Case report: Clinical course and treatment of SARS-CoV-2 in a pediatric CAR-T cell recipient with persistent hypogammaglobulinemia

Abstract

This report describes a pediatric patient who underwent chimeric antigen receptor (CAR) T-cell therapy for refractory B-cell acute lymphoblastic leukemia (B-ALL) four years prior, with resultant hypogammaglobulinemia for which he was receiving weekly subcutaneous immune globulin. He presented with persistent fever, dry cough, and a tingling sensation in his toes following a confirmed COVID-19 infection 3 weeks prior. His initial nasopharyngeal SARS-CoV-2 PCR was negative, leading to an extensive workup for other infections. He was ultimately diagnosed with persistent lower respiratory tract COVID-19 infection based on positive SARS-CoV-2 PCR from bronchoalveolar lavage (BAL) sampling. He was treated with a combination of remdesivir (antiviral) and casirivimab/imdevimab (combination monoclonal antibodies) with immediate improvement in fever, respiratory symptoms, and neurologic symptoms.

Blood cancer in children infected with COVID-19: A comprehensive systematic review

“…Most of those patients had acute leukaemic conditions (n = 892, 78.2%) (3, 4, 7, 8, 13-15, 17, 19-21, 23-34, 36-40, 58-64, 66-82, 84-86, 89, 90, 92-95, 97-100, 102, 104, 106, 108-129, 131-133, 135-137, 139-143, 146-151, 153-158, 160-163, 167-175, 177, 178) and only few cases had chronic leukaemia (n = 5, 0.4%) (91,92,129). Reported blood cancer status for the leukaemia in children infected with SARS-CoV-2 were active (n = 258/574, 44.9%) (8, 12-15, 17, 19-21, 23, 24, 29, 31, 32, 34, 35, 37, 40, 58-60, 64, 66, 73, 74, 76, 78, 79, 81, 82, 85, 86, 90, 92, 93, 95, 97-100, 102, 103, 108-112, 114, 115, 118, 120-122, 124, 127-129, 134, 136, 140, 142, 143, 146, 148-151, 154, 156, 158-160, 167, 169, 170, 172, 174, 175, 177), remission (n = 256/574, 44.6%) (3, 4, 8, 14, 15, 21, 23-28, 30, 33, 35-37, 40, 59-62, 67-72, 74, 78, 84, 89, 91, 92, 94, 107, 126, 128, 132, 135, 137, 139, 141, 150, 155, 157, 163, 167-177), or relapsed/refractory (n = 60/574, 10.4%) (7,13,14,29,37,63,67,74,77,80,92,106,117,125,131,133,147,150,169,171,173,174,176,178), however, blood cancer status in these leukaemia cases was not reported in a high percentage of patients (n = 567/1141, 49.7%) (18,20,21,38,39,92,96,104,108,113,…”

“…Many of these leukaemic children infected with SARS-CoV-2 were found to have active concurrent infections (n = 96) [including unspeci ed pathogens (n = 35) (19 bacteria (14,37,108,151,(171)(172)(173), 12 fungi (66, 108, 172, 173), and 4 other unknown pathogens) (113); Rhinovirus (n = 6) (28, 76, 133, 153, 160); Pseudomonas (n = 6) (17,19,21,31,33,128); Aspergillus (n = 4) (61, 71,110,171); Dengue virus (n = 4) (169); In uenza A virus (n = 4) (72,133,146,168) (13,19,23,62,64,74,77,78,84,106,114,119,128,129,133,147,153,160,176,178) and autologous (n = 1) (27)], graft versus host disease (n = 15) (13,19,64,99,114,128,129,136,153,160,…”

“…Most common clinical symptoms from leukaemia were febrile neutropenia (n = 29) (21,25,31,58,59,61,66,76,84,97,111,122,136,139,148,149,173,175), sepsis (n = 23) (17,21,37,59,99,110,114,132,150,154,172,173), bone marrow suppression (n = 21) (3,25,28,59,60,81,82,86,90,95,112,114,122,125,133,134,149,151,169), multiorgan failure (n = 18) (17,37,59,99,…”