospitalier Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, CNRS, CEA, UMR 5075, Institut de Biologie Structurale, Grenoble, France
| | - Joël Plumas
- Etablissement Français du Sang, Recherche et Développement, Grenoble, France
- PDC*line Pharma SAS, Grenoble, France
| | - Lucie Bouquet
- Université de Franche-Comté, Etablissement Français du Sang, INSERM, UMR RIGHT, Besançon, France
| | - Marina Deschamps
- Université de Franche-Comté, Etablissement Français du Sang, INSERM, UMR RIGHT, Besançon, France
| | - Philippe Saas
- Etablissement Français du Sang, Recherche et Développement, Grenoble, France
- Université Grenoble Alpes, INSERM U 1209, CNRS UMR 5309, Institute for Advanced Biosciences, Grenoble, France
| | - Laurence Chaperot
- Etablissement Français du Sang, Recherche et Développement, Grenoble, France
- Université Grenoble Alpes, INSERM U 1209, CNRS UMR 5309, Institute for Advanced Biosciences, Grenoble, France
| | - Olivier Manches
- Etablissement Français du Sang, Recherche et Développement, Grenoble, France
- Université Grenoble Alpes, INSERM U 1209, CNRS UMR 5309, Institute for Advanced Biosciences, Grenoble, France
| |
Collapse
|
4
|
Furuya C, Yasuda H, Hiki M, Shirane S, Yamana T, Uchimura A, Inano T, Takaku T, Hamano Y, Ando M. Case report: Ensitrelvir for treatment of persistent COVID-19 in lymphoma patients: a report of two cases. Front Immunol 2024; 15:1287300. [PMID: 38333218 PMCID: PMC10850233 DOI: 10.3389/fimmu.2024.1287300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
Persistent COVID-19 is a well recognized issue of concern in patients with hematological malignancies. Such patients are not only at risk of mortality due to the infection itself, but are also at risk of suboptimal malignancy-related outcomes because of delays and terminations of chemotherapy. We report two lymphoma patients with heavily pretreated persistent COVID-19 in which ensitrelvir brought about radical changes in the clinical course leading to rapid remissions. Patient 1 was on ibrutinib treatment for mantle cell lymphoma when he developed COVID-19 pneumonia which was severe and ongoing for 2 months despite therapy with molnupiravir, multiple courses of remdesivir, one course of sotrovimab, tocilizumab, and steroids. Patient 2 was administered R-CHOP therapy for diffuse large B-cell lymphoma when he developed COVID-19 which was ongoing for a month despite treatment with multiple courses of remdesivir and one course of sotrovimab. A 5-day administration of ensitrelvir promptly resolved the persistent COVID-19 accommodated by negative conversions of RT-qPCR tests in both patients within days. Ensitrelvir is a novel COVID-19 therapeutic that accelerates viral clearance through inhibition of the main protease of SARS-CoV-2, 3-chymotrypsin-like protease, which is vital for viral replication. Ensitrelvir is a promising treatment approach for immunocompromised lymphoma patients suffering from persisting and severe COVID-19.
Collapse
Affiliation(s)
- Chiho Furuya
- Department of Hematology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hajime Yasuda
- Department of Hematology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Makoto Hiki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shuichi Shirane
- Department of Hematology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomohito Yamana
- Department of Hematology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ayana Uchimura
- Department of Hematology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tadaaki Inano
- Department of Hematology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomoiku Takaku
- Department of Hematology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yasuharu Hamano
- Department of Hematology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Miki Ando
- Department of Hematology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| |
Collapse
|
5
|
Lee CM, Choe PG, Kang CK, Jo HJ, Kim NJ, Yoon SS, Kim TM, Park WB, Oh MD. Impact of T-Cell Engagers on COVID-19-Related Mortality in B-Cell Lymphoma Patients Receiving B-Cell Depleting Therapy. Cancer Res Treat 2024; 56:324-333. [PMID: 37448122 PMCID: PMC10789957 DOI: 10.4143/crt.2023.738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023] Open
Abstract
PURPOSE B-cell depleting therapies, including T-cell engager (TCE), are increasingly used for patients with hematologic malignancies, including during the coronavirus disease 2019 (COVID-19) pandemic. We aimed to evaluate the relationship between TCE therapy and COVID-19-related outcomes among patients with COVID-19 and B-cell lymphomas receiving B-cell depleting therapy. MATERIALS AND METHODS This retrospective cohort study included patients with B-cell lymphoma, who were admitted to Seoul Natio-nal University Hospital with COVID-19 between September 2021 and February 2023, and received B-cell depleting therapy before COVID-19 diagnosis. Multivariable logistic regression was used to identify factors associated with severe to critical COVID-19 and COVID-19-related mortality. RESULTS Of 54 patients with B-cell lymphomas and COVID-19 who received B-cell depleting therapy, 14 were treated with TCE (TCE group) and 40 with rituximab (RTX group). COVID-19-related mortality was higher in the TCE group than in the RTX group (57.1% vs. 12.5%, p=0.002). In multivariable analyses, TCE therapy (adjusted odds ratio [aOR], 7.08; 95% confidence interval [CI], 1.29 to 38.76; p=0.024) and older age (aOR, 1.06; 95% CI, 1.00 to 1.13; p=0.035) were associated with severe to critical COVID-19. TCE therapy (aOR, 8.98; 95% CI, 1.48 to 54.40; p=0.017), older age (aOR, 1.13; 95% CI, 1.02 to 1.26; p=0.022), and prior bendamustine therapy (aOR, 7.78; 95% CI, 1.17 to 51.65; p=0.034) were independent risk factors for COVID-19-related mortality. CONCLUSION B-cell lymphoma patients treated with TCE had significantly worse outcomes from COVID-19 than those treated with RTX. TCE therapy should be used with caution in B-cell lymphoma patients during the COVID-19 epidemic.
Collapse
Affiliation(s)
- Chan Mi Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Hyeon Jae Jo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Seoul National University Cancer Research Institute, Seoul,
Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| |
Collapse
|
6
|
Franklin A, John TM, Khawaja F, Jiang Y, Yepez E, Ahuja J, Faiz SA, Bashoura L, Sheshadri A, Shannon VR, Balachandran DD, McConn K, Mulanovich VE, Bhatti M, Chemaly RF. Utility of Bronchoalveolar Lavage for the Diagnosis and Management of COVID-19 in Patients With Cancer. J Infect Dis 2023; 228:1549-1558. [PMID: 37983000 DOI: 10.1093/infdis/jiad272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/14/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) on nasopharyngeal swab (NPS), remains the most reliable and practical test to diagnose coronavirus disease 2019 (COVID-19). Current literature is sparse regarding the rates of discordance between NPS and bronchoalveolar lavage (BAL) in patients with cancer. METHODS We conducted a retrospective cohort study of adult patients with cancer who had BAL samples tested for SARS-CoV-2 at a comprehensive cancer center. Patients without NPS PCR for SARS-CoV-2 before BAL were excluded. RESULTS In a cohort of 345 patients, 12% and 17% tested positive for SARS-CoV-2 on NPS and BAL, respectively. There was a 6.3% NPS-/BAL+ discordance rate and a 9.5% NPS+/BAL- discordance rate. Patients with lymphoma (adjusted odds ratio [aOR] = 4.06; P = .007) and Hispanic patients (aOR = 3.76; P = .009) were more likely to have NPS-/BAL+ discordance on multivariate analysis. Among patients with NPS- /BAL- for SARS-CoV-2, an alternate infectious (23%) and a noninfectious etiology (16%) were identified in BAL. CONCLUSIONS Our discordance rates between NPS and BAL were sufficient to recommend BAL in certain patients with cancer with a high clinical suspicion of COVID-19. BAL has value in identifying alternative etiologies of illness in patients with suspected or confirmed COVID-19.
Collapse
Affiliation(s)
- Alexander Franklin
- Department of Infectious Diseases, Infection Control and Employee Heath, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Teny M John
- Department of Infectious Diseases, Infection Control and Employee Heath, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Fareed Khawaja
- Department of Infectious Diseases, Infection Control and Employee Heath, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ying Jiang
- Department of Infectious Diseases, Infection Control and Employee Heath, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Yepez
- Department of Infectious Diseases, Infection Control and Employee Heath, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jitesh Ahuja
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Saadia A Faiz
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lara Bashoura
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ajay Sheshadri
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vickie R Shannon
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diwakar D Balachandran
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kelly McConn
- Department of Infectious Diseases, Infection Control and Employee Heath, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Victor E Mulanovich
- Department of Infectious Diseases, Infection Control and Employee Heath, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Micah Bhatti
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Roy F Chemaly
- Department of Infectious Diseases, Infection Control and Employee Heath, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
7
|
Zhu W, Xie T, Xu M, Chen R, Zhang T. Migratory Pulmonary Infiltrates in a B-Cell-Depleted COVID-19 Patient. Infect Drug Resist 2023; 16:7205-7208. [PMID: 38023406 PMCID: PMC10655725 DOI: 10.2147/idr.s439795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still rampant around the world. Immunocompromised patients are prone to have long-term infection with coronavirus disease 2019 (COVID-19). However, it is difficult to decide on an appropriate treatment for persistent SARS-CoV-2 infection. Case Presentation We present a case of prolonged SARS-CoV-2 infection in a patient who had undergone B-cell depletion therapy. Chest computed tomography (CT) revealed notable migratory pulmonary infiltrates, and bronchoalveolar lavage fluid was positive for SARS-CoV-2 (day-120). The patient responded well to the combination treatment of antiviral medication, convalescent plasma, and corticosteroid. Conclusion When chest CT shows migratory pulmonary infiltrates in patients with recent COVID-19, it is necessary to be alert to the possibility of persistent SARS-CoV-2 infection, especially in B-cell-depleted immunocompromised patients. Once the diagnosis is confirmed, repeated antiviral therapy and intravenous convalescent plasma should be considered.
Collapse
Affiliation(s)
- Wenyan Zhu
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People’s Republic of China
| | - Tiange Xie
- Department of General Practice, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People’s Republic of China
| | - Mengru Xu
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People’s Republic of China
| | - Ruxuan Chen
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People’s Republic of China
| | - Ting Zhang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People’s Republic of China
| |
Collapse
|
8
|
Furie N, Mandelboim M, Zuckerman N, Belkin A, Seluk L, Shafran I, Mass R, Levy L, Chatterji S, Baltaxe E, Peled M, Shulimzon T, Avigdor A, Amit S, Onn A, Marom EM, Rahav G, Segel MJ. Persistent Severe Acute Respiratory Syndrome Coronavirus 2 Pneumonia in Patients Treated With Anti-CD20 Monoclonal Antibodies. Open Forum Infect Dis 2023; 10:ofad464. [PMID: 37808896 PMCID: PMC10551847 DOI: 10.1093/ofid/ofad464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
We report 8 cases of persistent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia in patients previously treated with anti-CD20 monoclonal antibodies. Polymerase chain reaction of nasopharyngeal swabs for SARS-CoV-2 was negative in most cases; viral cell cultures confirmed that viable SARS-Co-2 virus was present. Four patients were treated with anti-SARS-CoV-2 hyperimmune globulins with rapid resolution of disease.
Collapse
Affiliation(s)
- Nadav Furie
- Institute of Pulmonology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Michal Mandelboim
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Tel-Hashomer, Israel
| | - Neta Zuckerman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Tel-Hashomer, Israel
| | - Ana Belkin
- Internal Medicine D, Sheba Medical Center, Tel Hashomer, Israel
- Infectious Diseases Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Lior Seluk
- Institute of Pulmonology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Inbal Shafran
- Institute of Pulmonology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ronen Mass
- Institute of Pulmonology, Sheba Medical Center, Tel Hashomer, Israel
| | - Liran Levy
- Institute of Pulmonology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Sumit Chatterji
- Institute of Pulmonology, Sheba Medical Center, Tel Hashomer, Israel
| | - Erik Baltaxe
- Institute of Pulmonology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Michael Peled
- Institute of Pulmonology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Tiberiu Shulimzon
- Institute of Pulmonology, Sheba Medical Center, Tel Hashomer, Israel
| | - Abraham Avigdor
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Division of Hematology and Bone-Marrow Transplantation, Sheba Medical Center, Ramat Gan, Israel
| | - Sharon Amit
- Microbiology Laboratory, Sheba Medical Center, Tel Hashomer, Israel
| | - Amir Onn
- Institute of Pulmonology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Edith M Marom
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Department of Diagnostic Radiology, Sheba Medical Center, Tel Hashomer, Israel
| | - Galia Rahav
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Infectious Diseases Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Michael J Segel
- Institute of Pulmonology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| |
Collapse
|
9
|
Kambe R, Sato M, Uehara D, Iizuka Y, Kakizaki S. Prolonged SARS-CoV-2 infection during obinutuzumab and bendamustine treatment for follicular lymphoma: A case report. Clin Case Rep 2023; 11:e7861. [PMID: 37649899 PMCID: PMC10462774 DOI: 10.1002/ccr3.7861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/14/2023] [Accepted: 08/19/2023] [Indexed: 09/01/2023] Open
Abstract
Key Clinical Message SARS-CoV-2 infection has been associated with a prolonged course and a poor prognosis in patients who receive anti-CD20 antibodies. However, there are no established treatments for such patients. Serial changes in the SARS-CoV-2 antigen titer during the clinical course and treatment strategies for immunosuppressed patients are discussed. Abstract We report a case of prolonged SARS-CoV-2 infection during obinutuzumab and bendamustine treatment for follicular lymphoma. Four years previously, the patient had been diagnosed with follicular lymphoma (Stage IIIA, Grade 2). She received several chemotherapy regimens, including rituximab and radiation therapy. Although these therapies achieved complete response temporally, they did not continue and recurred at 8 months before. Obinutuzumab and bendamustine therapy was selected, and she received five courses of obinutuzumab and bendamustine. She also received a SARS-CoV-2 mRNA vaccine two times. Although she did not have any symptoms, a routine check-up just before the 6th course of obinutuzumab and bendamustine revealed SARS-CoV-2 infection. Because she was immunosuppressed and was considered to be at high risk for the exacerbation of her disease, molnupiravir was immediately administered, and her SARS-CoV-2 antigen decreased. However, it was not completely cleared and flared-up at 6 weeks, with symptoms of COVID-19 appearing. Despite intensive treatment for SARS-CoV-2 infection, including remdesivir, baricitinib, tocilizumab and intravenous immunoglobulin, her SARS-CoV-2 antigen titer never became negative, and she finally died of respiratory failure caused by prolonged SARS-CoV-2 infection. Serial changes in the SARS-CoV-2 antigen titer during the clinical course and treatment strategies for immunosuppressed patients are discussed.
