Persistent viral shedding of severe acute respiratory syndrome coronavirus 2 after treatment with bendamustine and rituximab: A case report

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA is detectable in nasopharyngeal specimens for up to 12–20 days regardless of the presence of chronic diseases in patients. We report a case of prolonged SARS-CoV-2 infection that lasted for more than eight weeks. The patient had persistent lymphopenia after receiving six cycles of bendamustine and rituximab (BR) therapy for follicular lymphoma; the last chemotherapy session was completed nine months before admission. The first nasopharyngeal specimen (NPS) for the SARS-CoV-2 polymerase chain reaction assay tested positive for the N501Y variant five weeks before admission. The patient's general and respiratory conditions gradually worsened; therefore, he was admitted to our hospital, and the same SARS-CoV-2 variant was subsequently identified on admission. Treatment for coronavirus disease was initiated, and the patient's condition improved; however, the NPS tested positive on day 15. The patient was discharged on day 28 and was instructed to isolate at home for a month. Hence, possible prolonged SARS-CoV-2 shedding should be considered in patients who receive BR therapy.

Anti-CD20 antibodies and bendamustine attenuate humoral immunity to COVID-19 vaccination in patients with B-cell non-Hodgkin lymphoma

“…Since it has been reported that bendamustine reduced CD4-positive T cells, we speculated that bendamustine might impede the serologic response [45]. In fact, there have been several studies on B-NHL patients with COVID-19 severity and mortality who were previously exposed to both anti-CD20 antibody and bendamustine [46][47][48][49][50]. Our results also suggested that these immunocompromised patients have a high risk of COVID-19 infection.…”

Persistent SARS-CoV-2 Infection in a Patient with Nephrotic Syndrome under Rituximab Therapy: Successful Treatment with a Combination of Remdesivir and Monoclonal Antibodies

“…Persistent SARS-CoV-2 infection may occur in immunocompromised individuals, and these patients tend to remain infectious for !3 weeks. Table 2 lists reported cases of persistent SARS-CoV-2 infection in patients under anti-CD20 therapy, including this case (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Most case reports are of malignant lymphoma or chronic lymphocytic leukemia, and rarely of other diseases.…”

“…The coronavirus disease 2019 (COVID-19) pandemic continues to affect the global population. There have been several reports of immunocompromised patients developing persistent and prolonged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16).…”

Successful Elimination of SARS-CoV-2 Following Vaccination with BNT162b2 after Prolonged Viral Infection in an Immunocompromised Lymphoma Patient

“…We then speculated that either the virus in the present case had lost aggressiveness or the acquired anti-SARS-CoV-2 antibodies had restrained proliferation in the respiratory airways. Recently, several cases of COVID-19 after bendamustine and rituximab-treatment have been reported (25)(26)(27)(28). In these reports, even with prolonged viral shedding, the clinical outcomes were not always unfavorable.…”