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

Hagihara, Masao; Imai, Yui; Uchida, Tatsuo; Ohara, Shuichi; Inoue, Morihiro; Sugi, Tomiyuki; Mitamura, Keiko

doi:10.2169/internalmedicine.9513-22

Cited by 4 publications

(3 citation statements)

References 30 publications

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“…Similar successful viral clearance has been reported in immunodeficiency-associated patients with relapsing or prolonged COVID-19 (13,21). Previously, we treated a case of malignant lymphoma with an anti-CD20mAb-containing regimen, in which SARS-CoV-2 viral shedding persisted for as long as 246 days after the disease onset (8). In the present case, the patient was vaccinated, and the level of anti-SARS-CoV-2 IgG increased to more than 10,000 AU/mL at approximately 3 months after the onset, with the viruses ultimately eliminated.…”

Section: Discussionsupporting

confidence: 70%

“…We previously showed that patients with hema-tological diseases are less likely to develop antibodies against SARS-CoV-2 than are those with non-hematological diseases (7). Prolonged viral shedding in patients with B-cell depletion caused by anti-CD20mAb has been demonstrated, and prolonged COVID-19 pneumonia during anti-CD20mAb treatment has also been reported (8)(9)(10).…”

Section: Introductionmentioning

confidence: 98%

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Clinical Efficacy of Imdevimab/Casirivimab for Persistent Omicron SARS-CoV-2 Infection in Patients with Hematological Malignancies

Hagihara,

Hayashi,

Nakashima

et al. 2024

Intern. Med.

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Objective Prolonged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been reported in immunocompromised patients, as they poorly develop antibodies against SARS-CoV-2. We conducted a clinical trial to determine the efficacy of Imdevimab/Casirivimab (Imde/Casiri), an anti-viral monoclonal antibody (mAb), for prolonged infection at our institution. Methods Nine patients with hematological malignancies (six with malignant lymphoma and three with multiple myeloma) in our institution presented with coronavirus disease 2019 caused by SARS-CoV-2 omicron variants (one, five, and one with BA.2, BA.5, and BF.7, respectively; two undetermined). Although not all nine patients developed severe disease, viral mRNA was detected in all patients after treatment with remdesivir or molnupiravir. Imde/casiri was infused 11-49 days after the disease onset. Results Within seven days of infusion, viral RNA was undetectable in five of the nine cases. Because all seven viruses isolated from patients whose viral RNA became undetectable showed low or no sensitivity to this monoclonal antibody cocktail, the disappearance of viral RNA in these cases may not be attributable to the antibody cocktail. Conclusion It may be worth considering the use of monoclonal antibodies that show some activity against these virus variants to treat persistent SARS-CoV-2 infection in immunocompromised patients.

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Section: Discussionsupporting

confidence: 70%

Section: Introductionmentioning

confidence: 98%

Clinical Efficacy of Imdevimab/Casirivimab for Persistent Omicron SARS-CoV-2 Infection in Patients with Hematological Malignancies

Hagihara,

Hayashi,

Nakashima

et al. 2024

Intern. Med.

Self Cite

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“…A previous study including patients with lymphoma and a diagnosis of SARS-CoV-2 identified bendamustine exposure, active hematological disease, and comorbidity as prognostic factors for mortality [ 27 ]. Other studies have suggested that bendamustine exposure is a risk factor for patients with prolonged COVID-19 infection [ 28 , 29 ]. In the present study, we also showed that prior bendamustine therapy was a risk factor for COVID-19–related mortality.…”

Section: Discussionmentioning

confidence: 99%

Impact of T-Cell Engagers on COVID-19–Related Mortality in B-Cell Lymphoma Patients Receiving B-Cell Depleting Therapy