Collapse
Affiliation(s)
- Ryosuke Kambe
- Department of General Internal MedicineNational Hospital Organization Takasaki General Medical CenterTakasakiGunmaJapan
| | - Masamichi Sato
- Department of General Internal MedicineNational Hospital Organization Takasaki General Medical CenterTakasakiGunmaJapan
| | - Daisuke Uehara
- Department of General Internal MedicineNational Hospital Organization Takasaki General Medical CenterTakasakiGunmaJapan
| | - Yutaka Iizuka
- Department of General Internal MedicineNational Hospital Organization Takasaki General Medical CenterTakasakiGunmaJapan
| | - Satoru Kakizaki
- Department of Clinical ResearchNational Hospital Organization Takasaki General Medical CenterTakasakiGunmaJapan
| |
Collapse
|
10
|
Kawarada Y, Hara R, Kitahara T, Numata H, Watanabe S, Yamada M, Ando K. Aplastic Anemia with Epstein-Barr Virus Reactivation after Anti-thymocyte Globulin Therapy. Intern Med 2023; 62:2553-2557. [PMID: 36725050 PMCID: PMC10518559 DOI: 10.2169/internalmedicine.0539-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 12/11/2022] [Indexed: 02/03/2023] Open
Abstract
Lymphoproliferative disorders and Epstein-Barr virus reactivation (EBV-LPDs) have various forms of onset, ranging from infectious mononucleosis-like syndrome (IM-like) to lymphoma, although whether or not IM-like progresses to lymphoma remains unclear. A 61-year-old man was diagnosed with aplastic anemia (AA). Polyclonal atypical B-lymphocytes were observed in the peripheral blood, and IM-like was diagnosed. Atypical lymphocytes disappeared, but a gastrointestinal examination revealed diffuse large B-cell lymphoma (DLBCL). Rituximab was initiated but later discontinued because of severe acute respiratory syndrome coronavirus 2 infection. Pancytopenia due to AA exacerbation recurred. The patient ultimately died of multiple organ failure due to bacterial infection.
Collapse
Affiliation(s)
- Yo Kawarada
- Department of Hematology, Ebina General Hospital, Japan
| | - Ryujiro Hara
- Department of Hematology, Ebina General Hospital, Japan
- Division of Hematology/Oncology, Department of Internal Medicine, Tokai University School of Medicine, Japan
| | | | - Hiroki Numata
- Department of Hematology, Ebina General Hospital, Japan
- Division of Hematology/Oncology, Department of Internal Medicine, Tokai University School of Medicine, Japan
| | | | | | - Kiyoshi Ando
- Division of Hematology/Oncology, Department of Internal Medicine, Tokai University School of Medicine, Japan
| |
Collapse
|
11
|
Bakirtzis C, Konstantinidou N, Stavropoulou De Lorenzo S, Moysiadis T, Boziki MK, Grigoriadou E, Kesidou E, Theotokis P, Thireos E, Mitrou P, Grigoriadis N. COVID-19 Vaccination and Disease Course in People with Multiple Sclerosis in Greece. J Clin Med 2023; 12:5460. [PMID: 37685528 PMCID: PMC10488265 DOI: 10.3390/jcm12175460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/08/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
Over the past three years, humanity faced the abrupt spread of COVID-19, responsible for a worldwide health crisis. Initially, it was believed that individuals with chronic disorders, including multiple sclerosis, were more likely to be infected and suffer a worse degree of COVID-19 disease. Therefore, data with regard to COVID-19 disease outcomes in these populations may provide additional insight with regard to the management of chronic diseases during viral pandemics. The objective of this study is to evaluate COVID-19 disease course in people with multiple sclerosis (PwMS) during the COVID-19 pandemic in Greece and explore the impact of vaccination in the outcome of SARS-CoV-2 infection in this population. Anonymized data, extracted from nationwide administrative records between February 2020 and December 2021, were retrospectively analyzed in order to identify PwMS with SARS-CoV-2 infection. Demographic data, as well as data regarding COVID-19 infection and vaccination, were additionally collected. The study sample included 2351 PwMS (65.1% females, 51.2% unvaccinated at the time of infection). A total of 260 PwMS were hospitalized, while 25 PwMS died from COVID-19 disease and its complications. Older age, male sex and the presence of comorbidities were independently associated with a higher probability of hospitalization. The risk of hospitalization was decreased in PwMS receiving some disease-modifying treatments. Anti-CD20s demonstrated high odds ratios without reaching statistical significance. Regarding fatal outcome, only age reached statistical significance. Vaccination provided a significant protective effect against hospitalization but did not exhibit a statistically significant effect on mortality.
Collapse
Affiliation(s)
- Christos Bakirtzis
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (N.K.); (S.S.D.L.); (M.-K.B.); (E.G.); (E.K.); (P.T.); (N.G.)
| | - Natalia Konstantinidou
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (N.K.); (S.S.D.L.); (M.-K.B.); (E.G.); (E.K.); (P.T.); (N.G.)
| | - Sotiria Stavropoulou De Lorenzo
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (N.K.); (S.S.D.L.); (M.-K.B.); (E.G.); (E.K.); (P.T.); (N.G.)
| | - Theodoros Moysiadis
- Department of Computer Science, School of Sciences and Engineering, University of Nicosia, 2417 Nicosia, Cyprus;
| | - Marina-Kleopatra Boziki
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (N.K.); (S.S.D.L.); (M.-K.B.); (E.G.); (E.K.); (P.T.); (N.G.)
| | - Eleni Grigoriadou
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (N.K.); (S.S.D.L.); (M.-K.B.); (E.G.); (E.K.); (P.T.); (N.G.)
| | - Evangelia Kesidou
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (N.K.); (S.S.D.L.); (M.-K.B.); (E.G.); (E.K.); (P.T.); (N.G.)
| | - Paschalis Theotokis
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (N.K.); (S.S.D.L.); (M.-K.B.); (E.G.); (E.K.); (P.T.); (N.G.)
| | - Eleftherios Thireos
- Primary Health Center of Vari, National Health System of Greece, 16672 Athens, Greece;
| | - Panagiota Mitrou
- Independent Department of Therapeutic Protocols and Patient Registers, Hellenic Ministry of Health, 10433 Athens, Greece;
| | - Nikolaos Grigoriadis
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (N.K.); (S.S.D.L.); (M.-K.B.); (E.G.); (E.K.); (P.T.); (N.G.)
| |
Collapse
|
12
|
Nigro O, Oltolini C, Barzaghi F, Uberti Foppa C, Cicalese MP, Massimino M, Schiavello E. Pediatric cancer care management during the COVID-19 pandemic: a review of the literature and a single-centre real-life experience of an Italian pediatric oncology unit. Expert Rev Anticancer Ther 2023; 23:927-942. [PMID: 37712347 DOI: 10.1080/14737140.2023.2245148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/02/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION The severe acute respiratory syndrome coronavirus-2 pandemic significantly affected clinical practice, also in pediatric oncology units. Cancer patients needed to be treated with an adequate dose density despite the SARS-CoV-2 infection, balancing risks of developing severe COVID-19 disease. AREAS COVERED Although the pandemic spread worldwide, the prevalence of affected children was low. The percentage of children with severe illness was approximately 1-6%. Pediatric cancer patients represent a prototype of a previously healthy immune system that is hampered by the tumor itself and treatments, such as chemotherapy and steroids. Through a review of the literature, we reported the immunological basis of the response to SARS-CoV-2 infection, the existing antiviral treatments used in pediatric cancer patients, and the importance of vaccination. In conclusion, we reported the real-life experience of our pediatric oncology unit during the pandemic period. EXPERT OPINION Starting from the data available in literature, and our experience, showing the rarity of severe COVID-19 disease in pediatric patients with solid tumors, we recommend carefully tailoring all the oncological treatments (chemotherapy/targeted therapy/stem cell transplantation/radiotherapy). The aim is the preservation of the treatment's timing, balanced with an evaluation of possible severe COVID-19 disease.
Collapse
Affiliation(s)
- Olga Nigro
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Oltolini
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Barzaghi
- Pediatric Immunohematology and Bone Marrow Transplantation Unit and San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), San Raffaele Scientific Institute, Milan, Italy
| | - Caterina Uberti Foppa
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Pia Cicalese
- Pediatric Immunohematology and Bone Marrow Transplantation Unit and San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Maura Massimino
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | |
Collapse
|
13
|
Alqatari S, Nemer A, Hasan M, Bukhari R, Al Argan R, Al Khafaji D, Alwaheed A, Alzaki A, Al-wazza M, Al Warthan S, Al Saeed A, Albeladi F, Almeer H, AlSulaiman R, Abu Quren A. COVID-19 in patients with rheumatological diseases in the Eastern Province of Saudi Arabia. J Med Life 2023; 16:873-882. [PMID: 37675163 PMCID: PMC10478665 DOI: 10.25122/jml-2023-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/07/2023] [Indexed: 09/08/2023] Open
Abstract
The severity of the 2019 coronavirus disease (COVID-19) and its effects remain unpredictable. Certain factors, such as obesity, hypertension, and type 2 diabetes mellitus, may increase the severity of the disease. Rheumatology experts suggest that patients with active autoimmune conditions and controlled autoimmune diseases on immunosuppressive therapy may be at higher risk of developing severe COVID-19. In this retrospective observational study, we aimed to examine the patterns of COVID-19 in patients with underlying rheumatological diseases and their association with disease severity and hospital outcomes. A total of 34 patients with underlying rheumatological diseases who tested positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) by polymerase chain reaction (PCR) were included between March 2020 and April 2021 at King Fahd Hospital of the University. The study population consisted of 76.47% female and 23.53% male patients, with a mean age ranging from 20 to 40 years. Female gender (p=0.0001) and younger age (p=0.004) were associated with milder disease. The most frequent rheumatological disease was systemic lupus erythematosus (SLE) (38.24%), which was associated with a milder infection (p=0.045). Patients treated with mycophenolate mofetil (MMF) had a milder disease course (p=0.0037). Hypertension was significantly associated with severe COVID-19 disease (p=0.037). There was no significant relationship between SLE and the need for ICU admission. Patients on hydroxychloroquine and MMF tended to develop milder disease, and there was no association between the severity of the infection and the treatment with steroids.
Collapse
Affiliation(s)
- Safi Alqatari
- Department of Internal Medicine, College of Medicine, King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Ameera Nemer
- Department of Internal Medicine, College of Medicine, King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Manal Hasan
- Department of Internal Medicine, College of Medicine, King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Raed Bukhari
- Department of Internal Medicine, College of Medicine, King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Reem Al Argan
- Department of Internal Medicine, College of Medicine, King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Dania Al Khafaji
- Department of Internal Medicine, College of Medicine, King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Abrar Alwaheed
- Department of Internal Medicine, College of Medicine, King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Alaa Alzaki
- Department of Internal Medicine, College of Medicine, King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Marwan Al-wazza
- Department of Internal Medicine, College of Medicine, King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Sara Al Warthan
- Department of Internal Medicine, College of Medicine, King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Abir Al Saeed
- Department of Internal Medicine, College of Medicine, King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Feda Albeladi
- Department of Internal Medicine, College of Medicine, King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Hashim Almeer
- Department of Internal Medicine, College of Medicine, King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Reem AlSulaiman
- Department of Internal Medicine, College of Medicine, King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Ahmed Abu Quren
- Department of Internal Medicine, College of Medicine, King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| |
Collapse
|
14
|
Shah SZ, Alvarez FG, Sanghavi DK, Moreno Franco P, Isha S, Marquez CP, Libertin C, Guru PK, Sareyyupoglu B, Pham SM. Coronavirus Disease 2019 Causing Infection of Transplanted Lung Allograft: A Pitfall of Prolonged Shedding of Severe Acute Respiratory Syndrome Coronavirus-2 Pretransplant. Mayo Clin Proc Innov Qual Outcomes 2023; 7:93-98. [PMID: 36644594 PMCID: PMC9829600 DOI: 10.1016/j.mayocpiqo.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/25/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) pandemic has led to considerable morbidity and mortality across the world. Lung transplant is a viable option for a few with COVID-19-related lung disease. Whom and when to transplant has been the major question impacting the transplant community given the novelty of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We describe a pitfall of presumed prolonged shedding of SARS-CoV-2 in a patient with COVID-19 associated acute respiratory distress syndrome leading to COVID-19 pneumonia after lung transplant. This raises concerns that replication-competent SARS-CoV-2 virus can persist for months post-infection and can lead to re-infection of grafts in the future.
