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Giladi O, Bagnato G, Gentilini M, Shimony S, Pasvolsky O, Berger T, Itchaki G, Raanani P, Lolli G, Stefoni V, Broccoli A, Argnani L, Zinzani PL, Gurion R. Diffuse large B cell lymphoma characteristics and outcomes during the COVID-19 pandemic in two tertiary centers - an Israeli/ Italian study. Ann Hematol 2024; 103:803-811. [PMID: 37950052 DOI: 10.1007/s00277-023-05543-5] [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: 08/14/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023]
Abstract
The COVID-19 pandemic posed a major challenge in cancer care worldwide which might have an impact on the management of diffuse large B-cell lymphoma (DLBCL). We conducted a retrospective study comparing characteristics, management, and outcomes of DLBCL patients diagnosed during the first year of the COVID-19 pandemic (1/3/2020-28/2/2021) to those diagnosed in the previous year (1/3/2019-28/2/2020) in two tertiary centers in Italy and Israel. 182 patients were diagnosed with DLBCL during the study period. More patients were diagnosed during the pandemic compared to the year before: 60 vs. 29 and 54 vs. 39 in Italy and in Israel, respectively. Trends towards older age and higher transformation rates were shown during the pandemic. The interval between the initiation of symptoms and diagnosis was longer during the pandemic. Five and four patients were diagnosed with COVID-19 during treatment in Italy and in Israel, respectively. there was no difference in dose density and intensity of treatment, before and during the pandemic. The median follow-up during and before the pandemic was 15.2 and 25.5 months, respectively. Progression-free survival (PFS) was slightly shorter during the pandemic compared to the year before (64.9% vs. 70.6%; p = 0.0499). In multivariate analysis, older age and transformed disease were independently related to PFS, while diagnosis of DLBCL during the pandemic was not. Despite the challenges caused by COVID-19 pandemic, the management of DLBCL patients remained unchanged including dose density and intensity. Nevertheless, a shorter PFS during the outbreak might be attributed to differences in patients' characteristics.
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Affiliation(s)
- Odil Giladi
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Gianmarco Bagnato
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Marianna Gentilini
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Shai Shimony
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Oren Pasvolsky
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Tamar Berger
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Laboratory of Genome Maintenance, The Rockefeller University, New York, NY, USA
| | - Gilad Itchaki
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Hematology Institute, Meir Medical Center, Kfar Saba, Israel
| | - Pia Raanani
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ginerva Lolli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Vittorio Stefoni
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Alessandro Broccoli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Lisa Argnani
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Ronit Gurion
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Infante MS, Nemirovsky D, Devlin S, DeWolf S, Tamari R, Dahi PB, Lee YJ, Chung DJ, Politikos I, Barker J, Giralt SA, Babady NE, Ramanathan L, Papanicolaou GA, Seo S, Kamboj M, Perales MA, Shah GL. Outcomes and Management of the SARS-CoV2 Omicron Variant in Recipients of Hematopoietic Cell Transplantation and Chimeric Antigen Receptor T Cell Therapy. Transplant Cell Ther 2024; 30:116.e1-116.e12. [PMID: 37806446 DOI: 10.1016/j.jtct.2023.09.027] [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: 06/22/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/10/2023]
Abstract
Hematopoietic cell transplantation (HCT) and chimeric antigen receptor T cell therapy (CAR-T) recipients who develop Coronavirus disease 2019 (COVID-19) can have decreased overall survival (OS), likely due to disease-inherent and therapy-related immunodeficiency. The availability of COVID-19-directed therapies and vaccines have improved COVID-19-related outcomes, but immunocompromised individuals remain vulnerable. Specifically, the effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant infections, including Omicron and its sublineages, particularly in HCT recipients, remain to be defined. The aim of this study was to compare the impact of SARS-CoV-2 Omicron infections in HCT/CAR-T recipients with outcomes previously reported for ancestral SARS-CoV-2 infections early in the pandemic (March to June 2020). This was a retrospective analysis of adult HCT/CAR-T recipients diagnosed with COVID-19 at Memorial Sloan Kettering Cancer Center between July 2021 and July 2022. We identified 353 patients (172 autologous HCT recipients [49%], 152 allogeneic HCT recipients [43%], and 29 CAR-T recipients [8%]), with a median time from HCT/CAR-T to SARS-CoV-2 infection of 1010 days (interquartile range, 300 to 2046 days). Forty-one patients (12%) were diagnosed with COVID-19 during the delta wave, and 312 patients (88%) were diagnosed during the Omicron wave. Risk factors associated with increased odds of COVID-19-related hospitalization were the presence of 2 or more comorbidities (odds ratio [OR], 4.9; 95% confidence interval [CI], 2.4 to 10.7; P < .001), CAR-T therapy compared to allogeneic HCT (OR, 7.7; 95% CI, 3.0 to 20.0; P < .001), hypogammaglobulinemia (OR, 2.71; 95% CI, 1.06 to 6.40; P = .027), and age at COVID-19 diagnosis (OR, 1.03; 95% CI, 1.0 to 1.05; P = .04). In contrast, infection during the Omicron variant BA5/BA4-dominant period compared to variant BA1 (OR, .21; 95% CI, .03 to .73; P = .037) and more than 3 years from HCT/CAR-T therapy to COVID-19 diagnosis compared to early infection at <100 days (OR, .31; 95% CI, .12 to .79; P = .011) were associated with a decreased odds for hospitalization. The OS at 12 months from COVID-19 diagnosis was 89% (95% CI, 84% to 94%), with 6 of 26 deaths attributable to COVID-19. Patients with the ancestral strain of SAR-CoV-2 had a lower OS at 12 months, with 73% (95% CI, 62% to 84%) versus 89% (95% CI, 84% to 94%; P < .001) in the Omicron cohort. Specific COVID-19 treatment was administered in 62% of patients, and 84% were vaccinated with mRNA COVID-19 vaccines. Vaccinated patients had significantly better OS than unvaccinated patients (90% [95% CI, 86% to 95%] versus 82% [95% CI, 72% to 94%] at 12 months; P = .003). No significant difference in OS was observed in patients infected with the Omicron and those infected with the Delta variant (P = .4) or treated with specific COVID-19 treatments compared with those not treated (P = .2). We observed higher OS in HCT and CAR-T recipients infected with the Omicron variants compared to those infected with the ancestral strain of SARS-CoV2. The use of COVID-19 antivirals, mAbs, and vaccines might have contributed to the improved outcomes.
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Affiliation(s)
- Maria-Stefania Infante
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; University Hospital Infanta Leonor, Madrid, Spain.
| | - David Nemirovsky
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Susan DeWolf
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Roni Tamari
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Parastoo B Dahi
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Yeon Joo Lee
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - David J Chung
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Ioannis Politikos
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Juliet Barker
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Sergio A Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - N Esther Babady
- Clinical Microbiology Service, Department of Laboratory Medicine, Memorial SLoan Kettering Cancer Center, New York, New York
| | - Lakshmi Ramanathan
- Clinical Chemistry Service, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Genovefa A Papanicolaou
- Department of Medicine, Weill Cornell Medical College, New York, New York; Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Susan Seo
- Department of Medicine, Weill Cornell Medical College, New York, New York; Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mini Kamboj
- Department of Medicine, Weill Cornell Medical College, New York, New York; Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Gunjan L Shah
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
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Kanazawa A, Yan Y, Yuda M, Fukui N, Saita M, Mori H, Naito T. Risk factors for progressing to severe COVID-19 among people living with HIV in Japan: A hospital claims database study. J Infect Chemother 2024; 30:40-47. [PMID: 37708941 DOI: 10.1016/j.jiac.2023.09.009] [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: 05/06/2023] [Revised: 08/27/2023] [Accepted: 09/10/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION Risk factors for severe COVID-19 associated with people living with HIV (PLWH) have not been well studied in Japan. In this study, we aim to reveal how having AIDS and comorbidities affect adverse COVID-19 outcomes. METHODS This observational, retrospective study examined the clinical outcomes for PLWH hospitalized as COVID-19 inpatients in Japan, using data extracted from hospitals with the Diagnosis Procedure Combination (DPC) system between January 2020 and December 2021. From 4672 records of HIV patients receiving antiretroviral therapy, 85 adult PLWH became hospitalized with COVID-19. The associations between patients' AIDS diagnosis, comorbidities, and their adverse COVID-19 outcomes (mild/moderate and severe/death) were analyzed. RESULTS Among 85 studied patients, 78 were male (91.8%) with mean (SD) age of 48 (14.4) years. 75 (88.2%) were found to be COVID-19 mild/moderate; 9 (10.6%) were severe; 1 (1.2%) died. Older age (p = 0.002) and hypertension (p = 0.032) were significantly associated with progressing to severe COVID-19 or death. AIDS and other AIDS-defining illnesses were not found to be significant risk factors in this study. CONCLUSIONS While interpretation of the results from this hospital claim database study warrants caution, we found that among PLWH hospitalized as COVID-19 inpatients in Japan, those who are older or with hypertension have a higher risk for progression to severe COVID-19 outcomes, suggesting a careful monitoring of clinical course for these patients.
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Affiliation(s)
- Akio Kanazawa
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yan Yan
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Mayumi Yuda
- Center for Promotion of Data Science, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nobuyuki Fukui
- Center for Promotion of Data Science, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Mizue Saita
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hirotake Mori
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Toshio Naito
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan.
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4
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Sobhani N, Mondani G, Roviello G, Catalano M, Sirico M, D'Angelo A, Scaggiante B, Generali D. Cancer management during the COVID-19 world pandemic. Cancer Immunol Immunother 2023; 72:3427-3444. [PMID: 37642709 DOI: 10.1007/s00262-023-03524-1] [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: 06/09/2023] [Accepted: 08/10/2023] [Indexed: 08/31/2023]
Abstract
Since 2019, the world has been experiencing an outbreak of a novel beta-coronavirus, severe acute respiratory syndrome coronavirus (SARS-CoV)-2. The worldwide spread of this virus has been a severe challenge for public health, and the World Health Organization declared the outbreak a public health emergency of international concern. As of June 8, 2023, the virus' rapid spread had caused over 767 million infections and more than 6.94 million deaths worldwide. Unlike previous SARS-CoV-1 and Middle East respiratory syndrome coronavirus outbreaks, the COVID-19 outbreak has led to a high death rate in infected patients; this has been caused by multiorgan failure, which might be due to the widespread presence of angiotensin-converting enzyme 2 (ACE2) receptors-functional receptors of SARS-CoV-2-in multiple organs. Patients with cancer may be particularly susceptible to COVID-19 because cancer treatments (e.g., chemotherapy, immunotherapy) suppress the immune system. Thus, patients with cancer and COVID-19 may have a poor prognosis. Knowing how to manage the treatment of patients with cancer who may be infected with SARS-CoV-2 is essential. Treatment decisions must be made on a case-by-case basis, and patient stratification is necessary during COVID-19 outbreaks. Here, we review the management of COVID-19 in patients with cancer and focus on the measures that should be adopted for these patients on the basis of the organs or tissues affected by cancer and by the tumor stage.
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Affiliation(s)
- Navid Sobhani
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX, 77030, USA.
| | - Giuseppina Mondani
- Royal Infirmary Hospital, Foresterhill Health Campus, Foresterhill Rd, Aberdeen, AB25 2ZN, UK
| | - Giandomenico Roviello
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Florence, Italy
| | - Martina Catalano
- Royal Infirmary Hospital, Foresterhill Health Campus, Foresterhill Rd, Aberdeen, AB25 2ZN, UK
| | - Marianna Sirico
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via P. Maroncelli 40, 47014, Meldola, Italy
| | - Alberto D'Angelo
- Department of Biology and Biochemistry, University of Bath, Bath, BA2 7AX, UK
| | - Bruna Scaggiante
- Department of Life Sciences, University of Trieste, 34127, Trieste, Italy
| | - Daniele Generali
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127, Trieste, Italy
- Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, 26100, Cremona, Italy
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Szabó E, Modok S, Rónaszéki B, Faragó A, Gémes N, Nagy LI, Hackler L, Farkas K, Neuperger P, Balog JÁ, Balog A, Puskás LG, Szebeni GJ. Comparison of humoral and cellular immune responses in hematologic diseases following completed vaccination protocol with BBIBP-CorV, or AZD1222, or BNT162b2 vaccines against SARS-CoV-2. Front Med (Lausanne) 2023; 10:1176168. [PMID: 37529238 PMCID: PMC10389666 DOI: 10.3389/fmed.2023.1176168] [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: 02/28/2023] [Accepted: 06/23/2023] [Indexed: 08/03/2023] Open
Abstract
Background Vaccination has proven the potential to control the COVID-19 pandemic worldwide. Although recent evidence suggests a poor humoral response against SARS-CoV-2 in vaccinated hematological disease (HD) patients, data on vaccination in these patients is limited with the comparison of mRNA-based, vector-based or inactivated virus-based vaccines. Methods Forty-nine HD patients and 46 healthy controls (HCs) were enrolled who received two-doses complete vaccination with BNT162b2, or AZD1222, or BBIBP-CorV, respectively. The antibodies reactive to the receptor binding domain of spike protein of SARS-CoV-2 were assayed by Siemens ADVIA Centaur assay. The reactive cellular immunity was assayed by flow cytometry. The PBMCs were reactivated with SARS-CoV-2 antigens and the production of activation-induced markers (TNF-α, IFN-γ, CD40L) was measured in CD4+ or CD8+ T-cells ex vivo. Results The anti-RBD IgG level was the highest upon BNT162b2 vaccination in HDs (1264 BAU/mL) vs. HCs (1325 BAU/mL) among the studied groups. The BBIBP-CorV vaccination in HDs (339.8 BAU/mL ***p < 0.001) and AZD1222 in HDs (669.9 BAU/mL *p < 0.05) resulted in weaker antibody response vs. BNT162b2 in HCs. The response rate of IgG production of HC vs. HD patients above the diagnostic cut-off value was 100% vs. 72% for the mRNA-based BNT162b2 vaccine; 93% vs. 56% for the vector-based AZD1222, or 69% vs. 33% for the inactivated vaccine BBIBP-CorV, respectively. Cases that underwent the anti-CD20 therapy resulted in significantly weaker (**p < 0.01) anti-RBD IgG level (302 BAU/mL) than without CD20 blocking in the HD group (928 BAU/mL). The response rates of CD4+ TNF-α+, CD4+ IFN-γ+, or CD4+ CD40L+ cases were lower in HDs vs. HCs in all vaccine groups. However, the BBIBP-CorV vaccine resulted the highest CD4+ TNF-α and CD4+ IFN-γ+ T-cell mediated immunity in the HD group. Conclusion We have demonstrated a significant weaker overall response to vaccines in the immunologically impaired HD population vs. HCs regardless of vaccine type. Although, the humoral immune activity against SARS-CoV-2 can be highly evoked by mRNA-based BNT162b2 vaccination compared to vector-based AZD1222 vaccine, or inactivated virus vaccine BBIBP-CorV, whereas the CD4+ T-cell mediated cellular activity was highest in HDs vaccinated with BBIBP-CorV.