Lee¹,

Choe²,

Kang³

et al. 2024

Cancer Res Treat

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Purpose B-cell depleting therapies, including T-cell engager (TCE), are increasingly used for patients with hematologic malignancies, including during the coronavirus disease 2019 (COVID-19) pandemic. We aimed to evaluate the relationship between TCE therapy and COVID-19–related outcomes among patients with COVID-19 and B-cell lymphomas receiving B-cell depleting therapy.Materials and Methods This retrospective cohort study included patients with B-cell lymphoma, who were admitted to Seoul Natio-nal University Hospital with COVID-19 between September 2021 and February 2023, and received B-cell depleting therapy before COVID-19 diagnosis. Multivariable logistic regression was used to identify factors associated with severe to critical COVID-19 and COVID-19–related mortality.Results Of 54 patients with B-cell lymphomas and COVID-19 who received B-cell depleting therapy, 14 were treated with TCE (TCE group) and 40 with rituximab (RTX group). COVID-19–related mortality was higher in the TCE group than in the RTX group (57.1% vs. 12.5%, p=0.002). In multivariable analyses, TCE therapy (adjusted odds ratio [aOR], 7.08; 95% confidence interval [CI], 1.29 to 38.76; p=0.024) and older age (aOR, 1.06; 95% CI, 1.00 to 1.13; p=0.035) were associated with severe to critical COVID-19. TCE therapy (aOR, 8.98; 95% CI, 1.48 to 54.40; p=0.017), older age (aOR, 1.13; 95% CI, 1.02 to 1.26; p=0.022), and prior bendamustine therapy (aOR, 7.78; 95% CI, 1.17 to 51.65; p=0.034) were independent risk factors for COVID-19–related mortality.Conclusion B-cell lymphoma patients treated with TCE had significantly worse outcomes from COVID-19 than those treated with RTX. TCE therapy should be used with caution in B-cell lymphoma patients during the COVID-19 epidemic.

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Prolonged viral pneumonia and high mortality in COVID-19 patients on anti-CD20 monoclonal antibody therapy

Feuth,

Nieminen,

Palomäki

et al. 2024

Eur J Clin Microbiol Infect Dis

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Purpose In clinical practice, we observed an apparent overrepresentation of COVID-19 patients on anti-CD20 monoclonal antibody therapy. The aim of this study was to characterize the clinical picture of COVID-19 in these patients. Methods All adult patients from Turku University Hospital, Turku, Finland, with COVID-19 diagnosis and/or positive SARS-CoV-2 PCR test result up to March 2023, and with anti-CD20 therapy within 12 months before COVID-19 were included. Data was retrospectively obtained from electronic patient records. Results Ninety-eight patients were identified. 44/93 patients (47.3%) were hospitalized due to COVID-19. Patients with demyelinating disorder (n = 20) were youngest (median age 36.5 years, interquartile range 33–45 years), had less comorbidities, and were least likely to be hospitalized (2/20; 10.0%) or die (n = 0). COVID-19 mortality was 13.3% in the whole group, with age and male sex as independent risk factors. Persistent symptoms were documented in 33/94 patients (35.1%) alive by day 30, in 21/89 patients (23.6%) after 60 days, and in 15/85 after 90 days (17.6%), mostly in patients with haematological malignancy or connective tissue disease. Prolonged symptoms after 60 days predisposed to persistent radiological findings (odds ratio 64.0; 95% confidence interval 6.3–711; p < 0.0001) and persistently positive PCR (odds ratio 45.5, 95% confidence interval 4.0–535; p < 0.0001). Several patients displayed rapid response to late antiviral therapy. Conclusion Anti-CD20 monoclonal antibody therapy is associated with high COVID-19 mortality and with a phenotype consistent with prolonged viral pneumonia. Our study provides rationale for retesting of immunocompromised patients with prolonged COVID-19 symptoms and considering antiviral therapy.

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

Cited by 4 publications

References 30 publications

Clinical Efficacy of Imdevimab/Casirivimab for Persistent Omicron SARS-CoV-2 Infection in Patients with Hematological Malignancies

Clinical Efficacy of Imdevimab/Casirivimab for Persistent Omicron SARS-CoV-2 Infection in Patients with Hematological Malignancies

Impact of T-Cell Engagers on COVID-19–Related Mortality in B-Cell Lymphoma Patients Receiving B-Cell Depleting Therapy

Prolonged viral pneumonia and high mortality in COVID-19 patients on anti-CD20 monoclonal antibody therapy

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