Collapse
Key Words
- BAL, bronchoalveolar lavage
- BSL-3, Biosafety level-3
- COVID-19, coronavirus disease 2019
- CP, convalescent plasma
- CT, computed tomography
- LT, lung transplant
- NPS, nasopharyngeal swab
- RT-PCR, reverse transcriptase–polymerase chain reaction
- SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
- VV-ECMO, veno-venous extracorporeal membrane oxygenation
Collapse
Affiliation(s)
- Sadia Z. Shah
- Department of Transplantation, Mayo Clinic, Jacksonville, FL,Correspondence: Address to Sadia Z. Shah, Department of Transplantation, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224
| | | | | | | | - Shahin Isha
- Department of Critical Care, Mayo Clinic, Jacksonville, FL
| | | | - Claudia Libertin
- Division of Infectious Disease, Department of Medicine, and Mayo Clinic, Jacksonville, FL
| | - Pramod K. Guru
- Department of Critical Care, Mayo Clinic, Jacksonville, FL
| | | | - Si M. Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL
| |
Collapse
|
15
|
Chevalier K, Genin M, Jean TP, Avouac J, Flipo RM, Georgin-Lavialle S, El Mahou S, Pertuiset E, Pham T, Servettaz A, Marotte H, Domont F, Chazerain P, Devaux M, Mekinian A, Sellam J, Fautrel B, Rouzaud D, Ebstein E, Costedoat-Chalumeau N, Richez C, Hachulla E, Mariette X, Seror R. CovAID: Identification of factors associated with severe COVID-19 in patients with inflammatory rheumatism or autoimmune diseases. Front Med (Lausanne) 2023; 10:1152587. [PMID: 37035330 PMCID: PMC10075312 DOI: 10.3389/fmed.2023.1152587] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/27/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Autoimmune/inflammatory rheumatic diseases (AIRDs) patients might be at-risk of severe COVID-19. However, whether this is linked to the disease or to its treatment is difficult to determine. This study aimed to identify factors associated with occurrence of severe COVID-19 in AIRD patients and to evaluate whether having an AIRD was associated with increased risk of severe COVID-19 or death. Materials and methods Two databases were analyzed: the EDS (Entrepôt des Données de Santé, Clinical Data Warehouse), including all patients followed in Paris university hospitals and the French multi-center COVID-19 cohort [French rheumatic and musculoskeletal diseases (RMD)]. First, in a combined analysis we compared patients with severe and non-severe COVID-19 to identify factors associated with severity. Then, we performed a propensity matched score case-control study within the EDS database to compare AIRD cases and non-AIRD controls. Results Among 1,213 patients, 195 (16.1%) experienced severe COVID-19. In multivariate analysis, older age, interstitial lung disease (ILD), arterial hypertension, obesity, sarcoidosis, vasculitis, auto-inflammatory diseases, and treatment with corticosteroids or rituximab were associated with increased risk of severe COVID-19. Among 35,741 COVID-19 patients in EDS, 316 having AIRDs were compared to 1,264 Propensity score-matched controls. AIRD patients had a higher risk of severe COVID-19 [aOR = 1.43 (1.08-1.87), p = 0.01] but analysis restricted to rheumatoid arthritis and spondyloarthritis found no increased risk of severe COVID-19 [aOR = 1.11 (0.68-1.81)]. Conclusion In this multicenter study, we confirmed that AIRD patients treated with rituximab or corticosteroids and/or having vasculitis, auto-inflammatory disease, and sarcoidosis had increased risk of severe COVID-19. Also, AIRD patients had, overall, an increased risk of severe COVID-19 compares general population.
Collapse
Affiliation(s)
- Kevin Chevalier
- Department of Rheumatology, Université Paris-Saclay, INSERM UMR 1184: Center for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Michaël Genin
- University of Lille, CHU Lille, ULR 2694–METRICS: Evaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
| | | | | | | | | | | | | | - Thao Pham
- Hospital Sainte Marguerite, Rheumatology, Marseille, France
| | - Amelie Servettaz
- Hospital Robert Debré, Internal Medicine, Infectious Diseases and Clinical Immunology, Reims, France
| | - Hubert Marotte
- University Hospital of Saint-Étienne, Rheumatology, Saint-Priest-en-Jarez, France
| | - Fanny Domont
- University Hospitals Pitié Salpêtrière - Charles Foix, Internal Medicine and Clinical Immunology, Paris, France
| | - Pascal Chazerain
- Hopital de la Croix Saint-Simon, Rheumatology and Internal Medicine, Paris, France
| | - Mathilde Devaux
- Saint-Germain-en-Laye Intercommunal Hospital Center, Internal Medicine, Poissy, France
| | - Arsene Mekinian
- Hospital Saint-Antoine AP-HP, Internal Medicine, Paris, France
| | - Jérémie Sellam
- Hospital Saint-Antoine AP-HP, Rheumatology, Paris, France
| | - Bruno Fautrel
- Sorbonne Universite – APHP, Pitie Salpetriere Hospital, Department of Rheumatology, Pierre Louis Institute of Epidemiology and Public Health, INSERM UMRS 1136, Paris, France
| | - Diane Rouzaud
- Bichat-Claude Bernard Hospital, Internal Medicine, Paris, France
| | - Esther Ebstein
- Bichat-Claude Bernard Hospital, Rheumatology, Paris, France
| | | | | | - Eric Hachulla
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Centre for Rare Systemic Autoimmune Diseases North and North-West of France (CeRAINO), CHU Lille, University of Lille, INSERM, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - Xavier Mariette
- Department of Rheumatology, Université Paris-Saclay, INSERM UMR 1184: Center for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Raphaèle Seror
- Department of Rheumatology, Université Paris-Saclay, INSERM UMR 1184: Center for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| |
Collapse
|
16
|
Acute Kidney Injury with SARS-CoV-2 Infection in Pediatric Patients Receiving High-Dose Methotrexate Chemotherapy: A Report of Three Cases. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020331. [PMID: 36832467 PMCID: PMC9954875 DOI: 10.3390/children10020331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/09/2022] [Accepted: 02/07/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Methotrexate is renally excreted. HDMTX (high dose-methotrexate)-induced acute kidney injury (AKI) is a non-oliguric decrease in glomerular filtration rate (GFR) heralded by an acute rise in serum creatinine. Moreover, AKI is also a frequent complication of COVID-19. Among our patients treated with HDMTX, some of these developed AKI during SARS-CoV-2 infection. Therefore, we wondered whether our patients' kidney failure might have been triggered by their underlying SARS-CoV-2 positivity. METHODS Data were collected from the database at the Pediatric Oncology Unit of the Istituto Nazionale dei Tumori in Milan (Italy) regarding patients who matched the following selective criteria: (a) treatment with HDMTX during the pandemic period; (b) SARS-CoV-2 infection during the treatment; (c) development of AKI during HDMTX treatment and SARS-CoV-2 infection. RESULTS From March 2020 to March 2022, a total of 23 patients were treated with HDMTX; 3 patients were treated with HDMTX during SARS-CoV-2 infection and all 3 developed AKI. CONCLUSIONS Clinical manifestations associated with this virus are many, so we are not yet able to lower our guard and rule out this infection as a cause of clinical manifestations with any certainty.
Collapse
|
17
|
Bauer PR, Midthun DE. Bronchoscopy in the Critically Ill: Yes, No, Maybe? Chest 2023; 163:10-11. [PMID: 36628662 DOI: 10.1016/j.chest.2022.08.2234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 08/31/2022] [Indexed: 01/11/2023] Open
Affiliation(s)
- Philippe R Bauer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
| | - David E Midthun
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| |
Collapse
|
18
|
Delgado-Fernández M, García-Gemar GM, Fuentes-López A, Muñoz-Pérez MI, Oyonarte-Gómez S, Ruíz-García I, Martín-Carmona J, Sanz-Cánovas J, Castaño-Carracedo MÁ, Reguera-Iglesias JM, Ruíz-Mesa JD. Treatment of COVID-19 with convalescent plasma in patients with humoral immunodeficiency - Three consecutive cases and review of the literature. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:507-516. [PMID: 36336380 PMCID: PMC9631336 DOI: 10.1016/j.eimce.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/20/2021] [Indexed: 06/16/2023]
Abstract
Patients lacking humoral response have been suggested to develop a less severe COVID-19, but there are some reports with a prolonged, relapsing or deadly course. From April 2020, there is growing evidence on the benefits of COVID-19 convalescent plasma (CCP) for patients with humoral immunodeficiency. Most of them had a congenital primary immunodeficiency or were on treatment with anti CD20 antibodies. We report on three patients treated in our hospital and review thirty-one more cases described in the literature. All patients but three resolved clinical picture with CCP. A dose from 200 to 800ml was enough in most cases. Antibody levels after transfusion were negative or low, suggesting consumption of them in SARS-CoV-2 neutralization. These patients have a protracted clinical course shortened after CCP. CCP could be helpful for patients with humoral immunodeficiency. It avoid relapses and chronification. CCP should be transfused as early as possible in patients with COVID-19 and humoral immunodeficiency.
Collapse
Affiliation(s)
| | | | - Ana Fuentes-López
- Microbiology Department, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | | | - Salvador Oyonarte-Gómez
- Director of "Red andaluza de Medicina transfusional, tejidos y células" del Sistema Sanitario Público de Andalucía, Spain
| | | | | | - Jaime Sanz-Cánovas
- Internal Medicine Department, Hospital Regional Universitario de Málaga, Spain
| | | | | | - Juan Diego Ruíz-Mesa
- Infectious Diseases Department, Hospital Regional Universitario de Málaga, Spain
| |
Collapse
|
19
|
Longitudinal Analyses after COVID-19 Recovery or Prolonged Infection Reveal Unique Immunological Signatures after Repeated Vaccinations. Vaccines (Basel) 2022; 10:vaccines10111815. [DOI: 10.3390/vaccines10111815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/13/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022] Open
Abstract
To develop preventive and therapeutic measures against coronavirus disease 2019, the complete characterization of immune response and sustained immune activation following viral infection and vaccination are critical. However, the mechanisms controlling intrapersonal variation in antibody titers against SARS-CoV-2 antigens remain unclear. To gain further insights, we performed a robust molecular and cellular investigation of immune responses in infected, recovered, and vaccinated individuals. We evaluated the serum levels of 29 cytokines and their correlation with neutralizing antibody titer. We investigated memory B-cell response in patients infected with the original SARS-CoV-2 strain or other variants, and in vaccinated individuals. Longitudinal correlation analyses revealed that post-vaccination neutralizing potential was more strongly associated with various serum cytokine levels in recovered patients than in naïve individuals. We found that IL-10, CCL2, CXCL10, and IL-12p40 are candidate biomarkers of serum-neutralizing antibody titer after the vaccination of recovered individuals. We found a similar distribution of virus-specific antibody gene families in triple-vaccinated individuals and a patient with COVID-19 pneumonia for 1 year. Thus, distinct immune responses occur depending on the viral strain and clinical history, suggesting that therapeutic options should be selected on a case-by-case basis. Candidate biomarkers that correlate with repeated vaccination may support the efficacy and safety evaluation systems of mRNA vaccines and lead to the development of novel vaccine strategies.
Collapse
|
20
|
Sugita A, Inagaki FF, Takemura N, Nakamura M, Ito K, Mihara F, Yamamoto K, Morioka S, Kokudo N. Liver resection in a patient with persistent positive PCR test for coronavirus disease 2019 (COVID-19): a case report. Surg Case Rep 2022; 8:200. [PMID: 36264514 PMCID: PMC9583064 DOI: 10.1186/s40792-022-01553-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The perioperative mortality rate is high in patients with coronavirus disease 2019 (COVID-19), and infection control measures for medical care providers must be considered. Therefore, the timing for surgery in patients recovering from COVID-19 is difficult. CASE PRESENTATION A 65-year-old man was admitted to a hospital with a diagnosis of moderate COVID-19. He was transferred to our hospital because of risk factors, including heavy smoking history, type 2 diabetes mellitus, and obesity (BMI 34). Vital signs on admission were a temperature of 36.1 °C, oxygen saturation > 95% at rest, and 94% on exertion with 3 L/min of oxygen. Chest computed tomography (CT) showed bilateral ground-glass opacities, predominantly in the lower lungs. Contrast-enhanced abdominal CT incidentally revealed a liver tumor with a diameter of 80 mm adjacent to the middle hepatic vein, which was diagnosed as hepatocellular carcinoma (HCC). After being administered baricitinib, remdesivir, dexamethasone, and heparin, the patient's COVID-19 pneumonia improved, his oxygen demand resolved, and he was discharged on day 13. Furthermore, the patient was initially scheduled for hepatectomy 8 weeks after the onset of COVID-19 following a discussion with the infection control team. However, 8 weeks after the onset of illness, a polymerase chain reaction (PCR) test was performed on nasopharyngeal swab fluid, which was observed to be positive. The positive results persisted till 10 and 11 weeks after onset. Both Ct values were high (≥ 31) out of 45 cycles, with no subjective symptoms. Since we determined that he was no longer contagious, surgery was performed 12 weeks after the onset of COVID-19. Notably, medical staff wearing personal protective equipment performed extended anatomical resection of the liver segment 8 ventral area in a negative-pressure room. The patient had a good postoperative course, with no major complications, including respiratory complications, and was discharged on postoperative day 14. Finally, none of the staff members was infected with COVID-19. CONCLUSIONS We reported a case regarding the timing of surgery on a patient with persistently positive PCR test results after COVID-19, along with a literature review.
Collapse
Affiliation(s)
- Akiho Sugita
- grid.45203.300000 0004 0489 0290Department of Surgery, National Center for Global Health and Medicine, Hepato-Biliary-Pancreatic Surgery Division, 1-21-1 Toyama, Shinjyuku-ku, Tokyo, 162-8655 Japan ,grid.45203.300000 0004 0489 0290National Center for Global Health and Medicine, Disease Control and Prevention Center, Tokyo, Japan
| | - Fuyuki F. Inagaki
- grid.45203.300000 0004 0489 0290Department of Surgery, National Center for Global Health and Medicine, Hepato-Biliary-Pancreatic Surgery Division, 1-21-1 Toyama, Shinjyuku-ku, Tokyo, 162-8655 Japan
| | - Nobuyuki Takemura
- grid.45203.300000 0004 0489 0290Department of Surgery, National Center for Global Health and Medicine, Hepato-Biliary-Pancreatic Surgery Division, 1-21-1 Toyama, Shinjyuku-ku, Tokyo, 162-8655 Japan
| | - Mai Nakamura
- grid.45203.300000 0004 0489 0290Department of Surgery, National Center for Global Health and Medicine, Hepato-Biliary-Pancreatic Surgery Division, 1-21-1 Toyama, Shinjyuku-ku, Tokyo, 162-8655 Japan
| | - Kyoji Ito
- grid.45203.300000 0004 0489 0290Department of Surgery, National Center for Global Health and Medicine, Hepato-Biliary-Pancreatic Surgery Division, 1-21-1 Toyama, Shinjyuku-ku, Tokyo, 162-8655 Japan
| | - Fuminori Mihara
- grid.45203.300000 0004 0489 0290Department of Surgery, National Center for Global Health and Medicine, Hepato-Biliary-Pancreatic Surgery Division, 1-21-1 Toyama, Shinjyuku-ku, Tokyo, 162-8655 Japan
| | - Kei Yamamoto
- grid.45203.300000 0004 0489 0290National Center for Global Health and Medicine, Disease Control and Prevention Center, Tokyo, Japan
| | - Shinichiro Morioka
- grid.45203.300000 0004 0489 0290National Center for Global Health and Medicine, Disease Control and Prevention Center, Tokyo, Japan
| | - Norihiro Kokudo
- grid.45203.300000 0004 0489 0290Department of Surgery, National Center for Global Health and Medicine, Hepato-Biliary-Pancreatic Surgery Division, 1-21-1 Toyama, Shinjyuku-ku, Tokyo, 162-8655 Japan
| |
Collapse
|
21
|
Clinical and biological prognostic factors in follicular lymphoma patients. PLoS One 2022; 17:e0272787. [PMID: 35925993 PMCID: PMC9351995 DOI: 10.1371/journal.pone.0272787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/26/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
Follicular lymphoma (FL) is an indolent, yet heterogeneous, B-cell lymphoproliferative disorder. Although most FL patients respond well to treatment, few with specific traits have a poor prognosis; the latter are difficult to define.
