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Cowman K, Rossi J, Gendlina I, Guo Y, Liu S, Szymczak W, Forest SK, Wolgast L, Orner E, Bao H, Cervera-Hernandez ME, Ceniceros A, Thota R, Pirofski LA, Nori P. Elucidating the role of procalcitonin as a biomarker in hospitalized COVID-19 patients. Diagn Microbiol Infect Dis 2022; 103:115721. [PMID: 35635888 PMCID: PMC9065691 DOI: 10.1016/j.diagmicrobio.2022.115721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/11/2022] [Accepted: 04/28/2022] [Indexed: 01/08/2023]
Abstract
Our objectives were to evaluate the role of procalcitonin in identifying bacterial co-infections in hospitalized COVID-19 patients and quantify antibiotic prescribing during the 2020 pandemic surge. Hospitalized COVID-19 patients with both a procalcitonin test and blood or respiratory culture sent on admission were included in this retrospective study. Confirmed co-infection was determined by an infectious diseases specialist. In total, 819 patients were included; 335 (41%) had an elevated procalcitonin (>0.5 ng/mL) and of these, 42 (13%) had an initial bacterial co-infection. Positive predictive value of elevated procalcitonin for co-infection was 13% while the negative predictive value was 94%. Ninety-six percent of patients with an elevated procalcitonin received antibiotics (median 6 days of therapy), compared to 82% with low procalcitonin (median 4 days of therapy) (adjusted OR:3.3, P < 0.001). We observed elevated initial procalcitonin in many COVID patients without concurrent bacterial co-infections which potentially contributed to antibiotic over-prescribing.
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Affiliation(s)
- Kelsie Cowman
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Network Performance Group, Montefiore Medical Center, Bronx, NY, USA.
| | - James Rossi
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Inessa Gendlina
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Yi Guo
- Department of Pharmacy, Montefiore Medical Center, Bronx, NY, USA
| | - Sichen Liu
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Wendy Szymczak
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Stefanie K Forest
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Lucia Wolgast
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Erika Orner
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Hongkai Bao
- Department of Pharmacy, Montefiore Medical Center, Bronx, NY, USA
| | - Miguel E Cervera-Hernandez
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Ashley Ceniceros
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Raja Thota
- Network Performance Group, Montefiore Medical Center, Bronx, NY, USA
| | - Liise-Anne Pirofski
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Department of Microbiology and Immunology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Priya Nori
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
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Shapiro LC, Thakkar A, Campbell ST, Forest SK, Pradhan K, Gonzalez-Lugo JD, Quinn R, Bhagat TD, Choudhary GS, McCort M, Sica RA, Goldfinger M, Goel S, Anampa JD, Levitz D, Fromowitz A, Shah AP, Sklow C, Alfieri G, Racine A, Wolgast L, Greenberger L, Verma A, Halmos B. Efficacy of booster doses in augmenting waning immune responses to COVID-19 vaccine in patients with cancer. Cancer Cell 2022; 40:3-5. [PMID: 34838186 PMCID: PMC8595142 DOI: 10.1016/j.ccell.2021.11.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Anti-COVID-19 immunity dynamics were assessed in patients with cancer in a prospective clinical trial. Waning of immunity was detected 4-6 months post-vaccination with significant increases in anti-spike IgG titers after booster dosing, and 56% of seronegative patients seroconverted post-booster vaccination. Prior anti-CD20/BTK inhibitor therapy was associated with reduced vaccine efficacy.
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Affiliation(s)
- Lauren C Shapiro
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Astha Thakkar
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Sean T Campbell
- Department of Pathology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Stefanie K Forest
- Department of Pathology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Kith Pradhan
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Jesus D Gonzalez-Lugo
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Ryann Quinn
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Tushar D Bhagat
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Gaurav S Choudhary
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Margaret McCort
- Division of Infectious Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - R Alejandro Sica
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Mendel Goldfinger
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Swati Goel
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Jesus D Anampa
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - David Levitz
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Ariel Fromowitz
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Akash Pradip Shah
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Charlotte Sklow
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Gregory Alfieri
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Andrew Racine
- Department of Pediatrics, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Lucia Wolgast
- Department of Pathology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | | | - Amit Verma
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA.
| | - Balazs Halmos
- Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA.