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Affiliation(s)
- Enikő Szabó
- Laboratory of Functional Genomics, Biological Research Centre, Szeged, Hungary
| | - Szabolcs Modok
- Department of Medicine, Szent-Györgyi Albert Medical School-University of Szeged, Szeged, Hungary
| | - Benedek Rónaszéki
- Department of Medicine, Szent-Györgyi Albert Medical School-University of Szeged, Szeged, Hungary
| | - Anna Faragó
- Avidin Ltd., Szeged, Hungary
- Doctoral School in Biology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Nikolett Gémes
- Laboratory of Functional Genomics, Biological Research Centre, Szeged, Hungary
- Doctoral School in Biology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | | | | | | | - Patrícia Neuperger
- Laboratory of Functional Genomics, Biological Research Centre, Szeged, Hungary
- Doctoral School in Biology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - József Á. Balog
- Laboratory of Functional Genomics, Biological Research Centre, Szeged, Hungary
| | - Attila Balog
- Department of Rheumatology and Immunology, Faculty of Medicine, Albert Szent-Gyorgyi Health Centre, University of Szeged, Szeged, Hungary
| | - László G. Puskás
- Laboratory of Functional Genomics, Biological Research Centre, Szeged, Hungary
- Avidin Ltd., Szeged, Hungary
- Avicor Ltd., Szeged, Hungary
| | - Gabor J. Szebeni
- Laboratory of Functional Genomics, Biological Research Centre, Szeged, Hungary
- Department of Physiology, Anatomy and Neuroscience, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
- CS-Smartlab Devices, Kozarmisleny, Hungary
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Vasileiou S, Hill L, Kuvalekar M, Workineh AG, Watanabe A, Velazquez Y, Lulla S, Mooney K, Lapteva N, Grilley BJ, Heslop HE, Rooney CM, Brenner MK, Eagar TN, Carrum G, Grimes KA, Leen AM, Lulla P. Allogeneic, off-the-shelf, SARS-CoV-2-specific T cells (ALVR109) for the treatment of COVID-19 in high-risk patients. Haematologica 2023; 108:1840-1850. [PMID: 36373249 PMCID: PMC10316279 DOI: 10.3324/haematol.2022.281946] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/31/2022] [Indexed: 07/22/2023] Open
Abstract
Defects in T-cell immunity to SARS-CoV-2 have been linked to an increased risk of severe COVID-19 (even after vaccination), persistent viral shedding and the emergence of more virulent viral variants. To address this T-cell deficit, we sought to prepare and cryopreserve banks of virus-specific T cells, which would be available as a partially HLA-matched, off-the-shelf product for immediate therapeutic use. By interrogating the peripheral blood of healthy convalescent donors, we identified immunodominant and protective T-cell target antigens, and generated and characterized polyclonal virus-specific T-cell lines with activity against multiple clinically important SARS-CoV-2 variants (including 'delta' and 'omicron'). The feasibility of making and safely utilizing such virus-specific T cells clinically was assessed by administering partially HLA-matched, third-party, cryopreserved SARS-CoV-2-specific T cells (ALVR109) in combination with other antiviral agents to four individuals who were hospitalized with COVID-19. This study establishes the feasibility of preparing and delivering off-the-shelf, SARS-CoV-2-directed, virus-specific T cells to patients with COVID-19 and supports the clinical use of these products outside of the profoundly immune compromised setting (ClinicalTrials.gov number, NCT04401410).
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Affiliation(s)
- Spyridoula Vasileiou
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Houston Methodist Hospital, Houston, TX.
| | - LaQuisa Hill
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Houston Methodist Hospital, Houston, TX
| | - Manik Kuvalekar
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Houston Methodist Hospital, Houston, TX
| | - Aster G Workineh
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Houston Methodist Hospital, Houston, TX
| | - Ayumi Watanabe
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Houston Methodist Hospital, Houston, TX
| | - Yovana Velazquez
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Houston Methodist Hospital, Houston, TX
| | - Suhasini Lulla
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Houston Methodist Hospital, Houston, TX
| | - Kimberly Mooney
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Houston Methodist Hospital, Houston, TX
| | - Natalia Lapteva
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Houston Methodist Hospital, Houston, TX
| | - Bambi J Grilley
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Houston Methodist Hospital, Houston, TX
| | - Helen E Heslop
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Houston Methodist Hospital, Houston, TX
| | - Cliona M Rooney
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Houston Methodist Hospital, Houston, TX
| | - Malcolm K Brenner
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Houston Methodist Hospital, Houston, TX
| | - Todd N Eagar
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Houston Methodist Hospital, Houston, TX
| | - George Carrum
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Houston Methodist Hospital, Houston, TX
| | - Kevin A Grimes
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Houston Methodist Hospital, Houston, TX
| | - Ann M Leen
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Houston Methodist Hospital, Houston, TX
| | - Premal Lulla
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Houston Methodist Hospital, Houston, TX
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7
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Murase K, Takada K, Arihara Y, Miyanishi K, Kato J. Sotrovimab Treatment for COVID-19 Effective in a B-Cell-Depleted Patient After Anti-CD20 Treatment. Cureus 2023; 15:e41486. [PMID: 37551219 PMCID: PMC10404336 DOI: 10.7759/cureus.41486] [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] [Accepted: 07/06/2023] [Indexed: 08/09/2023] Open
Abstract
Patients with hematologic malignancies are well known to have prolonged COVID-19 pneumonia. The cause has been reported to be B cell depletion after administration of anti-CD20 antibodies. Here, we report a case of COVID-19 pneumonia due to prolonged B-cell depletion after anti-CD20 antibody therapy for malignant lymphoma two years before. Sotrovimab, a neutralizing antibody that was designed to prevent the progression of COVID-19, was successful in preventing the progression to severe disease in this B-cell-depleted patient.
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Affiliation(s)
- Kazuyuki Murase
- Department of Medical Oncology, Sapporo Medical University, Sapporo, JPN
| | - Kohichi Takada
- Department of Medical Oncology, Sapporo Medical University, Sapporo, JPN
| | - Yohei Arihara
- Department of Medical Oncology, Sapporo Medical University, Sapporo, JPN
| | - Koji Miyanishi
- Department of Medical Oncology, Sapporo Medical University, Sapporo, JPN
| | - Junji Kato
- Department of Medical Oncology, Sapporo Kiyota Hospital, Sapporo, JPN
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8
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Russo C, Mislang AR, Ferraioli D, Soto-Perez-de-Celis E, Colloca G, Williams GR, O'Hanlon S, Cooper L, O'Donovan A, Audisio RA, Cheung KL, Sarrió RG, Stauder R, Jaklitsch M, Cairo C, Gil LA, Sattar S, Kantilal K, Loh KP, Lichtman SM, Brain E, Kanesvaran R, Battisti NML. SIOG COVID-19 Working Group recommendations on COVID-19 therapeutic approaches in older adults with cancer. J Geriatr Oncol 2023; 14:101564. [PMID: 37393123 PMCID: PMC10288307 DOI: 10.1016/j.jgo.2023.101564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/23/2023] [Accepted: 06/21/2023] [Indexed: 07/03/2023]
Affiliation(s)
- Chiara Russo
- Department of Medical Oncology, Léon Bérard, Comprehensive Cancer Centre, Lyon, France.
| | - Anna Rachelle Mislang
- Department of Medical Oncology, Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia.
| | - Domenico Ferraioli
- Department of Gynaecology, Léon Bérard, Comprehensive Cancer Centre, Lyon, France.
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Giuseppe Colloca
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Grant R Williams
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.
| | - Shane O'Hanlon
- University College Dublin, St Vincent's University Hospital, Dublin, Ireland.
| | - Lisa Cooper
- Department of Geriatric Medicine, Rabin Medical Center, Sackler Faculty of Medicine, Division of Aging, Department of Medicine, Tel Aviv University, Israel.
| | - Anita O'Donovan
- Applied Radiation Therapy Trinity (ARTT), Trinity St James's Cancer Institute, Trinity College, Dublin, Ireland.
| | - Riccardo A Audisio
- Department of Surgery, Sahlgrenska Academy - University of Gothenburg, Gothenburg, Sweden.
| | - Kwok-Leung Cheung
- School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK.
| | - Regina Gironés Sarrió
- Department of Medical Oncology, Hospital Universitari i Politècnic La FE, Valencia, Spain.
| | - Reinhard Stauder
- Department of Internal Medicine V (Haematology and Oncology), Innsbruck Medical University, Innsbruck, Austria.
| | - Michael Jaklitsch
- Brigham and Women's Hospital - Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
| | - Clarito Cairo
- National Integrated Cancer Control Program, Department of Health, Manila, Philippines.
| | - Luiz Antonio Gil
- Geriatric Center for Advanced Medicine - Hospital Sirio-Libanês, São Paulo, SP, Brazil.
| | - Schroder Sattar
- College of Nursing - University of Saskatchewan, Saskatoon, Canada.
| | - Kumud Kantilal
- School of Pharmacy, University of East Anglia, Norwich, UK.
| | - Kah Poh Loh
- University of Rochester Medical Center, Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, Rochester, NY, USA.
| | - Stuart M Lichtman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Etienne Brain
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium.
| | | | - Nicolò Matteo Luca Battisti
- Breast Unit - Department of Medicine Department, The Royal Marsden NHS Foundation Trus, Breast Cancer Research Division, The Institute of Cancer Research, London, UK.
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9
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Desmarets M, Hoffmann S, Vauchy C, Rijnders BJA, Toussirot E, Durrbach A, Körper S, Schrezenmeier E, van der Schoot CE, Harvala H, Brunotte G, Appl T, Seifried E, Tiberghien P, Bradshaw D, Roberts DJ, Estcourt LJ, Schrezenmeier H. Early, very high-titre convalescent plasma therapy in clinically vulnerable individuals with mild COVID-19 (COVIC-19): protocol for a randomised, open-label trial. BMJ Open 2023; 13:e071277. [PMID: 37105693 PMCID: PMC10151238 DOI: 10.1136/bmjopen-2022-071277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION COVID-19 convalescent plasma (CCP) is a possible treatment option for COVID-19. A comprehensive number of clinical trials on CCP efficacy have already been conducted. However, many aspects of CCP treatment still require investigations: in particular (1) Optimisation of the CCP product, (2) Identification of the patient population in need and most likely to benefit from this treatment approach, (3) Timing of administration and (4) CCP efficacy across viral variants in vivo. We aimed to test whether high-titre CCP, administered early, is efficacious in preventing hospitalisation or death in high-risk patients. METHODS AND ANALYSIS COVIC-19 is a multicentre, randomised, open-label, adaptive superiority phase III trial comparing CCP with very high neutralising antibody titre administered within 7 days of symptom onset plus standard of care versus standard of care alone. We will enrol patients in two cohorts of vulnerable patients [(1) elderly 70+ years, or younger with comorbidities; (2) immunocompromised patients]. Up to 1020 participants will be enrolled in each cohort (at least 340 with a sample size re-estimation after reaching 102 patients). The primary endpoint is the proportion of participants with (1) Hospitalisation due to progressive COVID-19, or (2) Who died by day 28 after randomisation. Principal analysis will follow the intention-to-treat principle. ETHICS AND DISSEMINATION Ethical approval has been granted by the University of Ulm ethics committee (#41/22) (lead ethics committee for Germany), Comité de protection des personnes Sud-Est I (CPP Sud-Est I) (#2022-A01307-36) (ethics committee for France), and ErasmusMC ethics committee (#MEC-2022-0365) (ethics committee for the Netherlands). Signed informed consent will be obtained from all included patients. The findings will be published in peer-reviewed journals and presented at relevant stakeholder conferences and meetings. TRIAL REGISTRATION Clinical Trials.gov (NCT05271929), EudraCT (2021-006621-22).
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Affiliation(s)
- Maxime Desmarets
- Centre d'Investigation Clinique Inserm CIC1431, CHU Besançon, Besançon, Bourgogne Franche-Comté, France
- UMR 1098 Right, Inserm, Établissement Français du Sang, Université de Franche-Comté, Besançon, Bourgogne Franche-Comté, France
| | - Simone Hoffmann
- Blood Transfusion Service Baden-Württemberg-Hessen, German Red Cross, Ulm, Baden-Württemberg, Germany
| | - Charline Vauchy
- Centre d'Investigation Clinique Inserm CIC1431, CHU Besançon, Besançon, Bourgogne Franche-Comté, France
- UMR 1098 Right, Inserm, Établissement Français du Sang, Université de Franche-Comté, Besançon, Bourgogne Franche-Comté, France
| | - Bart J A Rijnders
- University Medical Center, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
| | - Eric Toussirot
- Centre d'Investigation Clinique Inserm CIC1431, CHU Besançon, Besançon, Bourgogne Franche-Comté, France
- UMR 1098 Right, Inserm, Établissement Français du Sang, Université de Franche-Comté, Besançon, Bourgogne Franche-Comté, France
| | - Antoine Durrbach
- Department of Nephrology, AP-HP Hôpital Henri Mondor, Créteil, Île-de-France, France
| | - Sixten Körper
- Blood Transfusion Service Baden-Württemberg-Hessen, German Red Cross, Ulm, Baden-Württemberg, Germany
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, Ulm, Baden-Württemberg, Germany
| | - Eva Schrezenmeier
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - C Ellen van der Schoot
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Noord-Holland, Netherlands
| | - Heli Harvala
- Microbiology Services, NHS Blood and Transplant, Colindale, London, UK
| | - Gaëlle Brunotte
- Centre d'investigation clinique Inserm CIC1431, CHU Besançon, Besançon, France
| | - Thomas Appl
- Blood Transfusion Service Baden-Württemberg-Hessen, German Red Cross, Ulm, Baden-Württemberg, Germany
| | - Erhard Seifried
- Blood Transfusion Service Baden-Württemberg-Hessen, German Red Cross, Ulm, Baden-Württemberg, Germany
| | - Pierre Tiberghien
- UMR 1098 Right, Inserm, Établissement Français du Sang, Université de Franche-Comté, Besançon, Bourgogne Franche-Comté, France
- Etablissement Francais du Sang, La Plaine Saint-Denis, Île-de-France, France
| | - Daniel Bradshaw
- Virus Reference Department, UK Health Security Agency, London, UK
| | - David J Roberts
- NHS Blood and Transplant, Oxford, Oxfordshire, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, Oxfordshire, UK
| | - Lise J Estcourt
- NHS Blood and Transplant, Oxford, Oxfordshire, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, Oxfordshire, UK
| | - Hubert Schrezenmeier
- Blood Transfusion Service Baden-Württemberg-Hessen, German Red Cross, Ulm, Baden-Württemberg, Germany
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, Ulm, Baden-Württemberg, Germany
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10
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Hus I, Szymczyk A, Mańko J, Drozd-Sokołowska J. COVID-19 in Adult Patients with Hematological Malignancies-Lessons Learned after Three Years of Pandemic. BIOLOGY 2023; 12:biology12040545. [PMID: 37106746 PMCID: PMC10136203 DOI: 10.3390/biology12040545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 04/29/2023]
Abstract
The COVID-19 pandemic is undoubtedly the most difficult health challenge of the 21st century with more than 600 million laboratory-confirmed SARS-CoV-2 infections and over 6.5 million deaths worldwide. The coronavirus pandemic contributed to rapid development of mRNA vaccines, which, along with new antiviral drugs, have been the subject of extensive research for many decades. Nevertheless, elderly, multi-morbid and immunocompromised patients continue to face a more severe clinical course and a higher risk of death from COVID-19, even now that the risk of COVID-19 in the general population is significantly reduced due to the introduction of global vaccination strategies. In this paper, we present the mechanisms of increased susceptibility to infectious complications and the evolution of the clinical course of COVID-19 in patients with hematological malignancies, taking into account the mutation of the virus and the introduction of vaccines and new antiviral drugs. We also present current recommendations for prophylactic and therapeutic management in patients with hematological malignancies.
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Affiliation(s)
- Iwona Hus
- Department of Hematology, National Medical Institute of the Ministry of Interior and Administration, 137 Wołoska Str., 02-507 Warsaw, Poland
- Department of Clinical Transplantology, Medical University of Lublin, 7 Chodźki Str., 20-093 Lublin, Poland
| | - Agnieszka Szymczyk
- Department of Hematology, National Medical Institute of the Ministry of Interior and Administration, 137 Wołoska Str., 02-507 Warsaw, Poland
- Department of Clinical Transplantology, Medical University of Lublin, 7 Chodźki Str., 20-093 Lublin, Poland
| | - Joanna Mańko
- Department of Hematology, National Medical Institute of the Ministry of Interior and Administration, 137 Wołoska Str., 02-507 Warsaw, Poland
| | - Joanna Drozd-Sokołowska
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, 1a Banacha Str., 02-097 Warsaw, Poland
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11
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Zuo S, Wang F, Hong YY, Chan HW, Chiu CPY, Wang X. Ecological introspection resulting from the COVID-19 pandemic: the threat perception of the pandemic was positively related to pro-environmental behaviors. THE JOURNAL OF POSITIVE PSYCHOLOGY 2023. [DOI: 10.1080/17439760.2023.2190923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Affiliation(s)
- Shijiang Zuo
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Fang Wang
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Ying-Yi Hong
- Business School, The Chinese University of Hong Kong, Hong Kong
| | - Hoi-Wing Chan
- Business School, The Chinese University of Hong Kong, Hong Kong
| | | | - Xue Wang
- Business School, Beijing Normal University, Beijing, China
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12
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Martínez-López J, De la Cruz J, Gil-Manso R, Alegre A, Ortiz J, Llamas P, Martínez Y, Hernández-Rivas JÁ, González-Gascón I, Benavente C, Estival Monteliu P, Jiménez-Yuste V, Canales M, Bastos M, Kwon M, Valenciano S, Callejas-Charavia M, López-Jiménez J, Herrera P, Duarte R, Núñez Martín-Buitrago L, Sanchez Godoy P, Jacome Yerovi C, Martínez-Barranco P, García Roa M, Escolano Escobar C, Matilla A, Rosado Sierra B, Aláez-Usón MC, Quiroz-Cervantes K, Martínez-Chamorro C, Pérez-Oteyza J, Martos-Martinez R, Herráez R, González-Santillana C, Del Campo JF, Alonso A, de la Fuente A, Pascual A, Bustelos-Rodriguez R, Sebrango A, Ruiz E, Marcheco-Pupo EA, Grande C, Cedillo Á, Lumbreras C, Arroyo Barea A, Casas-Rojo JM, Calbacho M, Diez-Martín JL, García-Suárez J. COVID-19 Severity and Survival over Time in Patients with Hematologic Malignancies: A Population-Based Registry Study. Cancers (Basel) 2023; 15:cancers15051497. [PMID: 36900296 PMCID: PMC10001264 DOI: 10.3390/cancers15051497] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 03/05/2023] Open
Abstract
Mortality rates for COVID-19 have declined over time in the general population, but data in patients with hematologic malignancies are contradictory. We identified independent prognostic factors for COVID-19 severity and survival in unvaccinated patients with hematologic malignancies, compared mortality rates over time and versus non-cancer inpatients, and investigated post COVID-19 condition. Data were analyzed from 1166 consecutive, eligible patients with hematologic malignancies from the population-based HEMATO-MADRID registry, Spain, with COVID-19 prior to vaccination roll-out, stratified into early (February-June 2020; n = 769 (66%)) and later (July 2020-February 2021; n = 397 (34%)) cohorts. Propensity-score matched non-cancer patients were identified from the SEMI-COVID registry. A lower proportion of patients were hospitalized in the later waves (54.2%) compared to the earlier (88.6%), OR 0.15, 95%CI 0.11-0.20. The proportion of hospitalized patients admitted to the ICU was higher in the later cohort (103/215, 47.9%) compared with the early cohort (170/681, 25.0%, 2.77; 2.01-3.82). The reduced 30-day mortality between early and later cohorts of non-cancer inpatients (29.6% vs. 12.6%, OR 0.34; 0.22-0.53) was not paralleled in inpatients with hematologic malignancies (32.3% vs. 34.8%, OR 1.12; 0.81-1.5). Among evaluable patients, 27.3% had post COVID-19 condition. These findings will help inform evidence-based preventive and therapeutic strategies for patients with hematologic malignancies and COVID-19 diagnosis.