Patients and methods
We retrospectively analyzed data from 143 FL patients treated at the University of Debrecen since 2009 and investigated prognostic factors that may influence the survival of FL patients.
Results
A maximum standardized uptake value (SUVmax) cut-off of 9.85 at the staging positron emission tomography/computed tomography (PET/CT) (p = 0.0001, hazard ratio [HR]: 0.2535, 95% confidence interval [CI]: 0.1118–0.4878) and a lymphocyte/monocyte (Ly/Mo) ratio of 3.41 (p = 0.0027, HR: 2.997, 95% CI: 1.463–6.142), drawn at diagnosis, significantly predicted FL patients’ progression-free survival (PFS). A staging SUVmax >9.85 with Ly/Mo <3.41 could delineate a high-risk group of FL patients (p<0.0001, HR: 0.0957, 95% CI: 0.03416–0.2685). Similarly, a significant difference was shown with an SUVmax cut-off of 3.15 at the interim PET/CT (p<0.0001, HR: 0.1614, 95% CI: 0.06684–0.3897). A staging SUVmax >9.85 in conjunction with interim SUVmax >3.15 predicted poor prognosis (p<0.0001, HR: 0.1037, 95% CI: 0.03811–0.2824). The PFS difference was translated into overall survival (OS) advantage (p = 0.0506, HR: 0.1187, 95% CI: 0.01401–1.005).
Conclusion
Biological prognostic factors, such as the Ly/Mo ratio, may improve the prognostic assessment of staging PET/CT. The survival advantage observed in PFS is translated into OS when determined using a combination of staging and interim SUVmax. We recommend investigating additional biological prognostic factors while highlighting the role of PET/CT in FL.
Collapse
|
22
|
Laracy JC, Kamboj M, Vardhana SA. Long and persistent COVID-19 in patients with hematologic malignancies: from bench to bedside. Curr Opin Infect Dis 2022; 35:271-279. [PMID: 35849516 PMCID: PMC9922441 DOI: 10.1097/qco.0000000000000841] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Cancer patients, especially those with hematologic malignancies, are at increased risk for coronavirus disease 2019 (COVID-19)-related complications and mortality. We describe the incidence, clinical characteristics, risk factors, and outcomes of persistent COVID-19 infection in patients with hematologic malignancies. RECENT FINDINGS The syndrome of persistent COVID-19 in patients with hematologic malignancies manifests as a chronic protracted illness marked by waxing and waning or progressive respiratory symptoms and prolonged viral shedding. Immunosuppressed patients with lymphoid malignancies may serve as partially immune reservoirs for the generation of immune-evasive viral escape mutants. SUMMARY Persistent COVID-19 infection is a unique concern in patients with hematologic malignancies. While vaccination against severe acute respiratory syndrome coronavirus 2 has reduced the overall burden of COVID-19 in patients with hematologic cancers, whether vaccination or other novel treatments for COVID-19 prevent or alleviate this syndrome remains to be determined.
Collapse
Affiliation(s)
- Justin C. Laracy
- Infectious Diseases, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Infection Control, Division of Quality and Safety, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mini Kamboj
- Infectious Diseases, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Infection Control, Division of Quality and Safety, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Santosha A. Vardhana
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
23
|
Fujii T, Hagihara M, Mitamura K, Nakashima S, Ohara S, Uchida T, Inoue M, Okuda M, Yasuhara A, Murakami J, Duong C, Iwatsuki-Horimoto K, Yamayoshi S, Kawaoka Y. Anti-SARS CoV-2 IgG in COVID-19 Patients with Hematological Diseases: A Single-center, Retrospective Study in Japan. Intern Med 2022; 61:1681-1686. [PMID: 35342138 PMCID: PMC9259303 DOI: 10.2169/internalmedicine.9209-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread globally. Although the relationship between anti-SARS-CoV-2 immunoglobulin G (IgG) antibodies and COVID-19 severity has been reported, information is lacking regarding the seropositivity of patients with particular types of diseases, including hematological diseases. Methods In this single-center, retrospective study, we compared SARS-CoV-2 IgG positivity between patients with hematological diseases and those with non-hematological diseases. Results In total, 77 adult COVID-19 patients were enrolled. Of these, 30 had hematological disorders, and 47 had non-hematological disorders. The IgG antibody against the receptor-binding domain of the spike protein was detected less frequently in patients with hematological diseases (60.0%) than in those with non-hematological diseases (91.5%; p=0.029). Rituximab use was significantly associated with seronegativity (p=0.010). Conclusion Patients with hematological diseases are less likely to develop anti-SARS-CoV-2 antibodies than those with non-hematological diseases, which may explain the poor outcomes of COVID-19 patients in this high-risk group.
Collapse
Affiliation(s)
- Takayuki Fujii
- Department of Hematology, Eiju General Hospital, Japan
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
| | | | - Keiko Mitamura
- Division of Infection Control, Eiju General Hospital, Japan
| | | | - Shin Ohara
- Department of Hematology, Eiju General Hospital, Japan
| | | | | | - Moe Okuda
- Division of Virology, Institute of Medical Science, University of Tokyo, Japan
| | - Atsuhiro Yasuhara
- Division of Virology, Institute of Medical Science, University of Tokyo, Japan
| | - Jurika Murakami
- Division of Virology, Institute of Medical Science, University of Tokyo, Japan
| | - Calvin Duong
- Division of Virology, Institute of Medical Science, University of Tokyo, Japan
| | | | - Seiya Yamayoshi
- Division of Virology, Institute of Medical Science, University of Tokyo, Japan
- The Research Center for Global Viral Diseases, Research Institute, National Center for Global Health and Medicine, Japan
| | - Yoshihiro Kawaoka
- Division of Virology, Institute of Medical Science, University of Tokyo, Japan
- The Research Center for Global Viral Diseases, Research Institute, National Center for Global Health and Medicine, Japan
| |
Collapse
|
24
|
Maekura C, Muramatsu A, Nagata H, Okamoto H, Onishi A, Kato D, Isa R, Fujino T, Tsukamoto T, Mizutani S, Shimura Y, Kobayashi T, Okumura K, Inaba T, Nukui Y, Kuroda J. Clinical Implication of the Effect of the Production of Neutralizing Antibodies Against SARS-Cov-2 for Chronic Immune Thrombocytopenia Flare-Up Associated with COVID-19 Infection: A Case Report and the Review of Literature. Infect Drug Resist 2022; 15:2723-2728. [PMID: 35668857 PMCID: PMC9166912 DOI: 10.2147/idr.s360238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/21/2022] [Indexed: 01/08/2023] Open
Abstract
Previous studies have demonstrated that the appropriate production of serum anti-severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) neutralizing antibody (nAb) plays a critical role in the recovery from coronavirus disease 2019 (COVID-19); however, the role of nAb production in the recovery from a flare-up of chronic immune thrombocytopenia (ITP) has been unknown. We here report the first retrospectively investigated case of serum anti-SARS-Cov-2 nAb production during chronic ITP flare-up triggered by COVID-19. A 79-year-old woman with a history of corticosteroid-refractory ITP visited our hospital complaining of fever, cough, and sore throat for 4 days. Although chronic ITP was controlled by 12.5 mg of eltrombopag (EPAG) every other day, laboratory tests showed a decreased peripheral blood platelet count of 15.0 × 109/L, which indicated worsening thrombocytopenia. Meanwhile, PCR testing of a nasopharyngeal swab revealed that the patient was positive for SARS-Cov-2, and a computed tomography scan revealed bilateral pneumonia. On the basis of the flare-up of chronic ITP associated with COVID-19 pneumonia which was determined as a moderately severe status according to the WHO clinical progression scale, intravenous immunoglobulin therapy for 5 days (days 0-4) and antiviral therapy were added on top of EPAG, which only resulted in a transient increase in the platelet count for several days. After decreasing to 8.0 × 109/L on day 13, the platelet count increased from day 16, coinciding with a positive detection for serum nAb against SARS-Cov-2. Although the increased dose up to 50 mg/day of EPAG was challenged during the clinical course, rapid dose reduction did not cause another relapse. In addition, no thrombotic or bleeding event was seen. These collectively suggest the vital role of the production of anti-SARS-Cov-2 nAb and improvement of clinical symptoms for recovery from a flare-up of chronic ITP in our case.
Collapse
Affiliation(s)
- Chika Maekura
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ayako Muramatsu
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroaki Nagata
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Haruya Okamoto
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Akio Onishi
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Daishi Kato
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Reiko Isa
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takahiro Fujino
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Taku Tsukamoto
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinsuke Mizutani
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuji Shimura
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Blood Transfusion, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tsutomu Kobayashi
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keita Okumura
- Faculty of Clinical Laboratory, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tohru Inaba
- Department of Infection Control & Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoko Nukui
- Department of Infection Control & Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Junya Kuroda
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| |
Collapse
|
25
|
Early Cellular and Humoral Responses Developed in Oncohematological Patients after Vaccination with One Dose against COVID-19. J Clin Med 2022; 11:jcm11102803. [PMID: 35628927 PMCID: PMC9147947 DOI: 10.3390/jcm11102803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 11/17/2022] Open
Abstract
Individuals with oncohematological diseases (OHD) may develop an impaired immune response against vaccines due to the characteristics of the disease or to its treatment. Humoral response against SARS-CoV-2 has been described to be suboptimal in these patients, but the quality and efficiency of the cellular immune response has not been yet completely characterized. In this study, we analyzed the early humoral and cellular immune responses in individuals with different OHD after receiving one dose of an authorized vaccine against SARS-CoV-2. Humoral response, determined by antibodies titers and neutralizing capacity, was overall impaired in individuals with OHD, except for the cohort of chronic myeloid leukemia (CML), which showed higher levels of specific IgGs than healthy donors. Conversely, the specific direct cytotoxic cellular immunity response (DCC) against SARS-CoV-2, appeared to be enhanced, especially in individuals with CML and chronic lymphocytic leukemia (CLL). This increased cellular immune response, developed earlier than in healthy donors, showed a modest cytotoxic activity that was compensated by significantly increased numbers, likely due to the disease or its treatment. The analysis of the immune response through subsequent vaccine doses will help establish the real efficacy of COVID-19 vaccines in individuals with OHD.
Collapse
|
26
|
Martínez-Chinchilla C, Vazquez-Montero L, Palazón-Carrión N, Fernández-Román IM, López-Barba J, de la Cruz-Merino L, Rodríguez-Baño J, Palacios-Baena ZR. Persistence of SARS-CoV-2 Infection in Severely Immunocompromised Patients With Complete Remission B-Cell Lymphoma and Anti-CD20 Monoclonal Antibody Therapy: A Case Report of Two Cases. Front Immunol 2022; 13:860891. [PMID: 35493500 PMCID: PMC9046988 DOI: 10.3389/fimmu.2022.860891] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/15/2022] [Indexed: 12/18/2022] Open
Abstract
Immunosuppressant conditions such as hematological malignancies increase the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. It has been described in the literature that patients on anti-CD20 maintenance therapies for lymphoid malignancies are susceptible to having recurrent flares together with viral replication or reinfections, although these cases are scarce. These patients are not well represented in randomized controlled trials, and as a consequence, the evidence for the use of certain treatments in this scenario is lacking. We present two cases of patients with B-cell lymphoma on remission and treated with rituximab on maintenance. They developed at least 1 flare of coronavirus disease 2019 (COVID-19) after acute infection and always after receiving rituximab. RT-PCR was positive in the nasopharyngeal swab and also in plasma. Patients were treated during flares with remdesivir, hyperimmune plasma, and corticosteroids. These two cases showed the unresolved problem of COVID-19 in immunosuppressant patients and showed that despite the vast amount of information available on SARS-CoV-2, information in this subgroup of patients is lacking.
Collapse
Affiliation(s)
| | | | - Natalia Palazón-Carrión
- Clinical Oncology Department, University Hospital Virgen Macarena, Seville, Spain
- Department of Medicine, University of Seville, Seville, Spain
| | | | - José López-Barba
- Infectious Diseases and Microbiology, University Hospital Virgen Macarena, and Biomedicine Institute of Sevilla (IBIS)/CSIC, Seville, Spain
| | - Luis de la Cruz-Merino
- Clinical Oncology Department, University Hospital Virgen Macarena, Seville, Spain
- Department of Medicine, University of Seville, Seville, Spain
| | - Jesús Rodríguez-Baño
- Department of Medicine, University of Seville, Seville, Spain
- Infectious Diseases and Microbiology, University Hospital Virgen Macarena, and Biomedicine Institute of Sevilla (IBIS)/CSIC, Seville, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- *Correspondence: Jesús Rodríguez-Baño,
| | - Zaira R. Palacios-Baena
- Infectious Diseases and Microbiology, University Hospital Virgen Macarena, and Biomedicine Institute of Sevilla (IBIS)/CSIC, Seville, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| |
Collapse
|
27
|
Progression of COVID-19 in a Patient on Anti-CD20 Antibody Treatment: Case Report and Literature Review. Case Rep Infect Dis 2022; 2022:8712424. [PMID: 35251723 PMCID: PMC8896938 DOI: 10.1155/2022/8712424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/28/2022] [Indexed: 11/17/2022] Open
Abstract
Accumulating evidence suggests that anti-CD20 treatments are associated with a more severe course of COVID-19. We present the case of a 72-year-old woman treated with the B-cell-depleting anti-CD20 antibody rituximab for seropositive rheumatoid arthritis with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causing a clinical relapse more than 4 weeks after the first manifestation. Persistently positive reverse transcription polymerase chain reaction (RT-PCR) results along with a drop in cycling threshold (Ct) values, in addition to recovery of identical viral genotype by whole genome sequencing (WGS) during the disease course, argued against reinfection. No seroconversion was noted, as expected on anti-CD20 treatment. Several other case reports have highlighted potentially fatal courses of COVID-19 associated with B-cell-depleting treatments.
