IL-1R blockade is not effective in patients with hematological malignancies and severe SARS-CoV-2 infection

Villegas, Carolina; Poza, María; Talayero, Paloma; Teller, José Manuel Caro; Zafra, Denis; García, Cristina Nevado; Vera, Elena; Hidalgo, Manuel; López, Nieves; Cuéllar, Clara; Zamanillo, Irene; Íñiguez, R.; Paz‐Artal, Estela; Aguado, J. M.; Martínez‐López, Joaquín

doi:10.1007/s00277-020-04160-w

Cited by 9 publications

(7 citation statements)

References 9 publications

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“…This result may be explained because during the first weeks of the pandemic this anti‐inflammatory approach was considered when patients suffered a significant worsening resulting in an important treatment delay. In this regard, our group reported an unsuccessful experience with anakinra in five patients with haematological malignancies and COVID‐CSS and previous refractoriness to tocilizumab 35 . It therefore seems likely that earlier use of tocilizumab, in the presence of COVID‐CSS but before clinical conditions worsen, could be highly recommended.…”

Section: Discussionmentioning

confidence: 99%

Clinical course and risk factors for mortality from COVID‐19 in patients with haematological malignancies

Sánchez-Pina

Rodríguez

Quismondo

et al. 2020

European J of Haematology

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109

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Background: The impact of coronavirus disease 2019 (COVID-19) in haematological patients (HP) has not been comprehensively reported. Methods: We analysed 39 patients with SARS-CoV-2 infection and haematological malignancies. Clinical characteristics and outcomes were compared to a matched control group of 53 non-cancer patients with COVID-19. Univariate and multivariate analyses were carried out to assess the risk factors associated with poor outcome. Results: The most frequent haematological diseases were lymphoma (30%) and multiple myeloma (30%). Eighty-seven % HP developed moderate or severe disease. Patients with haematological malignancies had a significantly higher mortality rate compared to non-cancer patients (35.9% vs 13.2%; P = .003 (odds ratio 6.652). The worst outcome was observed in chronic lymphocytic leukaemia patients. Only age >70 years and C reactive protein >10 mg/dl at admission were associated with higher risk of death (odds ratio 34.86, P = .003 and 13.56,P = .03). Persistent viral sheddind was detected in 5 HP. Active chemotherapy, viral load at diagnosis and COVID-19 therapy were not predictors of outcome. Conclusion: Mortality of COVID-19 is significantly higher in patients with haematological malignancies compared to non-cancer patients. The impact of persistent viral shedding must be considered in order to restart therapies and maintain infectious control measures.

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Section: Discussionmentioning

confidence: 99%

Clinical course and risk factors for mortality from COVID‐19 in patients with haematological malignancies

Sánchez-Pina

Rodríguez

Quismondo

et al. 2020

European J of Haematology

Self Cite

109

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“…Case series of COVID-19 patients who received anakinra after clinical deterioration, mechanical ventilation, and late after symptoms onset showed controversial results as is shown in Table 2 [47] , [48] , [49] . In a case series by Dimopoulos et al, anakinra administration in severe COVID-19 patients who were mostly intubated improved respiratory function.…”

Section: Anakinra In Covid-19; Published Studiesmentioning

confidence: 99%

Current evidence on the use of anakinra in COVID-19

Khani

Shahrabi

Rezaei

et al. 2022

International Immunopharmacology

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“…Limited clinical data regarding canakinumab [67] and rilonacept [65, 66] show similar, and disappointing, results. While no RCTs evaluated patients with HM specifically, anecdotal evidence supports the lack of added efficacy of anakinra to standard COVID-19 therapy in patients with HM [68, 69].…”

Section: Resultsmentioning

confidence: 99%

COVID-19 in Patients with Hematologic Malignancies: Clinical Manifestations, Persistence, and Immune Response

et al. 2022

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Background: The clinical presentation of coronavirus disease 19 (COVID-19) is the result of intricate interactions between the novel coronavirus and the immune system. In patients with hematologic malignancies (HM), these interactions dramatically change the clinical course and outcomes of COVID-19. Summary: Patients with HM and COVID-19 are at an increased risk for prolonged viral shedding, more protracted and severe presentation, and death, even when compared to other immunocompromised hosts. HM (e.g., multiple myeloma, chronic lymphocytic leukemia) and anticancer treatments (e.g., anti-CD20 agents) that impair humoral immunity markedly increase the risk of severe COVID-19 as well as protracted viral shedding and possibly longer infectivity. Cytokine release syndrome (CRS) is an important player in the pathophysiology of severe and fatal COVID-19. Treatments targeting specific cytokines involved in CRS such as interleukin-6 and Janus kinase have proven beneficial in COVID-19 patients but were not assessed specifically in HM patients. Although neutropenia (as well as neutrophilia) was associated with increased COVID-19 mortality, granulocyte colony-stimulating factors were not beneficial in patients with COVID-19 and may have been associated with worse outcomes. Decreased levels of T lymphocytes and especially decreased CD4+ counts, and depletion of CD8+ lymphocytes, are a hallmark of severe COVID-19, and even more so among patients with HM, underlying the important role of T-helper dysfunction in severe COVID-19. In HM patients with intact cellular immunity, robust T-cell responses may compensate for an impaired humoral immune system. Further prospective studies are needed to evaluate the mechanisms of severe COVID-19 among patients with HM and assess the efficacy of new immunomodulating COVID-19 treatments in this population. Key Messages: Understanding the immunopathology of COVID-19 has greatly benefited from the previous research in patients with HM. So far, no COVID-19 treatments were properly evaluated in patients with HM. Patients with HM should be included in future RCTs assessing treatments for COVID-19.

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IL-1R blockade is not effective in patients with hematological malignancies and severe SARS-CoV-2 infection

Cited by 9 publications

References 9 publications

Clinical course and risk factors for mortality from COVID‐19 in patients with haematological malignancies

Clinical course and risk factors for mortality from COVID‐19 in patients with haematological malignancies

Current evidence on the use of anakinra in COVID-19

COVID-19 in Patients with Hematologic Malignancies: Clinical Manifestations, Persistence, and Immune Response

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