Management of Persistent SARS-CoV-2 Infection in Patients with Follicular Lymphoma

Martínez-Barranco, Pilar; García-Roa, María Dolores; Trelles-Martínez, Roberto; Arribalzaga, Karmele; Velasco, María; Guijarro, Carlos; Marcos, J. Rojas; Campelo, Carolina; Acedo-Sanz, Juan Manuel; Villalón, Lucı́a; Ricard, Pilar; García-Bueno, María José; Pérez‐Fernández, Elia; Rodríguez-Caravaca, Gil; Peñalver, Francisco‐Javier

doi:10.1159/000521121

Cited by 11 publications

(13 citation statements)

References 32 publications

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“…For these exploratory analyses, 13 uncontrolled large case series without individual patient data enrolling 358 participants were included in descriptive analysis . In this study, 125 case reports or case series enrolling 265 participants were included for patient-level exploratory analyses. One study was included in both the descriptive analysis and the individual patient data analysis because individual patient data were available only for a subgroup of patients.…”

Section: Resultsmentioning

confidence: 99%

COVID-19 Convalescent Plasma for the Treatment of Immunocompromised Patients: A Systematic Review and Meta-analysis

et al. 2023

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ImportancePatients who are immunocompromised have increased risk for morbidity and mortality associated with coronavirus disease 2019 (COVID-19) because they less frequently mount antibody responses to vaccines. Although neutralizing anti-spike monoclonal-antibody treatment has been widely used to treat COVID-19, evolutions of SARS-CoV-2 have been associated with monoclonal antibody-resistant SARS-CoV-2 variants and greater virulence and transmissibility of SARS-CoV-2. Thus, the therapeutic use of COVID-19 convalescent plasma has increased on the presumption that such plasma contains potentially therapeutic antibodies to SARS-CoV-2 that can be passively transferred to the plasma recipient.ObjectiveTo assess the growing number of reports of clinical experiences of patients with COVID-19 who are immunocompromised and treated with specific neutralizing antibodies via COVID-19 convalescent plasma transfusion.Data SourcesOn August 12, 2022, a systematic search was performed for clinical studies of COVID-19 convalescent plasma use in patients who are immunocompromised.Study SelectionRandomized clinical trials, matched cohort studies, and case report or series on COVID-19 convalescent plasma use in patients who are immunocompromised were included. The electronic search yielded 462 unique records, of which 199 were considered for full-text screening.Data Extraction and SynthesisThe study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were extracted by 3 independent reviewers in duplicate and pooled.Main Outcomes and MeauresThe prespecified end point was all-cause mortality after COVID-19 convalescent plasma transfusion; exploratory subgroup analyses were performed based on putative factors associated with the potential mortality benefit of convalescent plasma.ResultsThis systematic review and meta-analysis included 3 randomized clinical trials enrolling 1487 participants and 5 controlled studies. Additionally, 125 case series or reports enrolling 265 participants and 13 uncontrolled large case series enrolling 358 participants were included. Separate meta-analyses, using models both stratified and pooled by study type (ie, randomized clinical trials and matched cohort studies), demonstrated that transfusion of COVID-19 convalescent plasma was associated with a decrease in mortality compared with the control cohort for the amalgam of both randomized clinical trials and matched cohort studies (risk ratio [RR], 0.63 [95% CI, 0.50-0.79]).Conclusions and RelevanceThese findings suggest that transfusion of COVID-19 convalescent plasma is associated with mortality benefit for patients who are immunocompromised and have COVID-19.

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Section: Resultsmentioning

confidence: 99%

COVID-19 Convalescent Plasma for the Treatment of Immunocompromised Patients: A Systematic Review and Meta-analysis

et al. 2023

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“…Since the beginning of the pandemic, some cases of COVID-19 in patients treated with anti-CD20 monoclonal antibodies (antyCD20mAB) due to haematological illnesses, have been described [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. The majority of those patients received rituximab.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of those patients received rituximab. The time from the last dose of medication and the infection with SARS-CoV-2 ranged between 2 weeks and 12 months, but in one case it was more than 14 years [ 6 ]. In some patients, the course of COVID-19 was mild at the beginning and they required only observation but after a couple of weeks, they presented to the hospital with symptoms such as elevated body temperature, dyspnoea, and dry cough [ 3 , 7 , 8 , 11 , 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…In some patients, the course of COVID-19 was mild at the beginning and they required only observation but after a couple of weeks, they presented to the hospital with symptoms such as elevated body temperature, dyspnoea, and dry cough [ 3 , 7 , 8 , 11 , 12 , 13 ]. Some patients developed respiratory failure during the disease course [ 3 , 4 , 5 , 6 , 7 , 8 , 10 , 11 , 12 , 14 ]. Only a few died because of severe COVID-19 courses [ 6 , 9 , 10 , 11 , 12 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