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Affiliation(s)
- Joaquín Martínez-López
- Hematology Department, Hospital Universitario 12 de Octubre, imas12, Universidad Complutense, CNIO-ISCIII, CIBERONC, 28041 Madrid, Spain
| | - Javier De la Cruz
- Research Institute, Hospital Universitario 12 de Octubre, imas12, 28041 Madrid, Spain
- Correspondence: ; Tel.: +34-93908000
| | - Rodrigo Gil-Manso
- Hematology Department, Hospital Universitario 12 de Octubre, imas12, Universidad Complutense, CNIO-ISCIII, CIBERONC, 28041 Madrid, Spain
| | - Adrián Alegre
- Hematology Department, Hospital Universitario de La Princesa, IIS-HUP, 28006 Madrid, Spain
| | - Javier Ortiz
- Hematology Department, Hospital Universitario de La Princesa, IIS-HUP, 28006 Madrid, Spain
| | - Pilar Llamas
- Hematology Department, Hospital Fundación Jiménez Díaz, Health Research Institute IIS-FJD, 28040 Madrid, Spain
| | - Yolanda Martínez
- Hematology Department, Hospital Fundación Jiménez Díaz, Health Research Institute IIS-FJD, 28040 Madrid, Spain
| | | | | | - Celina Benavente
- Hematology Department, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | | | | | - Miguel Canales
- Hematology Department, Clínica Universidad de Navarra, 28027 Madrid, Spain
| | - Mariana Bastos
- Hematology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Department of Medicine, Universidad Complutense, 28223 Madrid, Spain
| | - Mi Kwon
- Hematology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Department of Medicine, Universidad Complutense, 28223 Madrid, Spain
| | - Susana Valenciano
- Hematology Department, Hospital Universitario HM Sanchinarro, 28050 Madrid, Spain
| | - Marta Callejas-Charavia
- Hematology Department, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Alcalá de Henares, 28805 Madrid, Spain
| | - Javier López-Jiménez
- Hematology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Pilar Herrera
- Hematology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Rafael Duarte
- Hematology Department, Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain
| | | | - Pedro Sanchez Godoy
- Hematology Department, Hospital Universitario Severo Ochoa, 28911 Madrid, Spain
| | | | | | - María García Roa
- Hematology Department, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain
| | | | - Arturo Matilla
- Hematology Department, Hospital Central de la Defensa Gómez Ulla, 28047 Madrid, Spain
| | - Belén Rosado Sierra
- Hematology Department, Hospital Universitario Rey Juan Carlos, Móstoles, 28933 Madrid, Spain
| | | | | | - Carmen Martínez-Chamorro
- Hematology Department, Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón, 28223 Madrid, Spain
| | - Jaime Pérez-Oteyza
- Hematology Department, Hospital Universitario HM Sanchinarro, 28050 Madrid, Spain
| | - Rafael Martos-Martinez
- Hematology Department, Hospital Universitario General de Villalba, Villalba, 28400 Madrid, Spain
| | - Regina Herráez
- Hematology Department, Hospital Universitario Infanta Sofía, San Sebastián de Los Reyes, 28702 Madrid, Spain
| | | | | | - Arancha Alonso
- Hematology Department, Hospital Ruber, 28006 Madrid, Spain
| | - Adolfo de la Fuente
- Hematology Department, MD Anderson Cancer Center Madrid, 28033 Madrid, Spain
| | - Adriana Pascual
- Hematology Department, Hospital Universitario Infanta Elena, Valdemoro, 28340 Madrid, Spain
| | | | - Ana Sebrango
- Hematology Department, Hospital Universitario de Torrejón, 28850 Madrid, Spain
| | - Elena Ruiz
- Hematology Department, Hospital Universitario del Tajo, Aranjuez, 28300 Madrid, Spain
| | | | - Carlos Grande
- Hematology Department, Clínica Universidad de Navarra, 28027 Madrid, Spain
| | - Ángel Cedillo
- Asociación Madrileña de Hematología y Hemoterapia (AMHH), 28040 Madrid, Spain
| | - Carlos Lumbreras
- Internal Medicine Department, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Andrés Arroyo Barea
- Hematology Department, Hospital Universitario 12 de Octubre, imas12, Universidad Complutense, CNIO-ISCIII, CIBERONC, 28041 Madrid, Spain
| | - José Manuel Casas-Rojo
- Internal Medicine Department, Hospital Universitario Infanta Cristina, Parla, 28980 Madrid, Spain
| | - Maria Calbacho
- Hematology Department, Hospital Universitario 12 de Octubre, imas12, Universidad Complutense, CNIO-ISCIII, CIBERONC, 28041 Madrid, Spain
| | - José Luis Diez-Martín
- Hematology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Department of Medicine, Universidad Complutense, 28223 Madrid, Spain
| | - Julio García-Suárez
- Hematology Department, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Alcalá de Henares, 28805 Madrid, Spain
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13
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Schrezenmeier H, Hoffmann S, Hofmann H, Appl T, Jahrsdörfer B, Seifried E, Körper S. Immune Plasma for the Treatment of COVID-19: Lessons Learned so far. Hamostaseologie 2023; 43:67-74. [PMID: 36807822 DOI: 10.1055/a-1987-3682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
COVID-19 convalescent plasma (CCP) has been explored as one of the treatment options for COVID-19. Results of many cohort studies and clinical trials have been recently published. At first glance, the results of the CCP studies appear to be inconsistent. However, it became clear that CCP is not beneficial if CCP with low anti-SARS-CoV-2 antibody concentrations is used, if it is administered late in advanced disease stages, and to patients who already mounted an antibody response against SARS-CoV-2 at the time of CCP transfusion. On the other hand, CCP may prevent progression to severe COVID-19 when very high-titer CCP is given early in vulnerable patients. Immune escape of new variants is a challenge for passive immunotherapy. While new variants of concern developed resistance to most clinically used monoclonal antibodies very rapidly, immune plasma from individuals immunized by both a natural SARS-CoV-2 infection and SARS-CoV-2 vaccination retained neutralizing activity against variants. This review briefly summarizes the evidence on CCP treatment to date and identifies further research needs. Ongoing research on passive immunotherapy is not only relevant for improving care for vulnerable patients in the ongoing SARS-CoV-2 pandemic, but even more as a model for passive immunotherapy in case of future pandemics with a newly evolving pathogen. Compared to other drugs, which must be newly developed in a pandemic (e.g., monoclonal antibodies, antiviral drugs), convalescent plasma is rapidly available, inexpensive to produce, and can be adaptive to viral evolution by selection of contemporary convalescent donors.
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Affiliation(s)
- Hubert Schrezenmeier
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen, and, University Hospital Ulm, Ulm, Germany.,Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Simone Hoffmann
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen, and, University Hospital Ulm, Ulm, Germany.,Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Henrike Hofmann
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen, and, University Hospital Ulm, Ulm, Germany.,Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Thomas Appl
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen, and, University Hospital Ulm, Ulm, Germany.,Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Bernd Jahrsdörfer
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen, and, University Hospital Ulm, Ulm, Germany.,Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Erhard Seifried
- Institute of Transfusion Medicine and Immunohematology, German Red Cross Blood Transfusion Service Baden-Württemberg - Hessen, Frankfurt, Germany
| | - Sixten Körper
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen, and, University Hospital Ulm, Ulm, Germany.,Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
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14
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del Molino del Barrio I, Hayday TS, Laing AG, Hayday AC, Di Rosa F. COVID-19: Using high-throughput flow cytometry to dissect clinical heterogeneity. Cytometry A 2023; 103:117-126. [PMID: 34811890 PMCID: PMC9011838 DOI: 10.1002/cyto.a.24516] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/18/2021] [Accepted: 11/11/2021] [Indexed: 12/22/2022]
Abstract
Here we consider how high-content flow cytometric methodology at appropriate scale and throughput rapidly provided meaningful biological data in our recent studies of COVID-19, which we discuss in the context of other similar investigations. In our work, high-throughput flow cytometry was instrumental to identify a consensus immune signature in COVID-19 patients, and to investigate the impact of SARS-CoV-2 exposure on patients with either solid or hematological cancers. We provide here some examples of our 'holistic' approach, in which flow cytometry data generated by lymphocyte and myelomonocyte panels were integrated with other analytical metrics, including SARS-CoV-2-specific serum antibody titers, plasma cytokine/chemokine levels, and in-depth clinical annotation. We report how selective differences between T cell subsets were revealed by a newly described flow cytometric TDS assay to distinguish actively cycling T cells in the peripheral blood. By such approaches, our and others' high-content flow cytometry studies collectively identified overt abnormalities and subtle but critical changes that discriminate the immuno-signature of COVID-19 patients from those of healthy donors and patients with non-COVID respiratory infections. Thereby, these studies offered several meaningful biomarkers of COVID-19 severity that have the potential to improve the management of patients and of hospital resources. In sum, flow cytometry provides an important means for rapidly obtaining data that can guide clinical decision-making without requiring highly expensive, sophisticated equipment, and/or "-omics" capabilities. We consider how this approach might be further developed.
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Affiliation(s)
- Irene del Molino del Barrio
- Peter Gorer Department of ImmunobiologyKing's College LondonLondonUK
- University College LondonLondonUK
- Cancer Research UK Cancer Immunotherapy AcceleratorLondonUK
| | - Thomas S. Hayday
- Peter Gorer Department of ImmunobiologyKing's College LondonLondonUK
| | - Adam G. Laing
- Peter Gorer Department of ImmunobiologyKing's College LondonLondonUK
| | - Adrian C. Hayday
- Peter Gorer Department of ImmunobiologyKing's College LondonLondonUK
- Cancer Research UK Cancer Immunotherapy AcceleratorLondonUK
- Immunosurveillance LaboratoryThe Francis Crick InstituteLondonUK
| | - Francesca Di Rosa
- Institute of Molecular Biology and PathologyNational Research Council of ItalyRomeItaly
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15
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COVID-19 in Patients with Hematologic Diseases. Biomedicines 2022; 10:biomedicines10123069. [PMID: 36551825 PMCID: PMC9775038 DOI: 10.3390/biomedicines10123069] [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: 11/04/2022] [Revised: 11/22/2022] [Accepted: 11/25/2022] [Indexed: 12/02/2022] Open
Abstract
The COVID-19 outbreak had a strong impact on people's lives all over the world. Patients with hematologic diseases have been heavily affected by the pandemic, because their immune system may be compromised due to anti-cancer or immunosuppressive therapies and because diagnosis and treatment of their baseline conditions were delayed during lockdowns. Hematologic malignancies emerged very soon as risk factors for severe COVID-19 infection, increasing the mortality rate. SARS-CoV2 can also induce or exacerbate immune-mediated cytopenias, such as autoimmune hemolytic anemias, complement-mediated anemias, and immune thrombocytopenia. Active immunization with vaccines has been shown to be the best prophylaxis of severe COVID-19 in hematologic patients. However, the immune response to vaccines may be significantly impaired, especially in those receiving anti-CD20 monoclonal antibodies or immunosuppressive agents. Recently, antiviral drugs and monoclonal antibodies have become available for pre-exposure and post-exposure prevention of severe COVID-19. As adverse events after vaccines are extremely rare, the cost-benefit ratio is largely in favor of vaccination, even in patients who might be non-responders; in the hematological setting, all patients should be considered at high risk of developing complications due to SARS-CoV2 infection and should be offered all the therapies aimed to prevent them.
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16
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Carrara E, Razzaboni E, Azzini AM, De Rui ME, Pinho Guedes MN, Gorska A, Giannella M, Bussini L, Bartoletti M, Arbizzani F, Palacios‐Baena ZR, Caponcello G, Maldonado N, Rodríguez‐Baño J, Visco C, Krampera M, Tacconelli E. Predictors of clinical evolution of SARS-CoV-2 infection in hematological patients: A systematic review and meta-analysis. Hematol Oncol 2022; 41:16-25. [PMID: 36238977 PMCID: PMC9874549 DOI: 10.1002/hon.3084] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 08/14/2022] [Accepted: 10/11/2022] [Indexed: 02/03/2023]
Abstract
Main aim of this systematic review is to quantify the risk and identify predictors of clinical evolution of SARS-CoV-2 in hematological patients compared to different control populations. Two independent reviewers screened the literature assessing clinical outcomes of SARS-CoV-2 infection in adult patients with active hematological malignancies published up to June 2021. Primary outcome was COVID-19 related mortality, secondary outcomes were hospital and intensive-care admission, mechanical ventilation (MV), and thromboembolic events. Variables related to study setting, baseline patients' demographic, comorbidities, underlying hematological disease, ongoing chemotherapy, COVID-19 presentation, and treatments were extracted. A total of 67 studies including 10,061 hematological patients and 111,143 controls were included. Most of the studies were retrospective cohorts (51 studies, 76%) and only 19 (13%) provided data for a control group. A significant increased risk of clinical progression in the hematological population compared to the controls was found in terms of COVID-19 related mortality (OR, 2.12; 95% CI, 1.77-2.54), hospitalization (OR, 1.98; 95% CI, 1.15-3.43), intensive-care admission (OR, 1.77; 95% CI, 1.38-2.26), and MV (OR, 2.17; 95% CI, 1.71-2.75). The risk remained significantly higher in the subgroup analysis comparing hematological patients versus solid cancer. Meta-regression analysis of uncontrolled studies showed that older age, male sex, and hypertension were significantly related to worse clinical outcomes of COVID-19 in hematological population. Older age and hypertension were found to be associated also to thromboembolic events. In conclusion, hematological patients have a higher risk of COVID-19 clinical progression compared to both the general population and to patients with solid cancer.