Collapse
|
28
|
Thornton CS, Huntley K, Berenger BM, Bristow M, Evans DH, Fonseca K, Franko A, Gillrie MR, Lin YC, Povitz M, Shafey M, Conly JM, Tremblay A. Prolonged SARS-CoV-2 infection following rituximab treatment: clinical course and response to therapeutic interventions correlated with quantitative viral cultures and cycle threshold values. Antimicrob Resist Infect Control 2022; 11:28. [PMID: 35123573 PMCID: PMC8817557 DOI: 10.1186/s13756-022-01067-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA is completed through reverse transcriptase-PCR (RT-PCR) from either oropharyngeal or nasopharyngeal swabs, critically important for diagnostics but also from an infection control lens. Recent studies have suggested that COVID-19 patients can demonstrate prolonged viral shedding with immunosuppression as a key risk factor. Case presentation We present a case of an immunocompromised patient with SARS-CoV-2 infection demonstrating prolonged infectious viral shedding for 189 days with virus cultivability and clinical relapse with an identical strain based on whole genome sequencing, requiring a multi-modal therapeutic approach. We correlated clinical parameters, PCR cycle thresholds and viral culture until eventual resolution.
Conclusions We successfully demonstrate resolution of viral shedding, administration of COVID-19 vaccination and maintenance of viral clearance. This case highlights implications in the immunosuppressed patient towards infection prevention and control that should consider those with prolonged viral shedding and may require ancillary testing to fully elucidate viral activity. Furthermore, this case raises several stimulating questions around complex COVID-19 patients around the role of steroids, effect of antiviral therapies in absence of B-cells, role for vaccination and the requirement of a multi-modal approach to eventually have successful clearance of the virus. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-022-01067-1.
Collapse
Affiliation(s)
- Christina S Thornton
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kevin Huntley
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Byron M Berenger
- Alberta Precision Laboratories, Alberta Public Health Laboratory, Calgary, AB, Canada.,Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Michael Bristow
- Department of Radiology, University of Calgary, Calgary, AB, Canada.,Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - David H Evans
- Department of Medical Microbiology and Immunology and Li Ka Shing Institute of Virology, University of Alberta, Calgary, AB, Canada
| | - Kevin Fonseca
- Alberta Precision Laboratories, Alberta Public Health Laboratory, Calgary, AB, Canada.,Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB, Canada
| | - Angela Franko
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Mark R Gillrie
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB, Canada
| | - Yi-Chan Lin
- Department of Medical Microbiology and Immunology and Li Ka Shing Institute of Virology, University of Alberta, Calgary, AB, Canada
| | - Marcus Povitz
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mona Shafey
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - John M Conly
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB, Canada. .,Foothills Medical Centre, SSB, 1403 29 St NW, Calgary, AB, T2N2T9, Canada.
| | - Alain Tremblay
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Foothills Medical Centre, 3300 Hospital Drive NW, Calgary, AB, T2N4N1, Canada.
| |
Collapse
|
29
|
Bisceglia I, Canale ML, Gallucci G, Turazza FM, Lestuzzi C, Parrini I, Russo G, Maurea N, Quagliariello V, Oliva S, Di Fusco SA, Lucà F, Tarantini L, Trambaiolo P, Moreo A, Geraci G, Gabrielli D, Gulizia MM, Oliva F, Colivicchi F. Cardio-Oncology in the COVID Era (Co & Co): The Never Ending Story. Front Cardiovasc Med 2022; 9:821193. [PMID: 35155636 PMCID: PMC8831543 DOI: 10.3389/fcvm.2022.821193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/04/2022] [Indexed: 12/30/2022] Open
Abstract
The pathophysiology of some non-communicable diseases (NCDs) such as hypertension, cardiovascular disease (CVD), diabetes, and cancer includes an alteration of the endothelial function. COVID-19 is a pulmonary and vascular disease with a negative impact on patients whose damaged endothelium is particularly vulnerable. The peculiar SARS-CoV-2-induced “endothelitis” triggers an intriguing immune-thrombosis that affects both the venous and arterial vascular beds. An increased liability for infection and an increased likelihood of a worse outcome have been observed during the pandemic in patients with active cancer and in cancer survivors. “Overlapping commonalities” between COVID-19 and Cardio-Oncology have been described that include shared phenotypes of cardiovascular toxicities such as left ventricular dysfunction, ischemic syndromes, conduction disturbances, myocarditis, pericarditis and right ventricular failure; shared pathophysiologic mechanisms such as inflammation, release of cytokines, the renin-angiotensin-aldosterone-pathway, coagulation abnormalities, microthrombosis and endothelial dysfunction. For these features and for the catalyst role of NCDs (mainly CVD and cancer), we should refer to COVID-19 as a “syndemic.” Another challenging issue is the persistence of the symptoms, the so-called “long COVID” whose pathogenesis is still uncertain: it may be due to persistent multi-organ viral attacks or to an abnormal immune response. An intensive vaccination campaign is the most successful pharmacological weapon against SARS-CoV-2, but the increasing number of variants has reduced the efficacy of the vaccines in controlling SARS-CoV-2 infections. After a year of vaccinations we have also learned more about efficacy and side-effects of COVID-19 vaccines. An important byproduct of the COVID-19 pandemic has been the rapid expansion of telemedicine platforms across different care settings; this new modality of monitoring cancer patients may be useful even in a post pandemic era. In this paper we analyze the problems that the cardio-oncologists are facing in a pandemic scenario modified by the extensive vaccination campaign and add actionable recommendations derived from the ongoing studies and from the syndemic nature of the infection.
Collapse
Affiliation(s)
- Irma Bisceglia
- Integrated Cardiology Services, Cardio-Thoracic-Vascular Department, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Maria Laura Canale
- Cardiology Department, Nuovo Ospedale Versilia Lido di Camaiore Lucca, Camaiore, Italy
| | - Giuseppina Gallucci
- Cardio-Oncology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Referral Cancer Center of Basilicata, Rionero in Vulture, Italy
- *Correspondence: Giuseppina Gallucci
| | - Fabio Maria Turazza
- Cardiology Department, Fondazione IRCCS Instituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Lestuzzi
- Azienda Sanitaria Friuli Occidentale (ASFO) Cardiac and Cardio-Oncologic Rehabilitation Service at Centro di Riferimento Oncologico (CRO), National Cancer Institute, Aviano, Italy
| | - Iris Parrini
- Cardiology Department, Ospedale Mauriziano Umberto I, Turin, Italy
| | - Giulia Russo
- Cardiovascular and Sports Medicine Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) Trieste, Trieste, Italy
| | - Nicola Maurea
- Cardiology Department, G. Pascale National Cancer Institute Foundation (IRCCS), Naples, Italy
| | - Vincenzo Quagliariello
- Cardiology Department, G. Pascale National Cancer Institute Foundation (IRCCS), Naples, Italy
| | - Stefano Oliva
- Cardio-Oncology Department, Istituto Tumori Giovanni Paolo II, Bari, Italy
| | | | - Fabiana Lucà
- Cardiology Department, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Luigi Tarantini
- Divisione di Cardiologia, Arcispedale S. Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS di Reggio-Emilia, Reggio Emilia, Italy
| | | | - Antonella Moreo
- A. De Gasperis Cardio Center, Aziende Socio Sanitarie Territoriali (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giovanna Geraci
- Cardiology Unit, Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, Palermo, Italy
| | - Domenico Gabrielli
- Cardio-Thoracic-Vascular Department, San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Fabrizio Oliva
- Dipartimento Cardiotoracovascolare, Cardiology 1-Cath Lab, Coronary Care Unit (CCU), ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Department, Ospedale San Filippo Neri, Rome, Italy
| |
Collapse
|
30
|
Hagihara M, Imai Y, Uchida T, Ohara S, Inoue M, Sugi T, Mitamura K. Successful Elimination of SARS-CoV-2 Following Vaccination with BNT162b2 after Prolonged Viral Infection in an Immunocompromised Lymphoma Patient. Intern Med 2022; 61:2215-2219. [PMID: 35850990 PMCID: PMC9381351 DOI: 10.2169/internalmedicine.9513-22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 52-year-old man with mantle cell lymphoma treated with bendamustine and rituximab developed prolonged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Despite elevated titers of anti-spike IgG antibody, protracted pancytopenia persisted for more than six months. Finally, the anti-SARS CoV-2 vaccine, BNT162b2, was administered, which improved his blood cell count and eliminated the virus. The increased anti-spike IgG titer and lymphocyte count after vaccination suggested that both humoral and cellular immunity acted in coordination to eliminate the virus.
Collapse
Affiliation(s)
| | - Yui Imai
- Department of Hematology, Eiju General Hospital, Japan
| | | | - Shin Ohara
- Department of Hematology, Eiju General Hospital, Japan
| | | | - Tomiyuki Sugi
- Department of Pharmacy, Eiju General Hospital, Japan
| | - Keiko Mitamura
- Department of Preventive Medicine, Eiju General Hospital, Japan
| |
Collapse
|
31
|
Patel NJ, D'Silva KM, Hsu TYT, DiIorio M, Fu X, Cook C, Prisco L, Martin L, Vanni KMM, Zaccardelli A, Zhang Y, Sparks JA, Wallace ZS. Coronavirus Disease 2019 Outcomes Among Recipients of Anti-CD20 Monoclonal Antibodies for Immune-Mediated Diseases: A Comparative Cohort Study. ACR Open Rheumatol 2021; 4:238-246. [PMID: 34890478 PMCID: PMC8916578 DOI: 10.1002/acr2.11386] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 01/27/2023] Open
Abstract
Objective Patients with immune‐mediated diseases treated with anti‐CD20 monoclonal antibodies may have worse coronavirus disease 2019 (COVID‐19) outcomes due to impaired humoral immunity, but differences compared with the general population are unknown. Methods We identified patients with immune‐mediated diseases who received anti‐CD20 monoclonal antibodies within 1 year prior to the index date of polymerase chain reaction–confirmed COVID‐19 between January 31, 2020, and January 31, 2021. General population comparators with COVID‐19 were matched up 5:1 by age, sex, and polymerase chain reaction date. Unadjusted and multivariable adjusted (for age, race, body mass index, and Charlson Comorbidity Index) hazard ratios (HRs) and 95% confidence intervals (CIs) for hospitalization, mechanical ventilation, and death in recipients of anti‐CD20 monoclonal antibodies versus comparators were estimated by using Cox regression. Results We identified 114 cases patients COVID‐19 who had received anti‐CD20 monoclonal antibodies for immune‐mediated diseases (mean age 55 years, 70% female) and 559 matched comparators with COVID‐19 (mean age 54 years, 70% female). Patients treated with anti‐CD20 monoclonal antibodies had higher mortality (adjusted HR 2.16; 95% CI: 1.03‐4.54) than matched comparators. Risks of hospitalization (adjusted HR 0.88; 95% CI: 0.62‐1.26) and mechanical ventilation use (adjusted HR 0.82; 95% CI: 0.36‐1.87) were similar. Similar trends were seen in analyses according to type of indication (eg, rheumatic or neurologic disease) and duration of anti‐CD20 monoclonal antibody use (<1 or ≥1 year) and after patients with interstitial lung disease, those with cancer, and those on glucocorticoids prior to COVID‐19 diagnosis were excluded. Conclusion Patients who received anti‐CD20 monoclonal antibodies for immune‐mediated diseases prior to COVID‐19 had higher mortality following COVID‐19 than matched comparators, highlighting the urgent need to mitigate excess risks in recipients of anti‐CD20 monoclonal antibodies during the ongoing pandemic.
Collapse
Affiliation(s)
- Naomi J Patel
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kristin M D'Silva
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Tiffany Y-T Hsu
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Michael DiIorio
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Xiaoqing Fu
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Claire Cook
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lauren Prisco
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lily Martin
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kathleen M M Vanni
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Yuqing Zhang
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jeffrey A Sparks
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Zachary S Wallace
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
32
|
Cellular and humoral immunogenicity of the mRNA-1273 SARS-CoV-2 vaccine in patients with hematologic malignancies. Blood Adv 2021; 6:774-784. [PMID: 34844263 PMCID: PMC8632354 DOI: 10.1182/bloodadvances.2021006101] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/14/2021] [Indexed: 11/20/2022] Open
Abstract
SARS-CoV-2 mRNA-1273 vaccine induces an impaired humoral response in patients under anti-CD20 therapy, but cellular response is preserved. Immunosuppressive therapy for GVHD reduces cellular response with no impact in humoral immunogenicity.
Recent studies have shown a suboptimal humoral response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) messenger RNA (mRNA) vaccines in patients diagnosed with hematologic malignancies; however, data about cellular immunogenicity are scarce. The aim of this study was to evaluate both the humoral and cellular immunogenicity 1 month after the second dose of the mRNA-1273 vaccine. Antibody titers were measured by using the Elecsys and LIAISON anti–SARS-CoV-2 S assays, and T-cell response was assessed by using interferon-γ release immunoassay technology. Overall, 76.3% (184 of 241) of patients developed humoral immunity, and the cellular response rate was 79% (184 of 233). Hypogammaglobulinemia, lymphopenia, active hematologic treatment, and anti-CD20 therapy during the previous 6 months were associated with an inferior humoral response. Conversely, age >65 years, active disease, lymphopenia, and immunosuppressive treatment of graft-versus-host disease (GVHD) were associated with an impaired cellular response. A significant dissociation between the humoral and cellular responses was observed in patients treated with anti-CD20 therapy (the humoral response was 17.5%, whereas the cellular response was 71.1%). In these patients, B-cell aplasia was confirmed while T-cell counts were preserved. In contrast, humoral response was observed in 77.3% of patients undergoing immunosuppressive treatment of GVHD, whereas only 52.4% had a cellular response. The cellular and humoral responses to the SARS-CoV-2 mRNA-1273 vaccine in patients with hematologic malignancies are highly influenced by the presence of treatments such as anti-CD20 therapy and immunosuppressive agents. This observation has implications for the further management of these patients.
Collapse
|
33
|
Lee CY, Shah MK, Hoyos D, Solovyov A, Douglas M, Taur Y, Maslak P, Babady NE, Greenbaum B, Kamboj M, Vardhana SA. Prolonged SARS-CoV-2 infection in patients with lymphoid malignancies. Cancer Discov 2021; 12:62-73. [PMID: 34753749 DOI: 10.1158/2159-8290.cd-21-1033] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/18/2021] [Accepted: 10/27/2021] [Indexed: 11/16/2022]
Abstract
Coronavirus disease 2019 (COVID-19) infection results in both acute mortality and persistent and/or recurrent disease in patients with hematologic malignancies, but the drivers of persistent infection in this population are unknown. We found that B-cell lymphomas were at particularly high risk for persistent SARS-CoV-2 positivity. Further analysis of these patients identified discrete risk factors for initial disease severity as compared to disease chronicity. Active therapy and diminished T-cell counts were drivers of acute mortality in COVID-19 infected lymphoma patients. Conversely, B-cell-depleting therapy was the primary driver of re-hospitalization for COVID-19. In patients with persistent SARS-CoV-2 positivity, we observed high levels of viral entropy consistent with intrahost viral evolution, particularly in patients with impaired CD8+ T-cell immunity. These results suggest that persistent COVID-19 infection is likely to remain a risk in patients with impaired adaptive immunity and that additional therapeutic strategies are needed to enable viral clearance in this high-risk population.
