Case Report: Remdesivir and Convalescent Plasma in a Newly Acute B Lymphoblastic Leukemia Diagnosis With Concomitant Sars-CoV-2 Infection

Abstract

Introduction: The spread of Covid-19 has worsened the prognosis of oncology patients, interrupting or delaying life-saving therapies and contextually increasing the risk of severe SARS-CoV-2 infections. Acute lymphoblastic leukemia (ALL) is the most frequent cancer in pediatric age and the management of this disease with concomitant SARS-COV-2 infection represents a challenging situation.Case presentation: We present the case of a 6-year-old female newly diagnosed with ALL during a documented SARS-CoV-2 infection. Our patient was admitted 20 days after SARS-CoV-2 detection for evening-rise fever. Laboratory testing showed severe neutropenia while chest x-ray detected moderate pulmonary involvement. Acute lymphoblastic leukemia diagnosis was made through morphological and molecular analysis on bone marrow aspirate. Given the stability of the blood count and clinical conditions, antiviral therapy with Remdesivir and Convalescent Plasma was started before antileukemic treatment, obtaining a rapid resolution of the infection.Conclusion: In our experience, the treatment with Remdesivir and Convalescent Plasma led to a rapid resolution of Sars-Cov-2 infection. Our case did not present any adverse event to the therapy. Thus, this treatment could be considered in patients with malignancies, in order to accelerate the resolution of the infection and begin immunosuppressive treatment safely. Further studies are required to confirm this hypothesis.

Effectiveness of convalescent plasma therapy in COVID-19 patients with haematological malignancies

“…There are no recommended or standardized doses of CP, however, most of the studies used one to two-units and the titer of the antibody might determine the optimal dose (35). In our study, only four papers measured the titer of the donor antibodies before transfusion (7, 17, 20, 24). One of the included retrospective multicentre observational studies found that there was no significant differences in moratlity in patients who received one versus two-dose of CP or in patients who received early versus late transfusion of CP (23).…”

“…Most of the included articles in our analysis reported significant improvement in patient status after CPT, patients become asymptomatic and were discharged. Four articles reported improved viral clearance after using CPT (17-20). Similarly, Sarkar et al .…”

“…Thompson et al reported a mortality rate of 13.1% in the CPT recipient group and 24.8% in the non-recipient group, moreover, the mortality rate was significantly lower in intensive care unit patients on mechanical ventilation(26).Most of the included articles in our analysis reported significant improvement in patient status after CPT, patients become asymptomatic and were discharged. Four articles reported improved viral clearance after using CPT(17)(18)(19)(20). Similarly, Sarkar et al(30) concluded from 7 studies that CPT can enhance viral clearance and improve patient outcomes.…”

Effectiveness of Convalescent Plasma Therapy in COVID-19 Patients with Hematological Malignancies: A Systematic Review

“…Although several studies have reported less severe COVID-19 disease in children than adult cancer patients, there have been some reports of severe disease in children with cancer [ 7 ]. A few case reports have demonstrated improved outcomes following CPT in children with hematology malignancies [ 7 , 19 , 22 ].…”

Efficiency and safety of convalescent plasma therapy in patients with COVID-19: a systematic review

“…Safety and efficacy of CP on a large scale were not evaluated in children, except for isolated cases where using CP in children with leukemia was described [63,64]. The US guidelines do not recommend using CP for the treatment of COVID-19 in children to whom mechanical ventilation is performed; however, subject to a pediatric infectious disease specialist's approval, CP with a high VNA titer may be considered to be administered on an individual basis.…”