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Affiliation(s)
- Elena Carrara
- Department of Diagnostics and Public HealthDivision of Infectious DiseasesUniversity of VeronaVeronaItaly
| | - Elisa Razzaboni
- Department of Diagnostics and Public HealthDivision of Infectious DiseasesUniversity of VeronaVeronaItaly
| | - Anna Maria Azzini
- Department of Diagnostics and Public HealthDivision of Infectious DiseasesUniversity of VeronaVeronaItaly
| | - Maria Elena De Rui
- Department of Diagnostics and Public HealthDivision of Infectious DiseasesUniversity of VeronaVeronaItaly
| | - Mariana Nunes Pinho Guedes
- Department of Diagnostics and Public HealthDivision of Infectious DiseasesUniversity of VeronaVeronaItaly
| | - Anna Gorska
- Department of Diagnostics and Public HealthDivision of Infectious DiseasesUniversity of VeronaVeronaItaly
| | - Maddalena Giannella
- Department of Medical and Surgical SciencesInfectious Diseases UnitIRCCS Policlinico Sant’OrsolaUniversity of BolognaBolognaItaly
| | - Linda Bussini
- Department of Medical and Surgical SciencesInfectious Diseases UnitIRCCS Policlinico Sant’OrsolaUniversity of BolognaBolognaItaly
| | - Michele Bartoletti
- Department of Medical and Surgical SciencesInfectious Diseases UnitIRCCS Policlinico Sant’OrsolaUniversity of BolognaBolognaItaly
| | - Federica Arbizzani
- Department of Medical and Surgical SciencesInfectious Diseases UnitIRCCS Policlinico Sant’OrsolaUniversity of BolognaBolognaItaly
| | - Zaira R. Palacios‐Baena
- Department of MedicineInfectious Diseases and Microbiology UnitHospital Universitario Virgen MacarenaUniversity of SevilleBiomedicine Institute of Seville (IBiS) / CSIC; and Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC)SevilleSpain
| | - Giulia Caponcello
- Department of MedicineInfectious Diseases and Microbiology UnitHospital Universitario Virgen MacarenaUniversity of SevilleBiomedicine Institute of Seville (IBiS) / CSIC; and Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC)SevilleSpain
| | - Natalia Maldonado
- Department of MedicineInfectious Diseases and Microbiology UnitHospital Universitario Virgen MacarenaUniversity of SevilleBiomedicine Institute of Seville (IBiS) / CSIC; and Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC)SevilleSpain
| | - Jesús Rodríguez‐Baño
- Department of MedicineInfectious Diseases and Microbiology UnitHospital Universitario Virgen MacarenaUniversity of SevilleBiomedicine Institute of Seville (IBiS) / CSIC; and Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC)SevilleSpain
| | - Carlo Visco
- Department of MedicineSection of HematologyUniversity of VeronaVeronaItaly
| | - Mauro Krampera
- Department of MedicineSection of HematologyUniversity of VeronaVeronaItaly
| | - Evelina Tacconelli
- Department of Diagnostics and Public HealthDivision of Infectious DiseasesUniversity of VeronaVeronaItaly
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17
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Togitani K, Asagiri T, Iguchi M, Igawa T, Yoshino T, Kojima K. Systemic Abscopal Effect of Low-dose Radiotherapy (2 Gy ×2) against Palatine Tonsil Follicular Lymphoma. Intern Med 2022; 61:3107-3110. [PMID: 35314548 PMCID: PMC9646336 DOI: 10.2169/internalmedicine.8968-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 52-year-old man presented with palatine tonsillar swelling caused by follicular lymphoma. His tumor burden was low, but exacerbation of snoring and dysphagia was observed. Considering the first wave of coronavirus disease 2019 (COVID-19) pandemic, he received palliative 4-Gy irradiation to the tonsils in 2 fractions, which induced partial regression of tonsillar swellings and eradication of the circulating lymphoma cells. We suggest that low-dose radiotherapy triggered an abscopal effect of lymphoma, which allowed the patient time to receive COVID-19 vaccination before starting immunosuppressive chemo-immunotherapy.
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Affiliation(s)
- Kazuto Togitani
- Department of Hematology, Kochi Medical School, Kochi University, Japan
| | - Tadashi Asagiri
- Department of Laboratory Medicine, Kochi Medical School Hospital, Kochi University, Japan
| | - Mitsuko Iguchi
- Department of Pathology, Kochi Medical School, Kochi University, Japan
| | - Takuro Igawa
- Department of Pathology, Okayama University Graduate School, Japan
| | - Tadashi Yoshino
- Department of Pathology, Okayama University Graduate School, Japan
| | - Kensuke Kojima
- Department of Hematology, Kochi Medical School, Kochi University, Japan
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18
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Jaroszewicz J, Kowalska J, Pawłowska M, Rogalska M, Zarębska-Michaluk D, Rorat M, Lorenc B, Czupryna P, Sikorska K, Piekarska A, Dworzańska A, Zaleska I, Mazur W, Kozielewicz D, Kłos K, Podlasin R, Angielski G, Oczko-Grzesik B, Figlerowicz M, Szetela B, Bolewska B, Frańczak-Chmura P, Flisiak R, Tomasiewicz K. Remdesivir Decreases Mortality in COVID-19 Patients with Active Malignancy. Cancers (Basel) 2022; 14:cancers14194720. [PMID: 36230641 PMCID: PMC9563758 DOI: 10.3390/cancers14194720] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 12/15/2022] Open
Abstract
Data on the use of remdesivir, the first antiviral agent against SARS-CoV-2, are limited in oncologic patients. We aimed to analyze contributing factors for mortality in patients with malignancies in the real-world CSOVID-19 study. In total, 222 patients with active oncological disorders were selected from a nationwide COVID-19 study of 4890 subjects. The main endpoint of the current study was the 28-day in-hospital mortality. Approximately half of the patients were male, and the majority had multimorbidity (69.8%), with a median age of 70 years. Baseline SpO2 < 85% was observed in 25%. Overall, 59 (26.6%) patients died before day 28 of hospitalization: 29% due to hematological, and 20% due to other forms of cancers. The only factor increasing the odds of death in the multivariable model was eGFR < 60 mL/min/m2 (4.621, p = 0.02), whereas SpO2 decreased the odds of death at baseline (0.479 per 5%, p = 0.002) and the use of remdesivir (0.425, p = 0.03). This study shows that patients with COVID-19 and malignancy benefit from early remdesivir therapy, resulting in a decrease in early mortality by 80%. The prognosis was worsened by low glomerular filtration rate and low peripheral oxygen saturation at baseline underlying the role of kidney protection and early hospitalization.
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Affiliation(s)
- Jerzy Jaroszewicz
- Department of Infectious Diseases and Hepatology, Medical University of Silesia in Katowice, 41-902 Bytom, Poland
- Correspondence: ; Tel./Fax: +48-32-2819245
| | - Justyna Kowalska
- Department of Adult’s Infectious Diseases, Medical University of Warsaw, Hospital for Infectious Diseases, 02-091 Warsaw, Poland
| | - Małgorzata Pawłowska
- Department of Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100 Torun, Poland
| | - Magdalena Rogalska
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, 15-809 Bialystok, Poland
| | | | - Marta Rorat
- Department of Forensic Medicine, Wrocław Medical University, 50-367 Wroclaw, Poland
| | - Beata Lorenc
- Pomeranian Center of Infectious Diseases, Department of Infectious Diseases, 80-210 Gdansk, Poland
| | - Piotr Czupryna
- Department of Infectious Diseases and Neuroinfections, Medical University of Białystok, 15-809 Bialystok, Poland
| | - Katarzyna Sikorska
- Division of Tropical and Parasitic Diseases, Faculty of Health Sciences, Medical University of Gdańsk, 80-210 Gdansk, Poland
| | - Anna Piekarska
- Department of Infectious Diseases and Hepatology, Medical University of Łódź, 90-549 Lodz, Poland
| | - Anna Dworzańska
- Department of Infectious Diseases and Hepatology, Medical University of Lublin, 20-059 Lublin, Poland
| | - Izabela Zaleska
- Department of Paediatrics and Infectious Diseases, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Włodzimierz Mazur
- Clinical Department of Infectious Diseases in Chorzów, Medical University of Silesia, 41-500 Katowice, Poland
| | - Dorota Kozielewicz
- Department of Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100 Torun, Poland
| | - Krzysztof Kłos
- Department of Infectious Diseases and Allergology, Military Institute of Medicine, 04-141 Warsaw, Poland
| | - Regina Podlasin
- Hospital for Infectious Diseases, The IVth Department, 01-201 Warsaw, Poland
| | | | - Barbara Oczko-Grzesik
- Department of Infectious Diseases and Hepatology, Medical University of Silesia in Katowice, 41-902 Bytom, Poland
| | - Magdalena Figlerowicz
- Department of Infectious Diseases and Child Neurology, Poznan University of Medical Sciences, 60-572 Poznan, Poland
| | - Bartosz Szetela
- Department of Infectious Diseases, Liver Diseases and Acquired Immune Deficiencies, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Beata Bolewska
- Department of Infectious Diseases, Poznań University of Medical Sciences, 61-701 Poznan, Poland
| | - Paulina Frańczak-Chmura
- Department of Children’s Infectious Diseases, Provincial Jan Boży Hospital, 20-089 Lublin, Poland
| | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, 15-809 Bialystok, Poland
| | - Krzysztof Tomasiewicz
- Department of Infectious Diseases and Hepatology, Medical University of Lublin, 20-059 Lublin, Poland
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19
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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.
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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
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20
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Sahu T, Verma HK, Lvks B. Management of SARS-CoV-2 infection is a major challenge in patients with lymphoid malignancies: Warrants a clear therapeutic strategy. World J Virol 2022; 11:204-207. [PMID: 36159615 PMCID: PMC9372783 DOI: 10.5501/wjv.v11.i4.204] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/28/2021] [Accepted: 05/28/2022] [Indexed: 02/06/2023] Open
Abstract
Patients with lymphoid malignancies are at a higher risk of coronavirus disease 2019 (COVID-19) infection due to their immunocompromised state and results in higher mortality rates in these patients. Anti-CD 20 therapy is one of the leading causes of immunosuppression that worsens in COVID-19 cases. COVID-19 vaccines, on the other hand, appear to be less beneficial to these patients. App-ropriate treatment and recommendations are required for these COVID-19 patients with lymphoid malignancies.
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Affiliation(s)
- Tarun Sahu
- Physiology, All India Institute of Medical Science, Raipur 492001, Chhattisgarh, India
| | - Henu Kumar Verma
- Department of Immunopathology, Institute of Lung Health and Immunity, Comprehensive Pneumology Center, Helmholtz Zentrum, Munich 80331, Bayren, Germany
| | - Bhaskar Lvks
- Zoology, Guru Ghasidas Vishwavidyalaya, Bilaspur 495001, Chhattisgarh, India
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21
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Cheok KPL, Kirkwood AA, Menne T, Tholouli E, Chaganti S, Mathew A, Uttenthal B, Russell J, Irvine D, Johnson R, Nicholson E, Bazin J, Townsend W, Kuhnl A, O’Reilly M, Sanderson R, Patel A, Roddie C. Severe presentations and high mortality from SARS-CoV-2 in patients undergoing chimeric antigen receptor (CAR-T) therapy: a UK NCCP analysis. Leuk Lymphoma 2022; 63:1980-1984. [DOI: 10.1080/10428194.2022.2057487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kathleen P. L. Cheok
- Department of Hematology, University College London, London, UK
- Department of Hematology, University College London Hospital, London, UK
| | - Amy A. Kirkwood
- Cancer Research UK & UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK
| | - Tobias Menne
- Department of Hematology, Freeman Hospital, Newcastle, UK
| | - Eleni Tholouli
- Department of Hematology, Manchester Royal Infirmary, Manchester, UK
| | - Sridhar Chaganti
- Department of Hematology, Queen Elizabeth Hospital, Birmingham, UK
| | - Amrith Mathew
- Department of Hematology, Queen Elizabeth Hospital, Birmingham, UK
| | - Ben Uttenthal
- Department of Hematology, Addenbrooke’s Hospital, Cambridge, UK
| | - James Russell
- Department of Hematology, Addenbrooke’s Hospital, Cambridge, UK
| | - David Irvine
- Department of Hematology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Rod Johnson
- Department of Hematology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Emma Nicholson
- Department of Hematology, Royal Marsden Hospital, London, UK
| | - Jessica Bazin
- Department of Hematology, Royal Marsden Hospital, London, UK
| | - William Townsend
- Department of Hematology, University College London Hospital, London, UK
| | - Andrea Kuhnl
- Department of Hematology, King’s College Hospital, London, UK
| | - Maeve O’Reilly
- Department of Hematology, University College London Hospital, London, UK
| | - Robin Sanderson
- Department of Hematology, King’s College Hospital, London, UK
| | - Amit Patel
- Department of Hematology, Christie Hospital, Manchester, UK
| | - Claire Roddie
- Department of Hematology, University College London, London, UK
- Department of Hematology, University College London Hospital, London, UK
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22
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A O, A C, L V, F C, C B, F CD, G M, F G, S DB, P R, O T, Cm M, M V. Clinical course of Coronavirus Disease-19 in patients with haematological malignancies is characterized by a longer time to respiratory deterioration compared to non-haematological ones: results from a case-control study. Infection 2022; 50:1373-1382. [PMID: 35781785 PMCID: PMC9251021 DOI: 10.1007/s15010-022-01869-w] [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: 04/19/2022] [Accepted: 06/02/2022] [Indexed: 11/06/2022]
Abstract
Background We evaluated clinical features and risk factors for mortality in patients with haematological malignancies and COVID-19. Methods Retrospective, case–control (1:3) study in hospitalized patients with COVID-19. Cases were patients with haematological malignancies and COVID-19, controls had COVID-19 without haematological malignancies. Patients were matched for sex, age and time of hospitalization. Results Overall, 66 cases and 198 controls were included in the study. Cases had higher prior corticosteroid use, infection rates, thrombocytopenia and neutropenia and more likely received corticosteroids and antibiotics than controls. Cases had higher respiratory deterioration than controls (78.7% vs 65.5%, p = 0.04). Notably, 29% of cases developed respiratory worsening > 10 days after hospital admission, compared to only 5% in controls. Intensive Care Unit admission and mortality were higher in cases than in controls (27% vs 8%, p = 0.002, and 35% vs 10%, p < 0.001). At multivariable analysis, having haematological malignancy [OR4.76, p < 0.001], chronic corticosteroid therapy [OR3.65, p = 0.004], prior infections [OR57.7, p = 0.006], thrombocytopenia [OR3.03, p < 0.001] and neutropenia [OR31.1, p = 0.001], low albumin levels [OR3.1, p = 0.001] and ≥ 10 days from hospital admission to respiratory worsening [OR3.3, p = 0.002] were independently associated with mortality. In cases, neutropenia [OR3.1, p < 0.001], prior infections [OR7.7, p < 0.001], ≥ 10 days to respiratory worsening [OR4.1, p < 0.001], multiple myeloma [OR1.5, p = 0.044], the variation of the CT lung score during hospitalization [OR2.6, p = 0.006] and active treatment [OR 4.4, p < 0.001] all were associated with a worse outcome. Conclusion An underlying haematological malignancy was associated with a worse clinical outcome in COVID-19 patients. A prolonged clinical monitoring is needed, since respiratory worsening may occur later during hospitalization. Supplementary Information The online version contains supplementary material available at 10.1007/s15010-022-01869-w.
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Affiliation(s)
- Oliva A
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro, 500185, Rome, Italy.
| | - Curtolo A
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro, 500185, Rome, Italy
| | - Volpicelli L
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro, 500185, Rome, Italy
| | - Cancelli F
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro, 500185, Rome, Italy
| | - Borrazzo C
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Cogliati Dezza F
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro, 500185, Rome, Italy
| | - Marcelli G
- Unit of Emergency Radiology, Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Gavaruzzi F
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro, 500185, Rome, Italy
| | - Di Bari S
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro, 500185, Rome, Italy
| | - Ricci P
- Unit of Emergency Radiology, Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Turriziani O
- Microbiology and Virology Laboratory, Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Mastroianni Cm
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro, 500185, Rome, Italy
| | - Venditti M
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro, 500185, Rome, Italy
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23
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Diamantopoulos PT, Stafylidis C, Vlachopoulou D, Kontandreopoulou CN, Giannakopoulou N, Vardaka M, Mpouhla A, Mastrogianni E, Variami E, Galanopoulos A, Pappa V, Psichogiou M, Hatzakis A, Viniou NA. Safety and immunogenicity of the BNT162b2 mRNA Covid-19 vaccine in patients with chronic lymphocytic leukemia: a prospective study. Ther Adv Hematol 2022; 13:20406207221090150. [PMID: 35646300 PMCID: PMC9131386 DOI: 10.1177/20406207221090150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/04/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Immunization of patients with chronic lymphocytic leukemia (CLL) with vaccines against several infectious diseases has proven insufficient. Data on seroconversion of patients with CLL after vaccination against severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) are still young, but accumulating evidence shows low seroconversion rates. Methods: We conducted a prospective, noninterventional study evaluating the safety and immunogenicity of two doses of the BNT162b2 mRNA Covid-19 vaccine, administered 21 days apart in consecutive adult patients with CLL. Patients vaccinated with other vaccines against SARS-CoV-2, with a history of confirmed Coronavirus Disease 19 (COVID-19), with known human immunodeficiency virus infection, or with an inability to provide written informed consent were excluded. Sera were tested before the first and after the second dose of the vaccine for anti-SARS-CoV-2 receptor binding domain (RBD) spike protein IgG (anti-RBD), using the Abbott SARS-CoV-2 IgG II Quant assay (Abbott Laboratories, Abbott Park, IL, USA), with a cutoff value for seroconversion at 50 AU/ml. Results: Sixty-one patients (28 males/33 females) with CLL, with a median age of 61 years, were included in the study. The majority of the patients (82.0%) were lower (0–2) stage per the RAI staging system. The seroconversion rate at 14 days after the second dose was 45% and was correlated with RAI stage (0–2 versus 3–4; 51.0% versus 18.3%, p = 0.047), the treatment status (treatment naïve, previously treated, or actively treated patients; 63.0% versus 40.0% versus 26.1%, respectively, p = 0.031), the number of previous treatment lines (0–2 versus >2; 55.3% versus 8.3%, p = 0.004), and the platelet count of the patients (over or under 100 × 109/L; 52.9% versus 10.0%, p = 0.015). Moreover, there was a positive linear relationship between the antibody titers and the gamma-globulin levels ( r = 0.182, p = 0.046) and platelet count ( r = 0.277, p = 0.002). Finally, patients actively treated with venetoclax had higher antibody titers than those treated with ibrutinib (15.8 AU/ml versus 0.0 AU/ml, p = 0.047). No safety issues were identified while the emergence of adverse events was not correlated with immunogenicity. Discussion: This study confirms results from previous studies on the low seroconversion rates in patients with CLL vaccinated with the BNT162b2 mRNA Covid-19 vaccine and on the detrimental effect of advanced disease and multiple treatment lines on seroconversion, while it is suggested that treatment with venetoclax may offer a chance for higher antibody titers, suggesting a treatment strategy change during the pandemic provided that this result is confirmed by larger studies specifically designed to address this issue.