Collapse
Affiliation(s)
- Christina Y Lee
- Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, USA
| | - Monika K Shah
- Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, USA
| | - David Hoyos
- Computational Oncology, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center
| | | | - Melanie Douglas
- Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, USA
| | - Ying Taur
- Infectious Diseases, Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Peter Maslak
- Laboratory Medicine, Memorial Sloan Kettering Cancer Center
| | | | | | | | - Santosha A Vardhana
- Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, USA
| |
Collapse
|
34
|
Casarola G, D'Abbondanza M, Curcio R, Alcidi R, Campanella T, Rossi R, Fusaro J, Gandolfo V, Di Giuli C, Laoreti C, Veca V, Leone MC, Pucci G, Vaudo G. Efficacy of convalescent plasma therapy in immunocompromised patients with COVID-19: A case report. CLINICAL INFECTION IN PRACTICE 2021; 12:100096. [PMID: 34490417 PMCID: PMC8408049 DOI: 10.1016/j.clinpr.2021.100096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Management of immunocompromised COVID-19 patients is the object of current debate. Accumulating evidence suggest that treatment with high-titer COVID-19 convalescent plasma (CCP) may be effective in this characteristic clinical scenario. CASE REPORT A 52-years old immunocompromised female patient, previously treated with rituximab for low grade B-cell lymphoma, showed prolonged SARS-CoV-2 shedding and a long-term course of signs of severe COVID-19. A first cycle of treatment with remdesivir, a nucleotide analogue prodrug effective in inhibiting SARS-CoV-2 replication, did not provide fully and sustained clinical remission. A second hospitalization was deemed necessary after 10 days from the first hospital discharge due to recrudescence of symptoms of severe COVID-19 and the evidence of bilateral interstitial pneumonia at the chest-CT scan. Clinical and radiological findings completely disappeared after CCP administration. The viral culture confirmed the absence of SARS-CoV-2-related cytopathic effect. The clinical evaluation, performed two months after hospital discharge, was unremarkable. RESULTS Findings from our case report suggest that the host T-cell specific response to SARS-CoV-2 is not sufficient to reduce viral load in the absence of neutralizing antibodies. Acquired immune antibodies and/or related components passively infused with CCP might help in boosting the plasma recipient response to the virus and promoting complete viral clearance. CONCLUSIONS Independently from negative results in immunocompetent individuals, the potential effectiveness of CCP infusion in selected cohorts of patients with primary or secondary impaired immune response should be tested. Further research about mechanisms of host response in immunocompromised patients with SARS-CoV-2 infection is required.
Collapse
Affiliation(s)
- Genni Casarola
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy,COVID-1 Unit, Terni University Hospital, Terni, Italy
| | - Marco D'Abbondanza
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy,COVID-1 Unit, Terni University Hospital, Terni, Italy
| | - Rosa Curcio
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy,COVID-1 Unit, Terni University Hospital, Terni, Italy
| | - Riccardo Alcidi
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy,COVID-1 Unit, Terni University Hospital, Terni, Italy
| | - Tommaso Campanella
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy,COVID-1 Unit, Terni University Hospital, Terni, Italy
| | - Rachele Rossi
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy,COVID-1 Unit, Terni University Hospital, Terni, Italy
| | - Jessica Fusaro
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy,Unit of Internal Medicine, “S.Maria della Misericordia” University Hospital, Perugia
| | - Vito Gandolfo
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy,COVID-1 Unit, Terni University Hospital, Terni, Italy
| | - Cinzia Di Giuli
- Clinical Infectious Disease, Terni University Hospital, Terni, Italy
| | - Chiara Laoreti
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy,Unit of Internal Medicine, “S.Maria della Misericordia” University Hospital, Perugia
| | - Vito Veca
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy,COVID-1 Unit, Terni University Hospital, Terni, Italy
| | - Maria Comasia Leone
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy,COVID-1 Unit, Terni University Hospital, Terni, Italy
| | - Giacomo Pucci
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy,COVID-1 Unit, Terni University Hospital, Terni, Italy,Corresponding author at: Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano di Joannuccio, 1, IT-05100 Terni, Italy
| | - Gaetano Vaudo
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy,COVID-1 Unit, Terni University Hospital, Terni, Italy
| |
Collapse
|
35
|
Hagihara M, Ohara S, Uchida T, Inoue M. Practical management of patients with hematological diseases during the COVID-19 pandemic in Japan. Int J Hematol 2021; 114:709-718. [PMID: 34669154 PMCID: PMC8527309 DOI: 10.1007/s12185-021-03175-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/09/2021] [Indexed: 12/15/2022]
Abstract
Polymerase chain reaction (PCR) tests cannot always detect the SARS-CoV-2 virus, possibly due to differences in sensitivity between sample types. Under these circumstances, immunochromatography may serve as an alternative method to detect anti-SARS-CoV-2 IgG antibodies that indicate a history of infection. In our analysis of patients with severe COVID-19 infection, we found that 14 of 19 serum samples were positive for IgG antibodies, whereas 6 of 10 samples from patients with asymptomatic or mild cases were negative. Two patients with immune thrombocytopenia who were treated with prednisolone experienced aggressive COVID-19-related respiratory failure and eventually died. Patients not in remission and those who received steroid-based chemotherapy had a higher risk of death, and patients with lymphoid malignancies including lymphoma and myeloma died in larger numbers than those with myeloid malignancies. A stricter cohorting strategy based on repeat PCR tests or isolation to a private room should be adopted in routine care in hematology departments to prevent viral spread to the environment.
Collapse
|
36
|
Yadav A, Thakkar D, Wadhwa T, Sarma S, Upasana K, Rastogi N, Yadav SP. COVID-19 in children with blood and cancer disorders: An experience from India. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2021. [PMCID: PMC8517390 DOI: 10.1016/j.phoj.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
|
37
|
Vinh DC, Abel L, Bastard P, Cheng MP, Condino-Neto A, Gregersen PK, Haerynck F, Cicalese MP, Hagin D, Soler-Palacín P, Planas AM, Pujol A, Notarangelo LD, Zhang Q, Su HC, Casanova JL, Meyts I. Harnessing Type I IFN Immunity Against SARS-CoV-2 with Early Administration of IFN-β. J Clin Immunol 2021; 41:1425-1442. [PMID: 34101091 PMCID: PMC8186356 DOI: 10.1007/s10875-021-01068-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/17/2021] [Indexed: 02/08/2023]
Affiliation(s)
| | - Laurent Abel
- St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY, 10065, USA
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR 1163, Necker Hospital for Sick Children, 75015, Paris, France
- University of Paris, Imagine Institute, 75015, Paris, France
| | - Paul Bastard
- St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY, 10065, USA
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR 1163, Necker Hospital for Sick Children, 75015, Paris, France
- University of Paris, Imagine Institute, 75015, Paris, France
| | | | | | - Peter K Gregersen
- Feinstein Institute for Medical Research, Northwell Health USA, Manhasset, NY, USA
| | - Filomeen Haerynck
- Department of Paediatric Immunology and Pulmonology, Centre for Primary Immunodeficiency Ghent (CPIG), PID Research Lab, Jeffrey Modell Diagnosis and Research Centre, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Maria-Pia Cicalese
- Pediatric Immunohematology and Bone Marrow Transplantation Unit, San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - David Hagin
- Allergy and Clinical Immunology Unit, Department of Medicine, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Pere Soler-Palacín
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain
| | | | - Aurora Pujol
- Neurometabolic Diseases Laboratory, IDIBELL-Hospital Duran I Reynals; Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Catalonia, Spain
- CIBERER U759, ISCiii, Madrid, Spain
| | - Luigi D Notarangelo
- Laboratory of Clinical Immunology and Microbiology, National Institutes of Health, Bethesda, MD, USA
| | - Qian Zhang
- St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY, 10065, USA
| | - Helen C Su
- Laboratory of Clinical Immunology and Microbiology, National Institutes of Health, Bethesda, MD, USA
| | - Jean-Laurent Casanova
- St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY, 10065, USA
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR 1163, Necker Hospital for Sick Children, 75015, Paris, France
- University of Paris, Imagine Institute, 75015, Paris, France
- Howard Hughes Medical Institute, New York, NY, USA
| | - Isabelle Meyts
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium.
- Laboratory for Inborn Errors of Immunity, KU Leuven, Leuven, Belgium.
| |
Collapse
|
38
|
Luitel P, Vais D, Gidron A. Successful Treatment of Persistent Coronavirus Disease 2019 Infection in a Patient With Hypogammaglobulinemia With REGN-COV2: A Case Report. Open Forum Infect Dis 2021; 8:ofab335. [PMID: 34405092 PMCID: PMC8344477 DOI: 10.1093/ofid/ofab335] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/22/2021] [Indexed: 12/15/2022] Open
Abstract
A 55-year-old man with hypogammaglobulinemia due to previous rituximab treatment developed persistent coronavirus disease 2019 pneumonia. Treatment with REGN-COV2 (casirivimab and imdevimab) resulted in the clearance of the infection. Targeted antiviral antibodies may be an important weapon in the management of immunocompromised patients infected with severe acute respiratory syndrome coronavirus 2 who fail to mount an immune response.
Collapse
Affiliation(s)
- Pankaj Luitel
- Department of Internal Medicine, Amita Saint Francis Hospital Evanston, Evanston, Illinois, USA
| | - Dana Vais
- Department of Infectious Disease, Amita Saint Mary and Elizabeth Hospital Chicago, Chicago, Illinois, USA
| | - Adi Gidron
- Department of Hematology-Oncology, Amita Saint Francis Hospital Evanston, Evanston, Illinois, USA
| |
Collapse
|
39
|
Martínez-Urbistondo M, Gutiérrez-Rojas Á, Andrés A, Gutiérrez I, Escudero G, García S, Gutiérrez A, Sánchez E, Herráiz J, De La Fuente S, Callejas A, De Mendoza C, Moreno-Torres V. Severe Lymphopenia as a Predictor of COVID-19 Mortality in Immunosuppressed Patients. J Clin Med 2021; 10:jcm10163595. [PMID: 34441891 PMCID: PMC8396991 DOI: 10.3390/jcm10163595] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/08/2021] [Accepted: 08/12/2021] [Indexed: 12/19/2022] Open
Abstract
Background. Coronavirus disease 2019 (COVID-19) has a high mortality in certain group of patients. We analysed the impact of baseline immunosuppression in COVID-19 mortality and the role of severe lymphopenia in immunocompromised subjects. Methods. We analysed all patients admitted with COVID-19 in a tertiary hospital in Madrid between March 1st and April 30th 2020. Epidemiological and clinical data, including severe lymphopenia (<500 lymphocytes/mm3) during admission, were analysed and compared based on their baseline immunosuppression condition. Results. A total of 1594 patients with COVID-19 pneumonia were hospitalised during the study period. 166 (10.4%) were immunosuppressed. Immunocompromised patients were younger (64 vs. 67 years, p = 0.02) but presented higher rates of hypertension, diabetes, heart, neurological, lung, kidney and liver disease (p < 0.05). They showed more severe lymphopenia (53% vs 24.1%, p < 0.001), lower SapO2/FiO2 ratios (251 vs 276, p = 0.02) during admission and higher mortality rates (27.1% vs 13.5%, p < 0.001). After adjustment, immunosuppression remained as an independent factor related to mortality (Odds Ratio (OR): 2.24, p < 0.001). In the immunosuppressed group, age (OR = 1.06, p = 0.01), acute respiratory distress syndrome (ARDS) (OR = 12.27, p = 0.017) and severe lymphopenia (OR = 3.48, p = 0.04) were the factors related to high mortality rate. Conclusion. Immunosuppression is an independent mortality risk factor in COVID-19. Severe lymphopenia should be promptly identified in these patients.
Collapse
|
40
|
Patel NJ, D'Silva KM, Hsu TYT, DiIorio M, Fu X, Cook C, Prisco L, Martin L, Vanni KMM, Zaccardelli A, Zhang Y, Sparks JA, Wallace ZS. COVID-19 Outcomes Among Users of CD20 Inhibitors for Immune-Mediated Diseases: A Comparative Cohort Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021. [PMID: 34401883 PMCID: PMC8366799 DOI: 10.1101/2021.08.05.21261643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective: Patients with immune-mediated diseases treated with CD20 inhibitors may have worse COVID-19 outcomes due to impaired humoral immunity, but differences versus the general population are unknown. Methods: We identified patients with immune-mediated diseases who received CD20 inhibitors within one year prior to the index date of PCR-confirmed COVID-19 between January 31, 2020, and January 31, 2021. Comparators with COVID-19 were matched up to 5:1 by age, sex, and PCR date. Hazard ratios (HRs) and 95% confidence intervals (CIs) for hospitalization, mechanical ventilation, and death in CD20 inhibitor users versus comparators were estimated using Cox regression. Results: We identified 114 cases with COVID-19 who had received CD20 inhibitors for immune-mediated diseases (mean age 55 years, 70% female) and 559 matched comparators with COVID-19 (mean age 54 years, 70% female). CD20 inhibitor-treated cases had higher mortality (aHR 2.16; 95% CI: 1.03 to 4.54) than matched comparators. Risks of hospitalization (aHR 0.88; 95% CI: 0.62 to 1.26) and mechanical ventilation (aHR 0.82; 95% CI: 0.36 to 1.87) were similar. Similar trends were seen in analyses according to type of indication (e.g., rheumatic or neurologic disease) and duration of CD20 inhibitor use (<1 or ≥1 year), and after excluding patients with interstitial lung disease, cancer, and those on glucocorticoids prior to COVID-19 diagnosis. Conclusions: Patients who received CD20 inhibitors for immune-mediated diseases prior to COVID-19 had higher mortality following COVID-19 than matched comparators, highlighting the urgent need to mitigate excess risks in CD20 inhibitor users during the ongoing pandemic.