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Prolonged SARS-CoV-2 Infection and Organizing Pneumonia in a Patient with Follicular Lymphoma, Treated with Obinutuzumab—Challenging Recognition and Treatment

Łyżwa

Sobiecka

Lewandowska

et al. 2023

Viruses

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A Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) led to a pandemic outbreak in 2019. COVID-19’s course and its treatment in immunocompromised patients are uncertain. Furthermore, there is a possibility of protracted SARS-CoV-2 infection and the need for repeated antiviral treatment. Monoclonal antibodies against CD20, which are used, among other things, in the therapy of chronic lymphocytic leukaemia and follicular lymphoma, can induct immunosuppression. We present a case report of a patient with follicular lymphoma, treated with obinutuzumab, who was diagnosed with prolonged, ongoing SARS-CoV-2 infection and related organizing pneumonia. The recognition and the treatment were challenging which makes this case noteworthy. Antiviral therapy with several medications was administrated to our patient and their temporary, positive effect was observed. Moreover, high-dose intravenous immunoglobulin was applied, because slowly decreasing IgM and IgG levels were observed. The patient also received standard treatment of organizing pneumonia. We believe that such a complex approach can create an opportunity for recovery. Physicians should be conscious of the course and treatment possibilities facing similar cases.

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“…While the long-term outcomes of MG have been investigated in many studies, which do not cover the pathology addressed here (COVID and MG), we could conclude that the number of relapsing episodes represents an important risk factor for a detrimental long-term prognosis [ 24 ]. However, the prognosis of COVID-19 pneumonia in immunosuppressed patients appears to consist of prolonged viral shedding, even at levels lower than conventional assays’ detection limits, but not necessarily increased mortality [ 25 , 26 , 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

The Cumulative Detrimental Effect of COVID-19 Pneumonia in a Patient with Myasthenic Crisis: A Case Report and Overview of the Literature

Buzatu

Bobircă

Isac

et al. 2022

Life

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Background: As the COVID-19 pandemic reached its peak, it became unavoidable that patients with other risk factors for severe pulmonary impairment (such as neuromuscular illnesses) would become afflicted. While the subject of myasthenic crisis secondary to COVID-19 pneumonia represents an interesting topic in the literature, we could not find consistent data that include, as a novel therapeutic approach, both intravenous immunoglobulin and plasma exchange therapy for the treatment of these two concurrent diseases. Case summary: A 69-year-old man with known seropositive generalized myasthenia gravis, hypertension, ischaemic heart disease, NYHA class II-III heart failure, cerebrovascular disease, and recurrent urinary tract infections, was admitted to the ICU for mixed acute respiratory failure, elevated serum lactate and liver function enzymes, and severe thrombocytopenia. A SARS-CoV-2 PCR test was positive, despite a previous COVID-19 pneumonia episode, 10 months prior to the current one. The patient had a recent ICU admission for a myasthenic crisis, which required non-invasive mechanical ventilation and intravenous immunoglobulin therapy. He received supportive therapy, as well as etiological (intravenous remdesivir, plasmapheresis and intravenous dexamethasone). Fifteen days after admission, the patient was transferred to the neurological ward, whence he left 20 days later, with no apparent sequelae. Conclusions: Subsequent intravenous immunoglobulins and plasma exchange therapy appear to be effective and safe in patients with simultaneous acute myasthenic episode and COVID-19 pneumonia.

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Management of Persistent SARS-CoV-2 Infection in Patients with Follicular Lymphoma

Cited by 11 publications

References 32 publications

COVID-19 Convalescent Plasma for the Treatment of Immunocompromised Patients: A Systematic Review and Meta-analysis

COVID-19 Convalescent Plasma for the Treatment of Immunocompromised Patients: A Systematic Review and Meta-analysis

Prolonged SARS-CoV-2 Infection and Organizing Pneumonia in a Patient with Follicular Lymphoma, Treated with Obinutuzumab—Challenging Recognition and Treatment

The Cumulative Detrimental Effect of COVID-19 Pneumonia in a Patient with Myasthenic Crisis: A Case Report and Overview of the Literature

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