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Affiliation(s)
- Panagiotis T. Diamantopoulos
- Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Christos Stafylidis
- Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitra Vlachopoulou
- Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina-Nefeli Kontandreopoulou
- Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nefeli Giannakopoulou
- Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Vardaka
- Department of Clinical Hematology, ‘G. Gennimatas’ District General Hospital, Athens, Greece
| | - Anthi Mpouhla
- Haematology Division, Second Department of Internal Medicine, Attikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Elpida Mastrogianni
- Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Variami
- Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Galanopoulos
- Department of Clinical Hematology, ‘G. Gennimatas’ District General Hospital, Athens, Greece
| | - Vasiliki Pappa
- Haematology Division, Second Department of Internal Medicine, Attikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Mina Psichogiou
- Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nora-Athina Viniou
- Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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24
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Abstract
The coronavirus infectious disease (COVID-19) shows a remarkable symptomatic heterogeneity. Several risk factors including advanced age, previous illnesses and a compromised immune system contribute to an unfavorable outcome. In patients with hematologic malignancy, the immune response to severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is significantly reduced explaining why the mortality rate of hematologic patients hospitalized for a SARS-CoV-2 infection is about 34%. Active immunization is an essential pillar to prevent SARS-CoV-2 infections in patients with hematologic malignancy. However, the immune response to SARS-CoV-2 vaccines may be significantly impaired, as only half of patients with hematologic malignancy develop a measurable anti-viral antibody response. The subtype of hematologic malignancy and B-cell depleting treatment predict a poor immune response to vaccination. Recently, antiviral drugs and monoclonal antibodies for pre-exposure or post-exposure prophylaxis and for early treatment of COVID-19 have become available. These therapies should be offered to patients at high risk for severe COVID-19 and vaccine non-responder. Importantly, as the virus evolves, some therapies may lose their clinical efficacy against new variants. Therefore, the ongoing pandemic will remain a major challenge for patients with hematologic malignancy and their caregivers who need to constantly monitor the scientific progress in this area.
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25
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Jullien M, Le Bourgeois A, Coste-Burel M, Peterlin P, Garnier A, Rimbert M, Imbert BM, Le Gouill S, Moreau P, Mahe B, Dubruille V, Blin N, Lok A, Touzeau C, Gastinne T, Tessoulin B, Vantyghem S, Béné MC, Guillaume T, Chevallier P. B Cell Aplasia Is the Most Powerful Predictive Marker for Poor Humoral Response after BNT162b2 mRNA SARS-CoV-2 Vaccination in Recipients of Allogeneic Hematopoietic Stem Cell Transplantation. Transplant Cell Ther 2022; 28:279.e1-279.e4. [PMID: 35218998 PMCID: PMC8865956 DOI: 10.1016/j.jtct.2022.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 01/14/2022] [Accepted: 02/17/2022] [Indexed: 12/14/2022]
Abstract
Little is known about the immune response to SARS-CoV-2 vaccination in recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, several studies have reported that adequate protection could be provided to this population. The purpose of this study was to evaluate which factors can predict the efficacy of SARS-CoV-2 vaccination in these specifically immunosuppressed patients. Specific anti-Spike (S) antibody responses were assessed in a cohort of 117 allo-HSCT recipients after 2 injections of BNT162b2 mRNA SARS-CoV-2 vaccine (V1 and V2). Factors considered liable to influence the antibody response and analyzed in this series were the interval between allo-HSCT and V1, donor source, recipient and donor age, current immunosuppressive/chemotherapy (I/C) treatment, and levels of CD4+and CD8+ T cells, B cells, and natural killer cells at the time of V1. Overall, the S-antibody response rate, evaluated at a median of 35 days after V2, was 82.9% for the entire cohort, with 71 patients (61%) reaching the highest titer. In univariate analysis, a lower pre-V1 median total lymphocyte count, lower CD4+ T cell and B cell counts, ongoing I/C treatment, and a haploidentical donor were characteristic of nonhumoral responders. However, multiparameter analysis showed that B cell aplasia was the sole factor predicting the absence of a specific immune response (odds ratio, 0.01; 95% confidence interval, 0.00 to 0.10; P < 10-3). Indeed, the rate of humoral response was 9.1% in patients with B cell aplasia versus 95.9% in patients with a B cell count >0 (P < 10-9). These results advocate for the administration of anti-SARS-CoV-2 vaccination in allo-HSCT recipients as early as peripheral B cell levels can be detected, and also suggest the need for close monitoring of B-cell reconstitution after Allo-HSCT.
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Affiliation(s)
- Maxime Jullien
- Hematology Department, Nantes University Hospital, Nantes, France
| | | | | | - Pierre Peterlin
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Alice Garnier
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Marie Rimbert
- Immunology Department, Nantes University Hospital, Nantes, France
| | | | - Steven Le Gouill
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Philippe Moreau
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Beatrice Mahe
- Hematology Department, Nantes University Hospital, Nantes, France
| | | | - Nicolas Blin
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Anne Lok
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Cyrille Touzeau
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Thomas Gastinne
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Benoit Tessoulin
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Sophie Vantyghem
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Marie C. Béné
- INSERM UMR1232, CRCINA IRS-UN, University of Nantes, University Hospital, Nantes, France,Hematology Biology Department, Nantes University Hospital, Nantes, France
| | - Thierry Guillaume
- Hematology Department, Nantes University Hospital, Nantes, France,INSERM UMR1232, CRCINA IRS-UN, University of Nantes, University Hospital, Nantes, France
| | - Patrice Chevallier
- Hematology Department, Nantes University Hospital, Nantes, France,INSERM UMR1232, CRCINA IRS-UN, University of Nantes, University Hospital, Nantes, France,Correspondence and reprint requests: Patrice Chevallier, Service d'Hématologie Clinique, CHU Hotel-Dieu, Place A. Ricordeau, 44093 Nantes Cedex, France
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26
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Sanz C, Nomdedeu M, Pereira A, Sauleda S, Alonso R, Bes M, Brillembourg H, García‐Vidal C, Millan A, Martínez‐Llonch N, Pirón M, Puerta‐Alcalde P, Puig L, Rico V, Soriano A. Efficacy of early transfusion of convalescent plasma with high-titer SARS-CoV-2 neutralizing antibodies in hospitalized patients with COVID-19. Transfusion 2022; 62:974-981. [PMID: 35338710 PMCID: PMC9115410 DOI: 10.1111/trf.16863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/03/2022] [Accepted: 03/03/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Despite most controlled trials have shown no measurable benefit of COVID-19 convalescent plasma (CCP) in patients with COVID-19, some studies suggest that early administration of CCP with high-titer anti-SARS-CoV-2 can be beneficial in selected patients. We investigated the efficacy of early administration of high-titer CCP to patients with COVID-19 who required hospitalization, STUDY DESIGN AND METHODS: Observational, propensity score (PS) matched case-control study of COVID-19 patients treated with CCP within 72 h of hospital admission and untreated controls from August 2020 to February 2021. All CCP donations had a Euroimmun anti-SARS-CoV-2 sample-to-cutoff ratio ≥3. PS matching was based on prognostic factors and presented features with high-standardized differences between the treated and control groups. The primary endpoint was mortality within 30 days of diagnosis. RESULTS A total of 1604 patients were analyzed, 261 of whom received CCP, most (82%) within 24 h after admission. Median age was 67 years (interquartile range: 56-79), and 953 (60%) were men. Presenting factors independently associated with higher 30-day mortality were increased age, cardiac disease, hypoxemic respiratory failure, renal failure, and plasma d-dimer >700 ng/ml. After PS matching, transfusion of CCP was associated with a significant reduction in the 30-day mortality rate (odds ratio [OR]; 0.94, 95% confidence interval [CI]: 0.91-0.98; p = .001) that extended to the 60th day after COVID-19 diagnosis (OR: 0.95; 95% CI: 0.92-0.99; p = .01). CONCLUSION Our results suggest that CCP can still be helpful in selected patients with COVID-19 and call for further studies before withdrawing CCP from the COVID-19 therapeutic armamentarium.
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Affiliation(s)
- Cristina Sanz
- Blood Bank and Transfusion ServiceHospital Clínic de BarcelonaBarcelonaSpain
| | - Meritxell Nomdedeu
- Hemathology and Hemotherapy ServiceHospital Clínic de BarcelonaBarcelonaSpain
| | - Arturo Pereira
- Blood Bank and Transfusion ServiceHospital Clínic de BarcelonaBarcelonaSpain
| | | | - Rodrigo Alonso
- Infectious Diseases DepartmentHospital Clínic‐IDIBAPS, University of BarcelonaBarcelonaSpain
| | - Marta Bes
- Banc de Sang i TeixitsBarcelonaSpain
| | - Helena Brillembourg
- Blood Bank and Transfusion ServiceHospital Clínic de BarcelonaBarcelonaSpain
| | - Carolina García‐Vidal
- Infectious Diseases DepartmentHospital Clínic‐IDIBAPS, University of BarcelonaBarcelonaSpain
| | | | | | | | - Pedro Puerta‐Alcalde
- Infectious Diseases DepartmentHospital Clínic‐IDIBAPS, University of BarcelonaBarcelonaSpain
| | | | - Veronica Rico
- Infectious Diseases DepartmentHospital Clínic‐IDIBAPS, University of BarcelonaBarcelonaSpain
| | - Alex Soriano
- Infectious Diseases DepartmentHospital Clínic‐IDIBAPS, University of BarcelonaBarcelonaSpain
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27
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Hundal J, Vartanov AR, Huh K, Ballesteros E, Forbes V. Concurrent Lymphoma and COVID-19: Diagnostic and Therapeutic Challenges of High-Grade Lymphoma and COVID-19. Cureus 2022; 14:e22635. [PMID: 35371790 PMCID: PMC8960537 DOI: 10.7759/cureus.22635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2022] [Indexed: 11/17/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) global pandemic has put an unprecedented strain on cancer care. The initial months were marred by fears of immunocompromised patients becoming opportunistic hosts to this deadly virus. We present a case of newly diagnosed high-grade B-cell lymphoma in a patient with COVID-19 and discuss the diagnostic and therapeutic challenges posed. A 76-year-old female presented with one month of progressive malaise, poor appetite, weight loss, and night sweats. A surveillance COVID-19 polymerase chain reaction (PCR) resulted positive. With strict isolation precautions, the daily focused physical examination masked several key findings including multifocal adenopathy. She developed hypoxic respiratory failure and progressive transaminitis and cytopenias. Image-guided, rather than excisional, biopsy revealed high-grade B-cell lymphoma. Superimposed COVID-19 infection presented multiple challenges, but she completed treatment and achieved remission. Suspicion for underlying malignancy was high. Institutional concerns included obtaining imaging studies and the gold standard excisional tissue biopsy while maintaining acceptable staff exposure. Fortunately, a lymph node core biopsy confirmed the histopathological diagnosis of high-grade B-cell lymphoma. The administration of chemoimmunotherapy (rituximab, cyclophosphamide, doxorubicin, dose-reduced vincristine, and prednisone (R-CHOP)) posed inherent risks, notably, worsening cytopenias and hepatotoxicity. The approach to treatment was further complicated as the interaction of high-grade lymphoma and COVID-19 remained unclear. Medical teams have faced delays executing formerly routine diagnostic studies and formulating timely and appropriate treatment strategies. Careful consideration of risks and benefits must be weighed. A multidisciplinary approach is crucial to successfully treat patients. The relationship between COVID-19 and cancer treatment is yet to be established, and large sample-size studies are required.
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28
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Di Felice G, Visci G, Teglia F, Angelini M, Boffetta P. Effect of cancer on outcome of COVID-19 patients: a systematic review and meta-analysis of studies of unvaccinated patients. eLife 2022; 11:74634. [PMID: 35171096 PMCID: PMC8956284 DOI: 10.7554/elife.74634] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/08/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Since the beginning of the SARS-CoV-2 pandemic, cancer patients affected by COVID-19 have been reported to experience poor prognosis; however, a detailed quantification of the effect of cancer on outcome of unvaccinated COVID-19 patients has not been performed. Methods: To carry out a systematic review of the studies comparing the outcome of unvaccinated COVID-19 patients with and without cancer, a search string was devised which was used to identify relevant publications in PubMed up to December 31, 2020. We selected three outcomes: mortality, access to ICU, and COVID-19 severity or hospitalization. We considered results for all cancers combined as well as for specific cancers. We conducted random-effects meta-analyses of the results, overall and after stratification by region. We also performed sensitivity analyses according to quality score and assessed publication bias. Results: For all cancer combined, the pooled odds ratio (OR) for mortality was 2.32 (95% confidence interval [CI] 1.82–2.94, I2 for heterogeneity 90.1%, 24 studies), that for ICU admission was 2.39 (95% CI 1.90–3.02, I2 0.0%, 5 studies), that for disease severity or hospitalization was 2.08 (95% CI 1.60–2.72, I2 92.1%, 15 studies). The pooled mortality OR for hematologic neoplasms was 2.14 (95% CI 1.87–2.44, I2 20.8%, 8 studies). Data were insufficient to perform a meta-analysis for other cancers. In the mortality meta-analysis for all cancers, the pooled OR was higher for studies conducted in Asia than studies conducted in Europe or North America. There was no evidence of publication bias. Conclusions: Our meta-analysis indicates a twofold increased risk of adverse outcomes (mortality, ICU admission, and severity of COVID-19) in unvaccinated COVID-19 patients with cancer compared to COVID-19 patients without cancer. These results should be compared with studies conducted in vaccinated patients; nonetheless, they argue for special effort to prevent SARS-CoV-2 infection in patients with cancer. Funding: No external funding was obtained.
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Affiliation(s)
- Giulia Di Felice
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giovanni Visci
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Federica Teglia
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Marco Angelini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Paolo Boffetta
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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29
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Mohseni Afshar Z, Hosseinzadeh R, Barary M, Ebrahimpour S, Alijanpour A, Sayad B, Hosseinzadeh D, Miri SR, Sio TT, Sullman MJM, Carson‐Chahhoud K, Babazadeh A. Challenges posed by COVID-19 in cancer patients: A narrative review. Cancer Med 2022; 11:1119-1135. [PMID: 34951152 PMCID: PMC8855916 DOI: 10.1002/cam4.4519] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/08/2021] [Accepted: 12/08/2021] [Indexed: 01/09/2023] Open
Abstract
A novel coronavirus, or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified as the causative agent of coronavirus disease 2019 (COVID-19). In early 2020, the World Health Organization declared COVID-19 the sixth public health emergency of international concern. The COVID-19 pandemic has substantially affected many groups within the general population, but particularly those with extant clinical conditions, such as having or being treated for cancer. Cancer patients are at a higher risk of developing severe COVID-19 since the malignancy and chemotherapy may negatively affect the immune system, and their immunocompromised condition also increases the risk of infection. Substantial international efforts are currently underway to develop specific methods for diagnosing and treating COVID-19. However, cancer patients' risk profiles, management, and outcomes are not well understood. Thus, the main objective of this review is to discuss the relevant evidence to understand the prognosis of COVID-19 infections in cancer patients more clearly, as well as helping to improve the clinical management of these patients.