Collapse
|
41
|
Rabascall CX, Lou BX, Navetta-Modrov B, Hahn SS. Effective use of monoclonal antibodies for treatment of persistent COVID-19 infection in a patient on rituximab. BMJ Case Rep 2021; 14:e243469. [PMID: 34344651 PMCID: PMC8336168 DOI: 10.1136/bcr-2021-243469] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 11/24/2022] Open
Abstract
As we are over a year into the COVID-19 pandemic, we have made many forward strides in therapeutics. These treatments, such as monoclonal antibodies, have help mitigate the detrimental and often fatal consequences of COVID-19. The current indication for the use of monoclonal antibodies is mild to moderate COVID-19 infection within 10 days of symptom onset in those who are at high risk of progression to severe disease. However, their role in patients with prolonged symptoms is not clear. We present a unique case of monoclonal antibodies use after 54 days of symptom onset in an immunosuppressed patient with persistent COVID-19 infection despite standard treatment. This case illustrates the potential use of monoclonal antibodies outside of the current recommended therapeutic window in immunosuppressed patients, who may have difficulty with viral clearance.
Collapse
Affiliation(s)
- Carlos X Rabascall
- Pulmonary, Critical Care and Sleep Medicine, Northwell Health, New Hyde Park, New York, USA
| | - Becky X Lou
- Pulmonary, Critical Care and Sleep Medicine, Northwell Health, New Hyde Park, New York, USA
| | - Brianne Navetta-Modrov
- Rheumatology, Allergy and Immunology, Stony Brook University Renaissance School of Medicine, Stony Brook, New York, USA
| | - Stella S Hahn
- Pulmonary, Critical Care and Sleep Medicine, Northwell Health, New Hyde Park, New York, USA
| |
Collapse
|
42
|
Duléry R, Lamure S, Delord M, Di Blasi R, Chauchet A, Hueso T, Rossi C, Drenou B, Deau Fischer B, Soussain C, Feugier P, Noël N, Choquet S, Bologna S, Joly B, Philippe L, Kohn M, Malak S, Fouquet G, Daguindau E, Taoufik Y, Lacombe K, Cartron G, Thiéblemont C, Besson C. Prolonged in-hospital stay and higher mortality after Covid-19 among patients with non-Hodgkin lymphoma treated with B-cell depleting immunotherapy. Am J Hematol 2021; 96:934-944. [PMID: 33909916 PMCID: PMC8212109 DOI: 10.1002/ajh.26209] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 04/23/2021] [Accepted: 04/23/2021] [Indexed: 12/19/2022]
Abstract
Prolonged Covid-19 is an emerging issue for patients with lymphoma or immune deficiency. We aimed to examine prolonged length of in-hospital stay (LOS) due to Covid-19 among patients with lymphoma and assess its determinants and outcomes. Adult patients with lymphoma admitted for Covid-19 to 16 French hospitals in March and April, 2020 were included. Length of in-hospital stay was analyzed as a competitor vs death. The study included 111 patients. The median age was 65 years (range, 19-92). Ninety-four patients (85%) had B-cell non-Hodgkin lymphoma. Within the 12 months prior to hospitalization for Covid-19, 79 patients (71%) were treated for their lymphoma. Among them, 63 (57%) received an anti-CD20 therapy. Fourteen patients (12%) had relapsed/refractory disease. The median LOS was 14 days (range, 1-235). After a median follow-up of 191 days (3-260), the 6-month overall survival was 69%. In multivariable analyses, recent administration of anti-CD20 therapy was associated with prolonged LOS (subdistribution hazard ratio 2.26, 95% confidence interval 1.42-3.6, p < 0.001) and higher risk of death (hazard ratio 2.17, 95% confidence interval 1.04-4.52, p = 0.039). An age ≥ 70 years and relapsed/refractory lymphoma were also associated with prolonged LOS and decreased overall survival. In conclusion, an age ≥ 70 years, a relapsed/refractory lymphoma and recent administration of anti-CD20 therapy are risk factors for prolonged LOS and death for lymphoma patients hospitalized for Covid-19. These findings may contribute to guide the management of lymphoma during the pandemic, support evaluating specific therapeutic approaches, and raise questions on the efficacy and timing of vaccination of this particular population.
Collapse
Affiliation(s)
- Rémy Duléry
- Service d'Hématologie Clinique et de Thérapie Cellulaire Hôpital Saint Antoine, Assistance Publique—Hôpitaux de Paris, Sorbonne Université, Inserm UMRs Paris France
| | - Sylvain Lamure
- Département d'Hématologie Clinique, CHU de Montpellier, UMR‐CNRS 5535 Université de Montpellier Montpellier France
| | - Marc Delord
- Clinical Research Center Centre Hospitalier de Versailles Le Chesnay France
| | - Roberta Di Blasi
- Service d'Hématologie‐Oncologie Hôpital Saint Louis, Assistance Publique—Hôpitaux de Paris; Université de Paris – Diderot Paris France
| | | | - Thomas Hueso
- Service d'Hématologie Adulte Institut Gustave Roussy, Université Paris‐Sud, Université Paris‐Saclay Villejuif France
| | - Cédric Rossi
- Service d'Hématologie Clinique CHU de Dijon Bourgogne Dijon France
| | - Bernard Drenou
- Département d'Hématologie Groupe Hospitalier de Mulhouse Sud Alsace Mulhouse France
| | - Bénédicte Deau Fischer
- Service d'Hématologie Clinique Hôpital Cochin, Assistance Publique ‐ Hôpitaux de Paris Paris France
| | - Carole Soussain
- Département d'Oncologie Médicale ‐ Hématologie Institut Curie Saint Cloud France
| | | | - Nicolas Noël
- Service de Médecine Interne – Immunologie Hôpital Bicêtre, Assistance Publique ‐ Hôpitaux de Paris Le Kremlin‐Bicêtre France
| | - Sylvain Choquet
- Service d'Hématologie Clinique Hôpital Pitié‐Salpêtrière, Assistance Publique ‐ Hôpitaux de Paris Paris France
| | - Serge Bologna
- Service d'Hématologie Centre d'Oncologie de Gentilly Nancy France
| | - Bertrand Joly
- Service d'Hématologie Centre Hospitalier Sud Francilien Corbeil‐Essonnes France
| | - Laure Philippe
- Service d'Hématologie Centre Hospitalier d'Annecy Annecy France
| | - Milena Kohn
- Service d'Hématologie Oncologie Centre Hospitalier de Versailles Le Chesnay France
| | - Sandra Malak
- Département d'Oncologie Médicale ‐ Hématologie Institut Curie Saint Cloud France
| | - Guillemette Fouquet
- Service d'Hématologie Clinique Hôpital Cochin, Assistance Publique ‐ Hôpitaux de Paris Paris France
| | | | - Yassine Taoufik
- Service d'Hématologie et Immunologie Biologique Hôpital Bicêtre, Assistance Publique‐Hôpitaux de Paris, INSERM 1186, Institut Gustave Roussy Villejuif France
| | - Karine Lacombe
- Service des Maladies Infectieuses et Tropicales Sorbonne Université, Inserm IPLESP, Hôpital Saint Antoine, Assistance Publique—Hôpitaux de Paris Paris France
| | - Guillaume Cartron
- Département d'Hématologie Clinique, CHU de Montpellier, UMR‐CNRS 5535 Université de Montpellier Montpellier France
| | - Catherine Thiéblemont
- Service d'Hématologie‐Oncologie Hôpital Saint Louis, Assistance Publique—Hôpitaux de Paris; Université de Paris – Diderot Paris France
| | - Caroline Besson
- Service d'Hématologie Oncologie Centre Hospitalier de Versailles Le Chesnay France
- Centre de recherche en Epidémiologie et Santé des Populations (CESP), INSERM U1018 Université Paris‐Saclay, UVSQ, Inserm, Équipe Villejuif France
| |
Collapse
|
43
|
Yasuda H, Mori Y, Chiba A, Bai J, Murayama G, Matsushita Y, Miyake S, Komatsu N. Resolution of One-Year Persisting COVID-19 Pneumonia and Development of Immune Thrombocytopenia in a Follicular Lymphoma Patient With Preceding Rituximab Maintenance Therapy: A follow-up Report and Literature Review of Cases With Prolonged Infections. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:e810-e816. [PMID: 34393077 PMCID: PMC8286809 DOI: 10.1016/j.clml.2021.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 11/22/2022]
Abstract
Background We previously reported elsewhere of a follicular lymphoma patient suffering from persistent COVID-19 pneumonia that was still ongoing at 2 months after onset. Materials and Methods We provide a follow-up report of the case along with a literature review of immunocompromised lymphoma patients experiencing prolonged COVID-19 infections. Results Although requiring a full 1 year, the presented case eventually achieved spontaneous resolution of COVID-19 pneumonia. Anti-SARS-CoV-2 antibodies could not be detected throughout the disease course, but COVID-19-directed T-cell response was found to be intact. The patient also developed secondary immune thrombocytopenia subsequent to COVID-19 pneumonia. We found 19 case reports of immunocompromised lymphoma patients with prolonged COVID-19 infections in the literature. All 5 patients who died did not receive convalescent plasma therapy, whereas resolution of COVID-19 infection was achieved in 8 out of 9 patients who received convalescent plasma therapy. Conclusions We demonstrate through the presented case that while time-consuming, resolution of COVID-19 infections may be achieved without aid from humoral immunity if cellular immunity is intact. Immunocompromised lymphoma patients are at risk of a prolonged disease course of COVID-19, and convalescent plasma therapy may be a promising approach in such patients.
Collapse
Affiliation(s)
- Hajime Yasuda
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan.
| | - Yosuke Mori
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Asako Chiba
- Department of Immunology, Juntendo University School of Medicine, Tokyo, Japan
| | - Jie Bai
- Department of Immunology, Juntendo University School of Medicine, Tokyo, Japan
| | - Goh Murayama
- Department of Internal Medicine and Rheumatology, Faculty of Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Yasushi Matsushita
- Department of Internal Medicine and Rheumatology, Faculty of Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Sachiko Miyake
- Department of Immunology, Juntendo University School of Medicine, Tokyo, Japan
| | - Norio Komatsu
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan; Laboratory for the Development of Therapies Against MPN, Juntendo University School of Medicine, Tokyo, Japan; Department of Advanced Hematology, Juntendo University School of Medicine, Tokyo, Japan
| |
Collapse
|
44
|
Huda Z, Jahangir A, Sahra S, Rafay Khan Niazi M, Anwar S, Glaser A, Jahangir A. A Case of COVID-19-Associated Autoimmune Hemolytic Anemia With Hyperferritinemia in an Immunocompetent Host. Cureus 2021; 13:e16078. [PMID: 34345558 PMCID: PMC8324606 DOI: 10.7759/cureus.16078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 01/02/2023] Open
Abstract
We report an interesting case of a middle-aged gentleman who presented with diabetic ketoacidosis (DKA) and tested polymerase chain reaction (PCR) positive for COVID-19 infection. His hospital stay was complicated by acute kidney injury, hematuria, and normocytic anemia. Initial chest x-ray demonstrated bibasilar opacities. D-dimer and C-reactive protein were elevated. During his hospital stay, his hemoglobin decreased from 13.4 g/dL to 9 g/dL, and further workup demonstrated ferritin of 49,081 ng/mL with lactate dehydrogenase of 1665 U/L. He was treated with prednisone and folic acid for autoimmune hemolytic anemia (AIHA). Ferritin was downtrended, and hemoglobin stabilized. As demonstrated by this case report and prior literature review, COVID-19 infection can be associated with AIHA.
Collapse
Affiliation(s)
- Zoha Huda
- Medicine, The City University of New York (CUNY) School of Medicine, New York, USA
| | - Abdullah Jahangir
- Internal Medicine, Staten Island University Hospital, Northwell Health, New York, USA
| | - Syeda Sahra
- Internal Medicine, Northwell Health, New York, USA
| | | | - Shamsuddin Anwar
- Internal Medicine, Staten Island University Hospital, Northwell Health, New York, USA
| | | | | |
Collapse
|
45
|
Łącki S, Wyżgolik K, Nicze M, Georgiew-Nadziakiewicz S, Chudek J, Wdowiak K. Low symptomatic COVID-19 in an elderly patient with follicular lymphoma treated with rituximab-based immunotherapy: A case report. World J Clin Cases 2021; 9:4859-4865. [PMID: 34222459 PMCID: PMC8223830 DOI: 10.12998/wjcc.v9.i18.4859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/13/2021] [Accepted: 05/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Follicular lymphoma is an indolent lymphoma that may progress to a highly aggressive form requiring immunochemotherapy. Most regimens utilize rituximab, an anti-CD20 monoclonal antibody, which may affect the clinical course of novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections [coronavirus disease 2019 (COVID-19)]. Here we describe the first case of mild COVID-19 during ongoing oncological treatment without significant deterioration after rituximab administration.
CASE SUMMARY A 74-year-old female with an enlargement of her right palatine tonsil was diagnosed with follicular lymphoma following tonsillectomy and started immunochemotherapy according to the rituximab, cyclophosphamide, vincristine, prednisone regimen. At home before the fourth cycle, she developed nonspecific symptoms (excessive fatigue, loss of appetite and nausea), misdiagnosed as adverse effects of chemotherapy. Unexpectedly, interim positron emission tomography-computed tomography scan, performed shortly before rituximab administration, revealed previously nonexistent pulmonary changes, potentially of infectious etiology. SARS-CoV-2 infection was confirmed by a nasopharyngeal swab (with reverse transcriptase polymerase chain reaction test) performed the following day. Despite rituximab infusion, the patient remained oligosymptomatic and was discharged home for self-isolation. Having reached a negative SARS-CoV-2 status before the subsequently scheduled regimen, the patient successfully received six cycles of rituximab, cyclophosphamide, vincristine, prednisone and obtained complete remission by positron emission tomography-computed tomography.
CONCLUSION Our case shows that rituximab-based immunotherapy due to follicular lymphoma may have no evident negative effect on the COVID-19 clinical course.