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Thakkar A, Gonzalez-Lugo JD, Goradia N, Gali R, Shapiro LC, Pradhan K, Rahman S, Kim SY, Ko B, Sica RA, Kornblum N, Bachier-Rodriguez L, McCort M, Goel S, Perez-Soler R, Packer S, Sparano J, Gartrell B, Makower D, Goldstein YD, Wolgast L, Verma A, Halmos B. Seroconversion rates following COVID-19 vaccination among patients with cancer. Cancer Cell 2021; 39:1081-1090.e2. [PMID: 34133951 PMCID: PMC8179248 DOI: 10.1016/j.ccell.2021.06.002] [Citation(s) in RCA: 236] [Impact Index Per Article: 78.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/26/2021] [Accepted: 06/02/2021] [Indexed: 12/12/2022]
Abstract
As COVID-19 adversely affects patients with cancer, prophylactic strategies are critically needed. Using a validated antibody assay against SARS-CoV-2 spike protein, we determined a high seroconversion rate (94%) in 200 patients with cancer in New York City that had received full dosing with one of the FDA-approved COVID-19 vaccines. On comparison with solid tumors (98%), a significantly lower rate of seroconversion was observed in patients with hematologic malignancies (85%), particularly recipients following highly immunosuppressive therapies such as anti-CD20 therapies (70%) and stem cell transplantation (73%). Patients receiving immune checkpoint inhibitor therapy (97%) or hormonal therapies (100%) demonstrated high seroconversion post vaccination. Patients with prior COVID-19 infection demonstrated higher anti-spike IgG titers post vaccination. Relatively lower IgG titers were observed following vaccination with the adenoviral than with mRNA-based vaccines. These data demonstrate generally high immunogenicity of COVID-19 vaccination in oncology patients and identify immunosuppressed cohorts that need novel vaccination or passive immunization strategies.
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Affiliation(s)
- Astha Thakkar
- Department of Oncology, Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY 10461, USA
| | - Jesus D Gonzalez-Lugo
- Department of Oncology, Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY 10461, USA
| | - Niyati Goradia
- Department of Oncology, Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY 10461, USA
| | - Radhika Gali
- Department of Oncology, Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY 10461, USA
| | - Lauren C Shapiro
- Department of Oncology, Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY 10461, USA
| | - Kith Pradhan
- Department of Oncology, Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY 10461, USA
| | - Shafia Rahman
- Department of Oncology, Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY 10461, USA
| | - So Yeon Kim
- Department of Oncology, Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY 10461, USA
| | - Brian Ko
- Department of Oncology, Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY 10461, USA
| | - R Alejandro Sica
- Department of Oncology, Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY 10461, USA
| | - Noah Kornblum
- Department of Oncology, Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY 10461, USA
| | | | - Margaret McCort
- Department of Medicine, Division of Infectious Diseases, Montefiore Medical Center, Bronx, NY 10461, USA
| | - Sanjay Goel
- Department of Oncology, Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY 10461, USA
| | - Roman Perez-Soler
- Department of Oncology, Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY 10461, USA
| | - Stuart Packer
- Department of Oncology, Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY 10461, USA
| | - Joseph Sparano
- Department of Oncology, Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY 10461, USA
| | - Benjamin Gartrell
- Department of Oncology, Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY 10461, USA
| | - Della Makower
- Department of Oncology, Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY 10461, USA
| | - Yitz D Goldstein
- Department of Pathology, Montefiore Medical Center, Bronx, NY 10461, USA
| | - Lucia Wolgast
- Department of Pathology, Montefiore Medical Center, Bronx, NY 10461, USA
| | - Amit Verma
- Department of Oncology, Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY 10461, USA.
| | - Balazs Halmos
- Department of Oncology, Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY 10461, USA.
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Castano E, Glick S, Wolgast L, Naeem R, Sunkara J, Elston D, Jacobson M. Hypopigmented mycosis fungoides in childhood and adolescence: a long-term retrospective study. J Cutan Pathol 2013; 40:924-34. [DOI: 10.1111/cup.12217] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 06/20/2013] [Accepted: 08/11/2013] [Indexed: 11/28/2022]
Affiliation(s)
| | - Sharon Glick
- Department of Dermatology; Downstate Medical Center; Brooklyn; NY; USA
| | - Lucia Wolgast
- Department of Pathology; Montefiore Medical Center; Bronx; NY; USA
| | - Rizwan Naeem
- Department of Pathology; Montefiore Medical Center; Bronx; NY; USA
| | - Jaya Sunkara
- Department of Pathology; Montefiore Medical Center; Bronx; NY; USA
| | - Dirk Elston
- Ackerman Academy of Dermatopathology; New York; NY; USA
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Mahadeo KM, Wolgast L, McMahon C, Cole PD. Systemic mastocytosis in a child with t(8;21) acute myeloid leukemia. Pediatr Blood Cancer 2011; 57:684-7. [PMID: 21671435 DOI: 10.1002/pbc.23026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 12/16/2010] [Indexed: 11/09/2022]
Abstract
Mastocytosis is primarily limited to the cutaneous variant in pediatric patients. Systemic mastocytosis (SM) has been associated with t(8;21) acute myeloid leukemia (AML) in adults. We provide the first report of a child with t(8;21) AML, diagnosed with asymptomatic SM following four cycles of chemotherapy. Unlike most adults with SM/AML, she was not found to have a c-KIT (D816V) mutation. SM persisted in the bone marrow after completion of chemotherapy, and her AML relapsed 9 months off-treatment. Although she achieved a second remission, mastocytosis persists in the marrow. Pediatric patients with t(8;21) AML/SM may represent a high-risk group despite favorable cytogenetics.
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Affiliation(s)
- Kris M Mahadeo
- Division of Pediatric Hematology/Oncology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York 10467, USA
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