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Affiliation(s)
- Zeinab Mohseni Afshar
- Clinical Research Development CenterImam Reza HospitalKermanshah University of Medical SciencesKermanshahIran
| | | | - Mohammad Barary
- Student Research CommitteeBabol University of Medical SciencesBabolIran
- Students’ Scientific Research Center (SSRC)Tehran University of Medical SciencesTehranIran
| | - Soheil Ebrahimpour
- Infectious Diseases and Tropical Medicine Research CenterHealth Research InstituteBabol University of Medical SciencesBabolIran
| | | | - Babak Sayad
- Clinical Research Development CenterImam Reza HospitalKermanshah University of Medical SciencesKermanshahIran
| | | | - Seyed Rouhollah Miri
- Cancer Research CenterCancer Institute of IranTehran University of Medical ScienceTehranIran
| | - Terence T. Sio
- Department of Radiation OncologyMayo ClinicPhoenixArizonaUSA
| | - Mark J. M. Sullman
- Department of Social SciencesUniversity of NicosiaNicosiaCyprus
- Department of Life and Health SciencesUniversity of NicosiaNicosiaCyprus
| | | | - Arefeh Babazadeh
- Infectious Diseases and Tropical Medicine Research CenterHealth Research InstituteBabol University of Medical SciencesBabolIran
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30
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Avenoso D, Marsh JCW, Potter V, Pagliuca A, Slade S, Dignan F, Tholouli E, Mittal S, Davis B, Tauro S, Kesse-Adu R, Griffin M, Payne E, Gandhi S, Kulasekararaj AG. SARS-CoV-2 infection in aplastic anemia. Haematologica 2022; 107:541-543. [PMID: 34670361 PMCID: PMC8804560 DOI: 10.3324/haematol.2021.279928] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/13/2021] [Indexed: 01/08/2023] Open
Affiliation(s)
| | | | | | | | - Simon Slade
- King's College Hospital NHS Foundation Trust
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31
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Korath ADJ, Janda J, Untersmayr E, Sokolowska M, Feleszko W, Agache I, Adel Seida A, Hartmann K, Jensen‐Jarolim E, Pali‐Schöll I. One Health: EAACI Position Paper on coronaviruses at the human-animal interface, with a specific focus on comparative and zoonotic aspects of SARS-CoV-2. Allergy 2022; 77:55-71. [PMID: 34180546 PMCID: PMC8441637 DOI: 10.1111/all.14991] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/24/2021] [Indexed: 12/15/2022]
Abstract
The latest outbreak of a coronavirus disease in 2019 (COVID‐19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), evolved into a worldwide pandemic with massive effects on health, quality of life, and economy. Given the short period of time since the outbreak, there are several knowledge gaps on the comparative and zoonotic aspects of this new virus. Within the One Health concept, the current EAACI position paper dwells into the current knowledge on SARS‐CoV‐2’s receptors, symptoms, transmission routes for human and animals living in close vicinity to each other, usefulness of animal models to study this disease and management options to avoid intra‐ and interspecies transmission. Similar pandemics might appear unexpectedly and more frequently in the near future due to climate change, consumption of exotic foods and drinks, globe‐trotter travel possibilities, the growing world population, the decreasing production space, declining room for wildlife and free‐ranging animals, and the changed lifestyle including living very close to animals. Therefore, both the society and the health authorities need to be aware and well prepared for similar future situations, and research needs to focus on prevention and fast development of treatment options (medications, vaccines).
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Affiliation(s)
- Anna D. J. Korath
- Comparative Medicine Interuniversity Messerli Research Institute University of Veterinary Medicine and Medical University Vienna Vienna Austria
| | - Jozef Janda
- Faculty of Science Charles University Prague Czech Republic
| | - Eva Untersmayr
- Institute of Pathophysiology and Allergy Research Center of Pathophysiology, Infectiology and Immunology Medical University of Vienna Vienna Austria
| | - Milena Sokolowska
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich Zurich Switzerland
| | - Wojciech Feleszko
- Department of Paediatric Allergy and Pulmonology The Medical University of Warsaw Warsaw Poland
| | | | - Ahmed Adel Seida
- Department of Microbiology and Immunology Faculty of Veterinary Medicine Cairo University Cairo Egypt
| | - Katrin Hartmann
- Medizinische Kleintierklinik Zentrum für Klinische Tiermedizin LMU Munich Germany
| | - Erika Jensen‐Jarolim
- Comparative Medicine Interuniversity Messerli Research Institute University of Veterinary Medicine and Medical University Vienna Vienna Austria
- Institute of Pathophysiology and Allergy Research Center of Pathophysiology, Infectiology and Immunology Medical University of Vienna Vienna Austria
| | - Isabella Pali‐Schöll
- Comparative Medicine Interuniversity Messerli Research Institute University of Veterinary Medicine and Medical University Vienna Vienna Austria
- Institute of Pathophysiology and Allergy Research Center of Pathophysiology, Infectiology and Immunology Medical University of Vienna Vienna Austria
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32
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Schiller Salton N, Szwarcwort M, Tzoran I, Horowitz NA, Zuckerman T, Horesh N, Shachor‐Meyouhas Y, Hussein K, Lavi N. Attenuated humoral immune response following anti-SARS-CoV-2 vaccine in heavily pretreated patients with multiple myeloma and AL amyloidosis. Am J Hematol 2021; 96:E475-E478. [PMID: 34622495 PMCID: PMC8646558 DOI: 10.1002/ajh.26373] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/26/2021] [Accepted: 10/04/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Neta Schiller Salton
- The Ruth and Bruce Rappaport Faculty of Medicine Technion – Israel Institute of Technology Haifa Israel
| | | | - Inna Tzoran
- The Ruth and Bruce Rappaport Faculty of Medicine Technion – Israel Institute of Technology Haifa Israel
- Department of Hematology Rambam Health Care Campus Haifa Israel
| | - Netanel A. Horowitz
- The Ruth and Bruce Rappaport Faculty of Medicine Technion – Israel Institute of Technology Haifa Israel
- Department of Hematology Rambam Health Care Campus Haifa Israel
| | - Tsila Zuckerman
- The Ruth and Bruce Rappaport Faculty of Medicine Technion – Israel Institute of Technology Haifa Israel
- Department of Hematology Rambam Health Care Campus Haifa Israel
| | - Nurit Horesh
- Department of Hematology Rambam Health Care Campus Haifa Israel
| | | | - Khetam Hussein
- Infectious Diseases Institute Rambam Health Care Campus Haifa Israel
| | - Noa Lavi
- The Ruth and Bruce Rappaport Faculty of Medicine Technion – Israel Institute of Technology Haifa Israel
- Department of Hematology Rambam Health Care Campus Haifa Israel
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33
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Johnston EE, Martinez I, Davis ES, Caudill C, Richman J, Brackett J, Dickens DS, Kahn A, Schwalm C, Sharma A, Patel PA, Bhatia S, Levine JM, Wolfson JA. SARS-CoV-2 in Childhood Cancer in 2020: A Disease of Disparities. J Clin Oncol 2021; 39:3778-3788. [PMID: 34694886 PMCID: PMC8608263 DOI: 10.1200/jco.21.00702] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The Pediatric Oncology COVID-19 Case Report registry supplies pediatric oncologists with data surrounding the clinical course and outcomes in children with cancer and SARS-CoV-2. METHODS This observational study captured clinical and sociodemographic characteristics for children (≤ 21 years) receiving cancer therapy and infected with SARS-CoV-2 from the pandemic onset through February 19, 2021. The demographic and clinical characteristics of the cohort were compared with population-level pediatric oncology data (SEER). Multivariable binomial regression models evaluated patient characteristics associated with hospitalization, intensive care unit (ICU) admission, and changes in cancer therapy. RESULTS Ninety-four institutions contributed details on 917 children with cancer and SARS-CoV-2. Median age at SARS-CoV-2 infection was 11 years (range, 0-21 years). Compared with SEER, there was an over-representation of Hispanics (43.6% v 29.7%, P < .01), publicly insured (59.3% v 33.5%, P < .01), and patients with hematologic malignancies (65.8% v 38.3%, P < .01) in our cohort. The majority (64.1%) were symptomatic; 31.2% were hospitalized, 10.9% required respiratory support, 9.2% were admitted to the ICU, and 1.6% died because of SARS-CoV-2. Cancer therapy was modified in 44.9%. Hispanic ethnicity was associated with changes in cancer-directed therapy (adjusted risk ratio [aRR] = 1.3; 95% CI, 1.1 to 1.6]). Presence of comorbidities was associated with hospitalization (aRR = 1.3; 95% CI, 1.1 to 1.6) and ICU admission (aRR = 2.3; 95% CI, 1.5 to 3.6). Hematologic malignancies were associated with hospitalization (aRR = 1.6; 95% CI, 1.3 to 2.1). CONCLUSION These findings provide critical information for decision making among pediatric oncologists, including inpatient versus outpatient management, cancer therapy modifications, consideration of monoclonal antibody therapy, and counseling families on infection risks in the setting of the SARS-CoV-2 pandemic. The over-representation of Hispanic and publicly insured patients in this national cohort suggests disparities that require attention.
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Affiliation(s)
- Emily E Johnston
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.,Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Isaac Martinez
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Elizabeth S Davis
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Caroline Caudill
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Joshua Richman
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.,Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Julienne Brackett
- Pediatric Hematology-Oncology, Department of Pediatrics, Texas Children's Hospital, Houston, TX
| | - David S Dickens
- Pediatric Hematology-Oncology, Department of Pediatrics, University of Iowa, Iowa City, IA
| | - Alissa Kahn
- Pediatric Hematology-Oncology, Department of Pediatrics, Saint Joseph's University Medical Center, Paterson, NJ
| | - Carla Schwalm
- Pediatric Hematology-Oncology, Department of Pediatrics, Bronson Methodist Hospital, Kalamazoo, MI
| | - Archana Sharma
- Pediatric Hematology-Oncology, Department of Pediatrics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Pratik A Patel
- Pediatric Hematology-Oncology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.,Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Jennifer M Levine
- Pediatric Hematology-Oncology, Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Julie A Wolfson
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.,Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
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Horiuchi H, Sasaki H, Miyazaki K, Miyata N, Yoshimura Y, Tachikawa N. Recovery from severe persistent COVID-19 without evidence of an anti-SARS-CoV-2 antibody response in a man with mantle cell lymphoma treated with rituximab. J Infect Chemother 2021; 28:329-332. [PMID: 34887178 PMCID: PMC8612813 DOI: 10.1016/j.jiac.2021.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/06/2021] [Accepted: 11/20/2021] [Indexed: 01/28/2023]
Abstract
Lymphoma has been reported to worsen the prognosis of COVID-19 partly because it disturbs the normal production of antibodies. We treated a man with mantle cell lymphoma treated with rituximab, who developed severe COVID-19 with viral shedding that lasted for 78 days. He stayed in the intensive care unit for 28 days and did not respond to any treatment against COVID-19. His increased oxygen demand at rest eventually resolved despite the absence of anti-SARS-CoV-2-IgG. This case illustrates that recovery from COVID-19 can occur without antibody production, and that even patients with an inability to produce antibodies can recover from severe COVID-19. It also illustrates that lymphoma patients who develop severe COVID-19 while on rituximab therapy can recover from a prolonged viral shedding state if the acute lung injury can be overcome.
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Affiliation(s)
- Hiroshi Horiuchi
- Department of Infectious Diseases, Yokohama Municipal Citizen's Hospital. 1-1 Mitsuzawanishi-cho, Kanagawa Ward, Yokohama City, Kanagawa 221-0855, Japan.
| | - Hiroaki Sasaki
- Department of Infectious Diseases, Yokohama Municipal Citizen's Hospital. 1-1 Mitsuzawanishi-cho, Kanagawa Ward, Yokohama City, Kanagawa 221-0855, Japan
| | - Kazuhito Miyazaki
- Department of Infectious Diseases, Yokohama Municipal Citizen's Hospital. 1-1 Mitsuzawanishi-cho, Kanagawa Ward, Yokohama City, Kanagawa 221-0855, Japan
| | - Nobuyuki Miyata
- Department of Infectious Diseases, Yokohama Municipal Citizen's Hospital. 1-1 Mitsuzawanishi-cho, Kanagawa Ward, Yokohama City, Kanagawa 221-0855, Japan
| | - Yukihiro Yoshimura
- Department of Infectious Diseases, Yokohama Municipal Citizen's Hospital. 1-1 Mitsuzawanishi-cho, Kanagawa Ward, Yokohama City, Kanagawa 221-0855, Japan
| | - Natsuo Tachikawa
- Department of Infectious Diseases, Yokohama Municipal Citizen's Hospital. 1-1 Mitsuzawanishi-cho, Kanagawa Ward, Yokohama City, Kanagawa 221-0855, Japan
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Özdemir Ö. Effects of COVID-19 in lymphoid malignancies. World J Virol 2021; 10:329-331. [PMID: 34909407 PMCID: PMC8641039 DOI: 10.5501/wjv.v10.i6.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/04/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
I will have a couple of comments on the issues elaborated in the article titled as ‘Impact of COVID-19 in patients with lymphoid malignancies’. First, the author did not emphasize and overlook the prolonged persistence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in coronavirus disease 2019 (COVID-19) patients with hematological malignancies. Second, the rise of a chronic lymphoid leukemia clone in COVID-19 was not mentioned by the authors. Third, achieving a complete remission in asymptomatic COVID-19 patients with follicular lymphoma in partial remission after bendamustine-based therapy is not specific to this lymphoma subtype. Fourth, follicular lymphoma does not always undergo complete remission with SARS-CoV-2 infection. Our aim is to help the authors to discuss and clarify these issues a little more in COVID-19 patients with hematological malignancies.
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Affiliation(s)
- Öner Özdemir
- Division of Pediatric Allergy and Immunology, Sakarya University Medical Faculty, Adapazarı 54100, Sakarya, Turkey
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36
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Charwudzi A, Meng Y, Hu L, Ding C, Pu L, Li Q, Xu M, Zhai Z, Xiong S. Integrated bioinformatics analysis reveals dynamic candidate genes and signaling pathways involved in the progression and prognosis of diffuse large B-cell lymphoma. PeerJ 2021; 9:e12394. [PMID: 34760386 PMCID: PMC8570165 DOI: 10.7717/peerj.12394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/05/2021] [Indexed: 01/02/2023] Open
Abstract
Background Diffuse large B-cell lymphoma (DLBCL) is a highly heterogeneous malignancy with varied outcomes. However, the fundamental mechanisms remain to be fully defined. Aim We aimed to identify core differentially co-expressed hub genes and perturbed pathways relevant to the pathogenesis and prognosis of DLBCL. Methods We retrieved the raw gene expression profile and clinical information of GSE12453 from the Gene Expression Omnibus (GEO) database. We used integrated bioinformatics analysis to identify differentially co-expressed genes. The CIBERSORT analysis was also applied to predict tumor-infiltrating immune cells (TIICs) in the GSE12453 dataset. We performed survival and ssGSEA (single-sample Gene Set Enrichment Analysis) (for TIICs) analyses and validated the hub genes using GEPIA2 and an independent GSE31312 dataset. Results We identified 46 differentially co-expressed hub genes in the GSE12453 dataset. Gene expression levels and survival analysis found 15 differentially co-expressed core hub genes. The core genes prognostic values and expression levels were further validated in the GEPIA2 database and GSE31312 dataset to be reliable (p < 0.01). The core genes’ main KEGG (Kyoto Encyclopedia of Genes and Genomes) pathway enrichments were Ribosome and Coronavirus disease-COVID-19. High expressions of the 15 core hub genes had prognostic value in DLBCL. The core genes showed significant predictive accuracy in distinguishing DLBCL cases from non-tumor controls, with the area under the curve (AUC) ranging from 0.992 to 1.00. Finally, CIBERSORT analysis on GSE12453 revealed immune cells, including activated memory CD4+ T cells and M0, M1, and M2-macrophages as the infiltrates in the DLBCL microenvironment. Conclusion Our study found differentially co-expressed core hub genes and relevant pathways involved in ribosome and COVID-19 disease that may be potential targets for prognosis and novel therapeutic intervention in DLBCL.