Collapse
Affiliation(s)
- Stanisław Łącki
- Department of Internal Diseases and Oncological Chemotherapy, Medical University of Silesia, Katowice 40-027, Silesian Voivodeship, Poland
| | - Kinga Wyżgolik
- Department of Internal Diseases and Oncological Chemotherapy, Medical University of Silesia, Katowice 40-027, Silesian Voivodeship, Poland
| | - Michał Nicze
- Department of Internal Diseases and Oncological Chemotherapy, Medical University of Silesia, Katowice 40-027, Silesian Voivodeship, Poland
| | | | - Jerzy Chudek
- Department of Internal Diseases and Oncological Chemotherapy, Medical University of Silesia, Katowice 40-027, Silesian Voivodeship, Poland
| | - Kamil Wdowiak
- Department of Internal Diseases and Oncological Chemotherapy, Medical University of Silesia, Katowice 40-027, Silesian Voivodeship, Poland
| |
Collapse
|
46
|
Drouin AC, Theberge MW, Liu SY, Smither AR, Flaherty SM, Zeller M, Geba GP, Reynaud P, Rothwell WB, Luk AP, Tian D, Boisen ML, Branco LM, Andersen KG, Robinson JE, Garry RF, Fusco DN. Successful Clearance of 300 Day SARS-CoV-2 Infection in a Subject with B-Cell Depletion Associated Prolonged (B-DEAP) COVID by REGEN-COV Anti-Spike Monoclonal Antibody Cocktail. Viruses 2021; 13:1202. [PMID: 34201591 PMCID: PMC8310246 DOI: 10.3390/v13071202] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/02/2021] [Accepted: 06/16/2021] [Indexed: 12/20/2022] Open
Abstract
A 59-year-old male with follicular lymphoma treated by anti-CD20-mediated B-cell depletion and ablative chemotherapy was hospitalized with a COVID-19 infection. Although the patient did not develop specific humoral immunity, he had a mild clinical course overall. The failure of all therapeutic options allowed infection to persist nearly 300 days with active accumulation of SARS-CoV-2 virus mutations. As a rescue therapy, an infusion of REGEN-COV (10933 and 10987) anti-spike monoclonal antibodies was performed 270 days from initial diagnosis. Due to partial clearance after the first dose (2.4 g), a consolidation dose (8 g) was infused six weeks later. Complete virus clearance could then be observed over the following month, after he was vaccinated with the Pfizer-BioNTech anti-COVID-19 vaccination. The successful management of this patient required prolonged enhanced quarantine, monitoring of virus mutations, pioneering clinical decisions based upon close consultation, and the coordination of multidisciplinary experts in virology, immunology, pharmacology, input from REGN, the FDA, the IRB, the health care team, the patient, and the patient's family. Current decisions to take revolve around patient's follicular lymphoma management, and monitoring for virus clearance persistence beyond disappearance of REGEN-COV monoclonal antibodies after anti-SARS-CoV-2 vaccination. Overall, specific guidelines for similar cases should be established.
Collapse
Affiliation(s)
- Arnaud C. Drouin
- Department of Medicine, School of Medicine, Tulane University, New Orleans, LA 70112, USA; (S.Y.L.); (S.M.F.); (P.R.); (W.B.R.); (A.P.L.); (D.N.F.)
| | - Marc W. Theberge
- Department of Immunology and Microbiology, Tulane University, New Orleans, LA 70118, USA;
| | - Sharon Y. Liu
- Department of Medicine, School of Medicine, Tulane University, New Orleans, LA 70112, USA; (S.Y.L.); (S.M.F.); (P.R.); (W.B.R.); (A.P.L.); (D.N.F.)
| | - Allison R. Smither
- Department of Microbiology and Immunology, Tulane University School of Medicine, New Orleans, LA 70112, USA; (A.R.S.); (R.F.G.)
| | - Shelby M. Flaherty
- Department of Medicine, School of Medicine, Tulane University, New Orleans, LA 70112, USA; (S.Y.L.); (S.M.F.); (P.R.); (W.B.R.); (A.P.L.); (D.N.F.)
| | - Mark Zeller
- The Scripps Research Institute, San Diego, CA 92037, USA; (M.Z.); (K.G.A.)
| | | | - Peter Reynaud
- Department of Medicine, School of Medicine, Tulane University, New Orleans, LA 70112, USA; (S.Y.L.); (S.M.F.); (P.R.); (W.B.R.); (A.P.L.); (D.N.F.)
| | - W. Benjamin Rothwell
- Department of Medicine, School of Medicine, Tulane University, New Orleans, LA 70112, USA; (S.Y.L.); (S.M.F.); (P.R.); (W.B.R.); (A.P.L.); (D.N.F.)
| | - Alfred P. Luk
- Department of Medicine, School of Medicine, Tulane University, New Orleans, LA 70112, USA; (S.Y.L.); (S.M.F.); (P.R.); (W.B.R.); (A.P.L.); (D.N.F.)
| | - Di Tian
- Department of Pathology, Tulane University School of Medicine, New Orleans, LA 70112, USA;
| | | | - Luis M. Branco
- Zalgen Labs, Germantown, MD 20876, USA; (M.L.B.); (L.M.B.)
| | | | - James E. Robinson
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA 70112, USA;
| | - Robert F. Garry
- Department of Microbiology and Immunology, Tulane University School of Medicine, New Orleans, LA 70112, USA; (A.R.S.); (R.F.G.)
| | - Dahlene N. Fusco
- Department of Medicine, School of Medicine, Tulane University, New Orleans, LA 70112, USA; (S.Y.L.); (S.M.F.); (P.R.); (W.B.R.); (A.P.L.); (D.N.F.)
| |
Collapse
|
47
|
COVID-19 in a Post-transplant Heart Recipient Who Developed Aggressive Lymphoma: A Biphasic Course During Rituximab Treatment. Hemasphere 2021; 5:e592. [PMID: 34131632 PMCID: PMC8196101 DOI: 10.1097/hs9.0000000000000592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/26/2021] [Indexed: 01/08/2023] Open
|
48
|
Jakubíková M, Týblová M, Tesař A, Horáková M, Vlažná D, Ryšánková I, Nováková I, Dolečková K, Dušek P, Piťha J, Voháňka S, Bednařík J. Predictive factors for a severe course of COVID-19 infection in myasthenia gravis patients with an overall impact on myasthenic outcome status and survival. Eur J Neurol 2021; 28:3418-3425. [PMID: 34080271 PMCID: PMC8239548 DOI: 10.1111/ene.14951] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/14/2021] [Accepted: 05/26/2021] [Indexed: 12/21/2022]
Abstract
Background and purpose Myasthenia gravis (MG) patients could be a vulnerable group in the pandemic era of coronavirus 2019 (COVID‐19) mainly due to respiratory muscle weakness, older age and long‐term immunosuppressive treatment. We aimed to define factors predicting the severity of COVID‐19 in MG patients and risk of MG exacerbation during COVID‐19. Methods We evaluated clinical features and outcomes after COVID‐19 in 93 MG patients. Results Thirty‐five patients (38%) had severe pneumonia and we recorded 10 deaths (11%) due to COVID‐19. Higher forced vital capacity (FVC) values tested before COVID‐19 were shown to be protective against severe infection (95% CI 0.934–0.98) as well as good control of MG measured by the quantified myasthenia gravis score (95% CI 1.047–1.232). Long‐term chronic corticosteroid treatment worsened the course of COVID‐19 in MG patients (95% CI 1.784–111.43) and this impact was positively associated with dosage (p = 0.005). Treatment using azathioprine (95% CI 0.448–2.935), mycophenolate mofetil (95% CI 0.91–12.515) and ciclosporin (95% CI 0.029–2.212) did not influence the course of COVID‐19. MG patients treated with rituximab had a high risk of death caused by COVID‐19 (95% CI 3.216–383.971). Exacerbation of MG during infection was relatively rare (15%) and was not caused by remdesivir, convalescent plasma or favipiravir (95% CI 0.885–10.87). Conclusions As the most important predictors of severe COVID‐19 in MG patients we identified unsatisfied condition of MG with lower FVC, previous long‐term corticosteroid treatment especially in higher doses, older age, the presence of cancer, and recent rituximab treatment.
Collapse
Affiliation(s)
- Michala Jakubíková
- Department of Neurology and Center for Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic
| | - Michaela Týblová
- Department of Neurology and Center for Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic
| | - Adam Tesař
- Department of Neurology and Center for Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic.,Institute of Biophysics and Informatics of the First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Magda Horáková
- Department of Neurology, ERN EURO-NMD Center, University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Daniela Vlažná
- Department of Neurology, ERN EURO-NMD Center, University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
| | - Irena Ryšánková
- Department of Neurology and Center for Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic
| | - Iveta Nováková
- Department of Neurology and Center for Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic
| | - Kristýna Dolečková
- Department of Neurology and Center for Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic
| | - Pavel Dušek
- Department of Neurology and Center for Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic
| | - Jiří Piťha
- Department of Neurology and Center for Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic
| | - Stanislav Voháňka
- Department of Neurology, ERN EURO-NMD Center, University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Josef Bednařík
- Department of Neurology, ERN EURO-NMD Center, University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| |
Collapse
|
49
|
Marcacci G, Fiorentino G, Volzone F, Falcone U, Parrella R, Donnarumma D, D'Ovidio S, Annunziata A, Micallo G, Portella G, De Chiara A, De Filippi R, Crisci S, Pinto A. Atypical COVID-19 dynamics in a patient with mantle cell lymphoma exposed to rituximab. Infect Agent Cancer 2021; 16:38. [PMID: 34078415 PMCID: PMC8170447 DOI: 10.1186/s13027-021-00376-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/07/2021] [Indexed: 12/15/2022] Open
Abstract
Patients with non-hodgkin lymphomas (NHL) represent a population of special interest during the current Coronavirus disease-19 (COVID-19) pandemics. NHLs are associated with disease- and treatment-related immunodeficiencies which may generate unusual COVID-19 dynamics and pose unique management challenges. We report the unusual clinical course of COVID-19 in a patient with mantle cell lymphoma (MCL) exposed to nine doses of Rituximab shortly before infection with severe acute respiratory syndrome corona virus 2 (SARS-CoV-2). He had a prolonged asymptomatic phase, with negative molecular and antibody testing for SARS-CoV-2, followed by a rapidly progressive evolution to severe COVID-19. Despite detection of viral RNA overlapped with first symptoms occurrence, anti-SARS-CoV-2 antibodies displayed an asynchronous pattern, with IgG first appearing 2 days after RNA positivity and IgM never being detected throughout the entire clinical course. While disease-associated immune derangements and/or previous treatments involving anti-CD20 antibodies might have contributed to COVID-19 dynamics in our patient, data suggests that antibody testings, without concurrent molecular assessment for SARS-CoV-2, may turn inadequate for monitoring of MCL patients, and in general NHL patients heavily exposed to anti-CD20 antibodies, during the current pandemics. We suggest that repeated molecular testing of nasopharyngeal swab should be implemented in these subjects despite a negative serology and absence of symptoms of SARS-CoV-2 infection. For the same reasons, a customized strategy needs to be developed for patients exposed to anti-CD20 antibodies, based on different features and mechanism of action of available SARS-CoV-2 vaccines and novel vaccinomics developments.
Collapse
Affiliation(s)
- Gianpaolo Marcacci
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione 'G. Pascale', IRCCS, Naples, Italy
| | - Giuseppe Fiorentino
- Respiratory Physiopathology and Rehabilitation Unit, AORN dei Colli, Naples, Italy
| | - Francesco Volzone
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione 'G. Pascale', IRCCS, Naples, Italy
| | - Umberto Falcone
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione 'G. Pascale', IRCCS, Naples, Italy
| | - Roberto Parrella
- Respiratory Infectious Disease Unit, AORN dei Colli, Naples, Italy
| | - Daniela Donnarumma
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione 'G. Pascale', IRCCS, Naples, Italy
| | - Silvia D'Ovidio
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione 'G. Pascale', IRCCS, Naples, Italy
| | - Anna Annunziata
- Respiratory Physiopathology and Rehabilitation Unit, AORN dei Colli, Naples, Italy
| | - Giovanni Micallo
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione 'G. Pascale', IRCCS, Naples, Italy
| | - Giuseppe Portella
- Department of Translational Medical Sciences, Università degli Studi Federico II, Naples, Italy
| | - Annarosaria De Chiara
- Pathology Unit, Istituto Nazionale Tumori, Fondazione 'G. Pascale', IRCCS, Naples, Italy
| | - Rosaria De Filippi
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione 'G. Pascale', IRCCS, Naples, Italy
- Department of Clinical Medicine and Surgery, Università degli Studi Federico II, Naples, Italy
| | - Stefania Crisci
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione 'G. Pascale', IRCCS, Naples, Italy
| | - Antonio Pinto
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione 'G. Pascale', IRCCS, Naples, Italy.
| |
Collapse
|
50
|
Riches JC. Impact of COVID-19 in patients with lymphoid malignancies. World J Virol 2021; 10:97-110. [PMID: 34079692 PMCID: PMC8152455 DOI: 10.5501/wjv.v10.i3.97] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/08/2021] [Accepted: 04/26/2021] [Indexed: 02/06/2023] Open
Abstract
The first cases of coronavirus disease 2019 (COVID-19) were detected in Wuhan, China, in December 2019. Since this time a concerted global effort of research and observational data gathering has meant that a great deal has been learnt about the impact of COVID-19 in patients with lymphoid malignancies. Approximately one-third of patients with lymphoid malignancies who acquire COVID-19 and have it severely enough to require hospital assessment will die from this infection. Major risk factors for a poor outcome are age and co-morbidities, but when these are taken into account lymphoma patients have a slightly greater than 2-fold increased risk compared to the general population. Notably, despite early concerns regarding the particular vulnerability of lymphoma patients due to the immunosuppressive effects of therapy, active treatment, including B-cell depleting agents such as rituximab, do not appear to be associated with an increased risk of a poorer outcome. Indeed, some treatments such as ibrutinib may be beneficial due to their modulation of the potential fatal hyperinflammatory phase of infection. There are risks associated with hemopoietic stem cell transplantation, but the collective experience is that these can be minimized by preventive strategies and that the majority of transplant recipients with COVID-19 infection will survive. Many questions remain including those regarding the outcome of COVID-19 infection in the rarer lymphoid malignancies and the efficacy of COVID-19 vaccines in lymphoma patients. This review aims to discuss these issues and present a summary of the current knowledge of the impact of COVID-19 in lymphoid malignancies.
Collapse
Affiliation(s)
- John Charles Riches
- Centre for Haemato-Oncology, Barts Cancer Institute - a Cancer Research UK Centre of Excellence, Queen Mary University of London, John Vane Science Centre, Charterhouse Square, London EC1M 6BQ, United Kingdom
| |
Collapse
|