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Affiliation(s)
- Alice Charwudzi
- Department of Hematology/Hematological Lab, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Ye Meng
- Department of Hematology/Hematological Lab, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Linhui Hu
- Department of Hematology/Hematological Lab, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Chen Ding
- Department of Hematology/Hematological Lab, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Lianfang Pu
- Department of Hematology/Hematological Lab, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Qian Li
- Department of Hematology/Hematological Lab, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Mengling Xu
- Department of Hematology/Hematological Lab, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Zhimin Zhai
- Department of Hematology/Hematological Lab, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Shudao Xiong
- Department of Hematology/Hematological Lab, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
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Pallett SJC, Wake R, Youngs J, Pope C, Tan NK, Taylor J, Hawkins L, Witney AA, Laing KG, Monahan IM, Akay M, Cox A, Groppelli E, Kelleher P, Miller P, Bicanic T. Adjunctive viral cell culture supports treatment decision-making in patients with secondary humoral immunodeficiency and persistent SARS-CoV-2 infection. Br J Haematol 2021; 196:1170-1174. [PMID: 34766331 PMCID: PMC8652771 DOI: 10.1111/bjh.17957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 10/30/2021] [Indexed: 12/26/2022]
Affiliation(s)
- Scott J C Pallett
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK.,Centre of Defence Pathology, Royal Centre for Defence Medicine, Edgbaston, Birmingham, UK
| | - Rachel Wake
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK.,Institute for Infection and Immunity, St George's University of London, Cranmer Terrace, London, UK
| | - Jonathan Youngs
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Cassie Pope
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK.,Institute for Infection and Immunity, St George's University of London, Cranmer Terrace, London, UK
| | - Ngee Keong Tan
- South West London Pathology, Jenner Wing, St. George's Hospital, London, UK
| | - Joshua Taylor
- South West London Pathology, Jenner Wing, St. George's Hospital, London, UK
| | - Lois Hawkins
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Adam A Witney
- Institute for Infection and Immunity, St George's University of London, Cranmer Terrace, London, UK
| | - Kenneth G Laing
- Institute for Infection and Immunity, St George's University of London, Cranmer Terrace, London, UK
| | - Irene M Monahan
- Institute for Infection and Immunity, St George's University of London, Cranmer Terrace, London, UK
| | - Melek Akay
- Department of Haematology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Alison Cox
- Centre for Immunology and Vaccinology, Department of Medicine, Imperial College London, London, UK
| | - Elisabetta Groppelli
- Institute for Infection and Immunity, St George's University of London, Cranmer Terrace, London, UK
| | - Peter Kelleher
- Centre for Immunology and Vaccinology, Department of Medicine, Imperial College London, London, UK
| | - Paul Miller
- Department of Haematology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Tihana Bicanic
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK.,Institute for Infection and Immunity, St George's University of London, Cranmer Terrace, London, UK
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38
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COVID-19 and CAR-T cells: current challenges and future directions-a report from the EPICOVIDEHA survey by EHA-IDWP. Blood Adv 2021; 6:2427-2433. [PMID: 34749396 PMCID: PMC8575532 DOI: 10.1182/bloodadvances.2021005616] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/24/2021] [Indexed: 12/15/2022] Open
Abstract
The EHA-IDWP developed an observational registry collecting data on COVID-19 infection in patients who received CAR T-cell therapy. Prevalence of COVID-19 was 4.8%, and overall mortality was 50%, highlighting the need for prevention of infection in these patients.
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39
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Gupta A, Desai N, Sanjeev, Chauhan P, Nityanand S, Hashim Z, Gupta M. Clinical profile and outcome of COVID-19 in haematological malignancies: experience from tertiary care centre in India. Ann Hematol 2021; 101:69-79. [PMID: 34559278 PMCID: PMC8475490 DOI: 10.1007/s00277-021-04644-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/16/2021] [Indexed: 12/30/2022]
Abstract
There is limited evidence on various clinical aspects of SARS-CoV-2 infection in patients with haematological cancers. The risk factors, prognosis, and outcome of patients with haematological cancers with coexistent COVID-19 need to be explored in different subsets of population. A single-institutional prospective observational study was conducted at a tertiary level medical institute in North India. The clinical details of the recruited patients having haematological malignancies and diagnosed with COVID-19 between 15 March 2020 and 31 May 2021 were prospectively collected through the electronic patient database system. The outcomes with respect to 28-day and 56-day mortality and the associated risk factors for prognostication were analysed. Of the 5750 hospital admissions (inpatient and day-care) during the study period, two hundred and forty-two patients (4.2%) were diagnosed with COVID-19. Acute leukaemia was the most common haematological malignancy, seen in 117 (48.3%) patients. Eighty-nine (36.8%) patients had moderate-to-severe COVID-19 while 153 (63.2%) patients presented with mild infection. The 28-day and 56-day mortality rates in our cohort were 13.3% and 19.8% respectively. Amongst the risk factors associated with poor outcome, the severity of COVID-19 (HR = 1.8, 95% CI 1.16-10.35; p = 0.04), presence of secondary infection (HR = 2.1, 95% CI 2.45-21.3; p = 0.023), and need for invasive mechanical ventilation (HR = 2.3, 95% CI 1.8-18.43; p = 0.01) were prognostically significant on multivariate log rank analysis. The risk of SARS-CoV-2 infection does not increase with haematological malignancies; however, the outcome remains poor in patients with severe COVID-19, requirement of invasive mechanical ventilation, and pre-existing bacterial/fungal infection at presentation.
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Affiliation(s)
- Anshul Gupta
- Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, U.P., 226014, India
| | - Nihar Desai
- Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, U.P., 226014, India
| | - Sanjeev
- Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, U.P., 226014, India
| | - Priyanka Chauhan
- Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, U.P., 226014, India
| | - Soniya Nityanand
- Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, U.P., 226014, India
| | - Zia Hashim
- Department of Pulmonary Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, U.P., 226014, India
| | - Mansi Gupta
- Department of Pulmonary Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, U.P., 226014, India.
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40
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Hewamana S, Skandarajah T, Jayasinghe C, Deshapriya S, Senarathna D, Arseculeratne G, Harischandra M, Somasundaram G, Srinivasan V, Somiah S, Munasinghe N, Hewawasam S, Ekanayake L, Wadanamby R, Galagoda G, Lin TT, Balawardena J. Blood cancer care in a resource limited setting during the Covid-19 outbreak; a single center experience from Sri Lanka. PLoS One 2021; 16:e0256941. [PMID: 34534228 PMCID: PMC8448336 DOI: 10.1371/journal.pone.0256941] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/18/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The Covid-19 pandemic has caused significant morbidity and mortality among patients with cancer. Most countries employed measures to prevent spread of Covid-19 infection which include shielding, quarantine, lockdown, travel restrictions, physical distancing and the use of personal protective equipment. This study was carried out to assess the change in patient attendance and the efficacy of newly implemented strategies to mitigate the impact of Covid-19 on services at the Lanka Hospital Blood Cancer Centre (LHBCC) in Colombo, Sri Lanka. METHODOLOGY Telephone consultation, infection control, personal protective measures and emergency admission policy were implemented with the aim of having a Covid-19 free ward and to prevent cross-infections. This descriptive cross-sectional study was conducted with 1399 patient episodes (in-patient care or day-case review). We analysed patients treated as in-patient as well as day-case basis between 01st April 2020 and 31st December 2020. RESULTS There were 977 day-case based episodes and 422 in-patient based episodes. There was a 14% drop in episode numbers compared to same period in 2019. There was no cross infection and no patients with Covid-19 related symptoms or positive test results entered the LHBCC during the study period. CONCLUSION Services in blood cancer care were maintained to prevent late stage presentation and adverse outcome. Measures implemented to prevent Covid-19 were effective to allow continuation of treatment. This study highlights the importance of implementing strict protocols, clinical screening, use of appropriate personal protective equipment in delivering blood cancer care during the Covid-19 pandemic. This is the only documented study relating to outcome and successful applicability of measures to prevent spread of Covid-19 infection and maintaining services among blood cancer patients in Sri Lanka.
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Affiliation(s)
- Saman Hewamana
- Clinical Haematology Unit, Lanka Hospital, Colombo, Sri Lanka
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Thet Thet Lin
- Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom
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Poncelet A, Verschelden G, Colard M, Hildebrand M, Hites M, Yin N, Michel C, Grimaldi D, De Wilde V. Worsening of COVID-19 after chemotherapy in patients considered to have recovered from a SARS-CoV-2 infection. Leuk Lymphoma 2021; 63:253-255. [PMID: 34521312 DOI: 10.1080/10428194.2021.1978086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Arthur Poncelet
- Departement of Hematology, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Gil Verschelden
- Clinic of Infectious Disease, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Martin Colard
- Departement of Hematology, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Marc Hildebrand
- Department of Internal Medicine, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Maya Hites
- Clinic of Infectious Disease, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Nicolas Yin
- Department of Microbiology, Laboratoire hospitalier universitaire de Bruxelles (LHUB-ULB)- Université libre de Bruxelles, Brussels, Belgium
| | - Charlotte Michel
- Department of Microbiology, Laboratoire hospitalier universitaire de Bruxelles (LHUB-ULB)- Université libre de Bruxelles, Brussels, Belgium
| | - David Grimaldi
- Departement of Intensive Care, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Virginie De Wilde
- Departement of Hematology, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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42
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Arcani R, Colle J, Cauchois R, Koubi M, Jarrot PA, Jean R, Boyer A, Lachamp J, Tichadou A, Couderc AL, Farnault L, Costello R, Venton G, Kaplanski G. Clinical characteristics and outcomes of patients with haematologic malignancies and COVID-19 suggest that prolonged SARS-CoV-2 carriage is an important issue. Ann Hematol 2021; 100:2799-2803. [PMID: 34518918 PMCID: PMC8437431 DOI: 10.1007/s00277-021-04656-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/25/2021] [Indexed: 12/23/2022]
Abstract
Specificities of COVID-19 disease course in patients with haematologic malignancies are still poorly studied. So, we aimed to compare patients with haematologic malignancies to patients without malignancies, matched by sex and age and hospitalised for COVID-19 at the same time and in the same centre. Among 25 patients with haematologic malignancies, we found that mortality (40% versus 4%, p < 0.01), number of days with RT-PCR positivity (21.2 ± 15.9 days [range, 3-57] versus 7.4 ± 5.6 days [range, 1-24], p < 0.01), maximal viral load (mean minimal Ct, 17.2 ± 5.2 [range, 10-30] versus 26.5 ± 5.1 [range, 15-33], p < 0.0001) and the delay between symptom onset and clinical worsening (mean time duration between symptom onset and first day of maximum requirement in inspired oxygen fraction, 14.3 ± 10.7 days versus 9.6 ± 3.7 days, p = 0.0485) were higher than in other patients. COVID-19 course in patients with haematologic malignancies has a delayed onset and is more severe with a higher mortality, and patients may be considered as super-spreaders. Clinicians and intensivists need to be trained to understand the specificity of COVID-19 courses in patients with haematological malignancies.
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Affiliation(s)
- Robin Arcani
- Department of Internal Medicine and Clinical Immunology, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), 145 Boulevard Baille, Marseille, 13005, France.
- Center for Cardiovascular and Nutrition Research (C2VN), INRA 1260, INSERM UMR_S 1263, Aix-Marseille University, Marseille, France.
| | - Julien Colle
- Hematology and Cellular Therapy Department, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Raphaël Cauchois
- Department of Internal Medicine and Clinical Immunology, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), 145 Boulevard Baille, Marseille, 13005, France
- Center for Cardiovascular and Nutrition Research (C2VN), INRA 1260, INSERM UMR_S 1263, Aix-Marseille University, Marseille, France
| | - Marie Koubi
- Department of Internal Medicine and Clinical Immunology, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), 145 Boulevard Baille, Marseille, 13005, France
| | - Pierre-André Jarrot
- Department of Internal Medicine and Clinical Immunology, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), 145 Boulevard Baille, Marseille, 13005, France
- Center for Cardiovascular and Nutrition Research (C2VN), INRA 1260, INSERM UMR_S 1263, Aix-Marseille University, Marseille, France
| | - Rodolphe Jean
- Department of Internal Medicine and Clinical Immunology, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), 145 Boulevard Baille, Marseille, 13005, France
| | - Arthur Boyer
- Réanimation Des Brûlés, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Julie Lachamp
- Réanimation Des Brûlés, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Antoine Tichadou
- Hematology and Cellular Therapy Department, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Anne-Laure Couderc
- Geriatric and Therapeutic Unit, Internal Medicine, CHU Sainte Marguerite, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Etablissement Français du Sang, Anthropologie, Droit, Ethique en Santé, Centre National de La Recherche Scientifique (CNRS), Marseille, France
| | - Laure Farnault
- Hematology and Cellular Therapy Department, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Regis Costello
- Hematology and Cellular Therapy Department, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Geoffroy Venton
- Hematology and Cellular Therapy Department, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Gilles Kaplanski
- Department of Internal Medicine and Clinical Immunology, CHU La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), 145 Boulevard Baille, Marseille, 13005, France
- Center for Cardiovascular and Nutrition Research (C2VN), INRA 1260, INSERM UMR_S 1263, Aix-Marseille University, Marseille, France
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Treskova-Schwarzbach M, Haas L, Reda S, Pilic A, Borodova A, Karimi K, Koch J, Nygren T, Scholz S, Schönfeld V, Vygen-Bonnet S, Wichmann O, Harder T. Pre-existing health conditions and severe COVID-19 outcomes: an umbrella review approach and meta-analysis of global evidence. BMC Med 2021; 19:212. [PMID: 34446016 PMCID: PMC8390115 DOI: 10.1186/s12916-021-02058-6] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/08/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND This study applies an umbrella review approach to summarise the global evidence on the risk of severe COVID-19 outcomes in patients with pre-existing health conditions. METHODS Systematic reviews (SRs) were identified in PubMed, Embase/Medline and seven pre-print servers until December 11, 2020. Due to the absence of age-adjusted risk effects stratified by geographical regions, a re-analysis of the evidence was conducted. Primary studies were extracted from SRs and evaluated for inclusion in the re-analysis. Studies were included if they reported risk estimates (odds ratio (OR), hazard ratio (HR), relative risk (RR)) for hospitalisation, intensive care unit admission, intubation or death. Estimated associations were extracted from the primary studies for reported pre-existing conditions. Meta-analyses were performed stratified for each outcome by regions of the World Health Organization. The evidence certainty was assessed using GRADE. Registration number CRD42020215846. RESULTS In total, 160 primary studies from 120 SRs contributed 464 estimates for 42 pre-existing conditions. Most studies were conducted in North America, European, and Western Pacific regions. Evidence from Africa, South/Latin America, and the Eastern Mediterranean region was scarce. No evidence was available from the South-East Asia region. Diabetes (HR range 1.2-2.0 (CI range 1.1-2.8)), obesity (OR range 1.5-1.75 (CI range 1.1-2.3)), heart failure (HR range 1.3-3.3 (CI range 0.9-8.2)), COPD (HR range 1.12-2.2 (CI range 1.1-3.2)) and dementia (HR range 1.4-7.7 (CI range 1.2-39.6)) were associated with fatal COVID-19 in different regions, although the estimates varied. Evidence from Europe and North America showed that liver cirrhosis (OR range 3.2-5.9 (CI range 0.9-27.7)) and active cancer (OR range 1.6-4.7 (CI range 0.5-14.9)) were also associated with increased risk of death. Association between HIV and undesirable COVID-19 outcomes showed regional heterogeneity, with an increased risk of death in Africa (HR 1.7 (CI 1.3-2.2)). GRADE certainty was moderate to high for most associations. CONCLUSION Risk of undesirable COVID-19 health outcomes is consistently increased in certain patient subgroups across geographical regions, showing high variability in others. The results can be used to inform COVID-19 vaccine prioritisation or other intervention strategies.
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Affiliation(s)
| | - Laura Haas
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Sarah Reda
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Antonia Pilic
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Anna Borodova
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Kasra Karimi
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Judith Koch
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Teresa Nygren
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Stefan Scholz
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Viktoria Schönfeld
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Sabine Vygen-Bonnet
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Ole Wichmann
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Thomas Harder
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
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44
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Nadkarni AR, Vijayakumaran SC, Gupta S, Divatia JV. Mortality in Cancer Patients With COVID-19 Who Are Admitted to an ICU or Who Have Severe COVID-19: A Systematic Review and Meta-Analysis. JCO Glob Oncol 2021; 7:1286-1305. [PMID: 34406802 PMCID: PMC8457815 DOI: 10.1200/go.21.00072] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
There are scarce data to aid in prognostication of the outcome of critically ill cancer patients with COVID-19. In this systematic review and meta-analysis, we investigated the mortality of critically ill cancer patients with COVID-19. In 28 studies, pooled mortality in cancer patients with COVID-19 admitted to an ICU was not prohibitively high (60%)![]()
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Affiliation(s)
- Amogh Rajeev Nadkarni
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Swapna C Vijayakumaran
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Jigeeshu V Divatia
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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45
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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.
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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
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46
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Palanques-Pastor T, Megías-Vericat JE, Martínez P, López Lorenzo JL, Cornago Navascués J, Rodriguez Macias G, Cano I, Arnan Sangerman M, Vidriales Vicente MB, Algarra Algarra JL, Foncillas MÁ, Herrera P, Botella Prieto C, Vives S, Figuera Álvarez Á, Cuevas Palomares L, Sobas M, Contento Gonzalo A, Cuello García R, Amutio Diez ME, De Miguel Llorente D, Navas Elorza B, Bergua Burgues JM, Bernal Del Castillo T, Mateos Rodríguez MC, de Cabo López E, Franco Villegas AC, García Boyero R, Escolano Escobar C, Seri Merino C, Cervero C, Roldán Pérez A, Hermosín Ramos L, Cervera Calvo M, Olave MT, Villafuerte Gutiérrez P, de Laiglesiai A, Serrano J, Najera Irazu MJ, Piñana JL, Sanz MÁ, Martínez-López J, Montesinos P. Characteristics, clinical outcomes, and risk factors of SARS-COV-2 infection in adult acute myeloid leukemia patients: experience of the PETHEMA group. Leuk Lymphoma 2021; 62:2928-2938. [PMID: 34292118 DOI: 10.1080/10428194.2021.1948031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection produces higher morbidity and mortality in hematological malignancies, but evidence in acute myeloid leukemia (AML) is scarce. A multicenter observational study was conducted to determine the clinical outcomes and assess the impact of therapeutic approaches in adult AML patients with SARS-CoV-2 infection in the first wave (March-May 2020). Overall, 108 patients were included: 51.9% with active leukemia and 70.4% under therapeutic schedules for AML. Signs and symptoms of SARS-CoV-2 were present in 96.3% of patients and 82.4% received specific treatment for SARS-CoV-2. The mortality rate was 43.5% and was correlated with age, gender, active leukemia, dyspnea, severe SARS-CoV-2, intensive care measures, neutrophil count, and D-dimer levels. A protective effect was found with azithromycin, lopinavir/ritonavir, and normal liver enzyme levels. During the SARS-CoV-2 first wave, our findings suggested an increased mortality in AML in a short period. SARS-CoV-2 management could be guided by risk factors in AML patients.
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Affiliation(s)
| | | | - Pilar Martínez
- Hematology and Hemotherapy Department, Hospital Universitario, Madrid, Spain
| | - José Luis López Lorenzo
- Hematology and Hemotherapy Department, Hospital Universitario Fundación Jiménez Díaz, Valencia, Spain
| | - Javier Cornago Navascués
- Hematology and Hemotherapy Department, Hospital Universitario Fundación Jiménez Díaz, Valencia, Spain
| | - Gabriela Rodriguez Macias
- Hematology and Hemotherapy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Isabel Cano
- Hematology and Hemotherapy Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | | | | | | | - Pilar Herrera
- Hematology and Hemotherapy Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Carmen Botella Prieto
- Hematology and Hemotherapy Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Susana Vives
- Clinic Hematology Department, Instituto Catalán de Oncología, Badalona, Spain
| | - Ángela Figuera Álvarez
- Hematology and Hemotherapy Department, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Marta Sobas
- Haematology, Blood Neoplasms, and Bone Marrow Transplantation, Wroclaw Medical University, Wrocław, Poland
| | | | - Rebeca Cuello García
- Hematology and Hemotherapy Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | - Begoña Navas Elorza
- Hematology and Hemotherapy Department, Hospital HLA Universitario Moncloa, Madrid, Spain
| | | | | | | | - Erik de Cabo López
- Hematology Department, Hospital Universitario del Bierzo, Ponferrada, Spain
| | | | - Raimundo García Boyero
- Hematology and Hemotherapy Department, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | | | - Cristina Seri Merino
- Hematology and Hemotherapy Department, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain
| | - Carlos Cervero
- Hematology Department, Hospital Virgen de la Luz, Cuenca, Spain
| | - Alicia Roldán Pérez
- Hematology and Hemotherapy Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain
| | - Lourdes Hermosín Ramos
- Hematology and Hemotherapy Department, Hospital Jerez de la Frontera, Jerez de la Frontera, Spain
| | | | - María Telesa Olave
- Hematology and Hemotherapy Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Almudena de Laiglesiai
- Hematology and Hemotherapy Department, Hospital Universitario Puerta del Hierro, Majadahonda, Spain
| | - Josefina Serrano
- Hematology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
| | | | - José Luis Piñana
- Hematology and Hemotherapy Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Miguel Ángel Sanz
- Hematology and Hemotherapy Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Pau Montesinos
- Hematology and Hemotherapy Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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47
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Lai C, Liu X, Yan Q, Lv H, Zhou L, Hu L, Cai Y, Wang G, Chen Y, Chai R, Liu Z, Xu Y, Huang W, Xiao F, Hu L, Li Y, Huang J, Zhou Q, Li L, Peng T, Zhang H, Zhang Z, Chen L, Chen C, Ji T. Low Innate Immunity and Lagged Adaptive Immune Response in the Re-Tested Viral RNA Positivity of a COVID-19 Patient. Front Immunol 2021; 12:664619. [PMID: 34305895 PMCID: PMC8295488 DOI: 10.3389/fimmu.2021.664619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/31/2021] [Indexed: 11/21/2022] Open
Abstract
Recent studies have highlighted observations regarding re-tested positivity (RP) of SARS-CoV-2 RNA in discharged COVID-19 patients, however, the immune mechanisms underlying SARS-CoV-2 RNA RP in immunocompetent patients remain elusive. Herein, we describe the case of an immunocompetent COVID-19 patient with moderate symptoms who was twice re-tested as positive for SARS-CoV-2 RNA, and the period between first and third viral RNA positivity was 95 days, longer than previously reported (18–25 days). The chest computed tomography findings, plasma anti-SARS-CoV-2 antibody, neutralizing antibodies (NAbs) titer, and whole blood transcriptic characteristics in the viral RNA RP patient and other COVID-19 patients were analyzed. During the SARS-CoV-2 RNA RP period, new lung lesions were observed. The COVID-19 patient with viral RNA RP had delayed seroconversion of anti-spike/receptor-binding domain (RBD) IgA antibody and NAbs and were accompanied with disappearance of the lung lesions. Further experimental data validated that NAbs titer was significantly associated with anti-RBD IgA and IgG, and anti-spike IgG. The RP patient had lower interferon-, T cells- and B cell-related genes expression than non-RP patients with mild-to-moderate symptoms, and displayed lower cytokines and chemokines gene expression than severe patients. Interestingly, the RP patient had low expression of antigen presentation-related genes and low B cell counts which might have contributed to the delayed anti-RBD specific antibody and low CD8+ cell response. Collectively, delayed antigen presentation-related gene expression was found related to delayed adaptive immune response and contributed to the SARS-CoV-2 RNA RP in this described immunocompetent patient.
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Affiliation(s)
- Changchun Lai
- Clinical Laboratory Medicine Department, Maoming People's Hospital, Maoming, China.,Department of Emergency, Maoming People's Hospital, Maoming, China.,Clinical Laboratory Medicine Department, Xinyi People's Hospital, Xinyi, China
| | - Xinglong Liu
- Guangzhou Regenerative Medicine and Health-Guangdong Laboratory (GRMH-GDL), Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Qihong Yan
- Guangzhou Regenerative Medicine and Health-Guangdong Laboratory (GRMH-GDL), Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Hualiang Lv
- Pulmonary and Critical Care Medicine Department, Maoming People's Hospital, Maoming, China
| | - Lei Zhou
- Pathology Laboratory Department, Maoming People's Hospital, Maoming, China
| | - Longbo Hu
- State Key Laboratory of Respiratory Disease, Sino-French Hoffmann Institute, School of Basic Medical Science, Guangzhou Medical University, Guangzhou, China
| | - Yong Cai
- CT Department, Maoming People's Hospital, Maoming, China
| | - Guoqiang Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yufeng Chen
- Clinical Laboratory Medicine Department, Maoming People's Hospital, Maoming, China
| | - Renjie Chai
- Cardiovascular Department, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhenwei Liu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuhua Xu
- Vaccine Research and Development Department, Guangdong South China Vaccine Co. Ltd, Guangzhou, China
| | - Wendong Huang
- Scientific Research Center, Maoming People's Hospital, Maoming, China
| | - Fei Xiao
- Clinical Laboratory Medicine Department, Maoming People's Hospital, Maoming, China
| | - Linhui Hu
- Clinical Research Center, Maoming People's Hospital, Maoming, China
| | - Yaocai Li
- Infection Department, Maoming People's Hospital, Maoming, China
| | - Jianhong Huang
- Medical Department, Maoming People's Hospital, Maoming, China
| | - Qiang Zhou
- Clinical Laboratory Medicine Department, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Luqian Li
- Clinical Laboratory Medicine Department, Maoming People's Hospital, Maoming, China
| | - Tao Peng
- State Key Laboratory of Respiratory Disease, Sino-French Hoffmann Institute, School of Basic Medical Science, Guangzhou Medical University, Guangzhou, China
| | - Haiye Zhang
- Clinical Laboratory Medicine Department, Xinyi People's Hospital, Xinyi, China
| | - Zhenhui Zhang
- Critical Care Medicine Department, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ling Chen
- Bioland Laboratory (GRMH-GDL), Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China.,State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chunbo Chen
- Department of Emergency, Maoming People's Hospital, Maoming, China.,Scientific Research Center, Maoming People's Hospital, Maoming, China
| | - Tianxing Ji
- Clinical Laboratory Medicine Department, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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48
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Ohara S, Fujii T, Ide S, Uchida T, Inoue M, Hagaihara M. Clinical characteristics and risk factors associated with nosocomial COVID-19 infection in patients with hematological disorders in Japan. Int J Hematol 2021; 114:719-724. [PMID: 34152562 PMCID: PMC8215476 DOI: 10.1007/s12185-021-03172-0] [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: 11/23/2020] [Revised: 06/06/2021] [Accepted: 06/09/2021] [Indexed: 11/08/2022]
Abstract
Patients with cancer are considered at high risk of acquiring coronavirus disease (COVID-19). To identify patients who are likely to be diagnosed with severe COVID-19, we analyzed the risk factors for mortality in patients admitted to the hematology department at our institute. The mortality rate of all patients was as high as 62% (21 of the 34 patients), and most of these patients had malignant malignancies. Patients before an achievement of remission had a 10.8-fold higher risk of death than those in remission. The group receiving chemotherapy with steroids had a shorter survival time and had an 8.3-fold higher risk of death than that receiving chemotherapy without steroids. During the COVID-19 pandemic, it is necessary to carefully monitor or follow-up patients with active diseases and patients receiving steroid-containing chemotherapy.
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Affiliation(s)
- Shin Ohara
- Eiju General Hospital, 2-23-16, Higashi-Ueno, Taito, Tokyo, Japan.
| | - Takayuki Fujii
- Eiju General Hospital, 2-23-16, Higashi-Ueno, Taito, Tokyo, Japan
| | - Shiro Ide
- Eiju General Hospital, 2-23-16, Higashi-Ueno, Taito, Tokyo, Japan
| | - Tomoyuki Uchida
- Eiju General Hospital, 2-23-16, Higashi-Ueno, Taito, Tokyo, Japan
| | - Morihiro Inoue
- Eiju General Hospital, 2-23-16, Higashi-Ueno, Taito, Tokyo, Japan
| | - Masao Hagaihara
- Eiju General Hospital, 2-23-16, Higashi-Ueno, Taito, Tokyo, Japan
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49
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Levi G, Rocchetti C, Magri R, Uccelli S, Bottone D, Quadri F, Novali M, Santin AD, Bezzi M. Hyperimmune plasma infusion in an immunocompromised Covid-19 patient previously treated for follicular lymphoma. Monaldi Arch Chest Dis 2021; 91. [PMID: 34121379 DOI: 10.4081/monaldi.2021.1867] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/12/2021] [Indexed: 11/23/2022] Open
Abstract
Covid-19 in immunocompromised patients shows a prolonged course and may lead to a poor prognosis. Although data on hyperimmune plasma for treatment of Covid-19 suggest an improved outcome in immunocompetent patients, limited data are currently available in immunocompromised patients. We present the case of a 62-year-old Caucasian woman, who was previously treated with obinutuzumab and bendamustine for follicular lymphoma and showed a prolonged positive test for Covid-19. Since no improvement was observed with standard of care (including remdesivir), the possibility of hyperimmune plasma infusion was discussed. A first dose of hyperimmune plasma was administered, with subsequent onset of fever, increasing inflammatory indexes and worsening radiological findings. Three days later a second dose of plasma was administered. Within twelve hours cough and fever disappeared, and oxygen at rest was discontinued. The patient was discharged 5 days later, and nasopharyngeal swabs resulted negative 16 days after discharge.
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Affiliation(s)
- Guido Levi
- Interventional Pulmonology Department, ASST Spedali Civili, Brescia.
| | - Chiara Rocchetti
- Interventional Pulmonology Department, ASST Spedali Civili, Brescia.
| | - Roberto Magri
- Interventional Pulmonology Department, ASST Spedali Civili, Brescia.
| | - Silvia Uccelli
- Interventional Pulmonology Department, ASST Spedali Civili, Brescia.
| | - Damiano Bottone
- Interventional Pulmonology Department, ASST Spedali Civili, Brescia.
| | - Federico Quadri
- Interventional Pulmonology Department, ASST Spedali Civili, Brescia.
| | - Mauro Novali
- Interventional Pulmonology Department, ASST Spedali Civili, Brescia.
| | - Alessandro D Santin
- Department of Obstetrics & Gynecology, Yale University School of Medicine, New Haven, CT.
| | - Michela Bezzi
- Interventional Pulmonology Department, ASST Spedali Civili, Brescia.
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50
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Chevallier P, Coste-Burel M, Le Bourgeois A, Peterlin P, Garnier A, Béné MC, Imbert BM, Drumel T, Le Gouill S, Moreau P, Mahe B, Dubruille V, Blin N, Lok A, Touzeau C, Gastinne T, Jullien M, Vanthygem S, Guillaume T. Safety and immunogenicity of a first dose of SARS-CoV-2 mRNA vaccine in allogeneic hematopoietic stem-cells recipients. ACTA ACUST UNITED AC 2021; 2:520-524. [PMID: 34226903 PMCID: PMC8242867 DOI: 10.1002/jha2.242] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/18/2021] [Accepted: 05/18/2021] [Indexed: 12/28/2022]
Abstract
This was a monocentric prospective study testing the efficacy and safety of a first injection of BNT162b2 (Pfizer‐BioNTech) in 112 Allo‐HSCT patients. Antibody response to SARS‐CoV‐2 spike protein receptor‐binding domain was tested at the time of the second injection (Roche Elecsys). The study also included a non‐randomized control arm of 26 healthy controls. This study shows that a first dose of SARS‐CoV‐2 messenger RNA vaccine is safe and provides a 55% rate of seroconversion in allotransplanted patients compared to 100% for the controls (p < 0.001). Factors influencing the absence of response in patients were recent transplantation (<2 years), lymphopenia (<1 × 109/L) and immunosuppressive treatment or chemotherapy at the time of vaccination.
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Affiliation(s)
- Patrice Chevallier
- Department of Hematology Nantes University Hospital Nantes France.,INSERM UMR1232 CRCINA IRS-UN University of Nantes Nantes France
| | | | | | - Pierre Peterlin
- Department of Hematology Nantes University Hospital Nantes France
| | - Alice Garnier
- Department of Hematology Nantes University Hospital Nantes France
| | - Marie C Béné
- INSERM UMR1232 CRCINA IRS-UN University of Nantes Nantes France.,Department of Hematology Biology Nantes University Hospital Nantes France
| | | | - Thomas Drumel
- Department of Virology Nantes University Hospital Nantes France
| | - Steven Le Gouill
- Department of Hematology Nantes University Hospital Nantes France
| | - Philippe Moreau
- Department of Hematology Nantes University Hospital Nantes France
| | - Beatrice Mahe
- Department of Hematology Nantes University Hospital Nantes France
| | | | - Nicolas Blin
- Department of Hematology Nantes University Hospital Nantes France
| | - Anne Lok
- Department of Hematology Nantes University Hospital Nantes France
| | - Cyrille Touzeau
- Department of Hematology Nantes University Hospital Nantes France
| | - Thomas Gastinne
- Department of Hematology Nantes University Hospital Nantes France
| | - Maxime Jullien
- Department of Hematology Nantes University Hospital Nantes France
| | - Sophie Vanthygem
- Department of Hematology Nantes University Hospital Nantes France
| | - Thierry Guillaume
- Department of Hematology Nantes University Hospital Nantes France.,INSERM UMR1232 CRCINA IRS-UN University of Nantes Nantes France
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