A potential role for cyclophosphamide in the mitigation of acute respiratory distress syndrome among patients with SARS-CoV-2

Revannasiddaiah, Swaroop; Devadas, Santhosh Kumar; Palassery, Rasmi; Pant, Nirdosh Kumar; Maka, V.V.

doi:10.1016/j.mehy.2020.109850

Cited by 19 publications

(12 citation statements)

References 17 publications

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“…Cyclophosphamide is also used as immunosuppressive drug after haploidentical stem-cell transplantation or other organ transplantations and is widely used in rheumatological disorders. There are attempts to use cyclophosphamide in cytokine storm prevention (27). A case of a young man who underwent COVID-19 simultaneously with immunosuppressive regimen containing cyclophosphamide has been reported.…”

Section: Discussionmentioning

confidence: 99%

Chemotherapy During Active SARS-CoV2 Infection: A Case Report and Review of the Literature

et al. 2021

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COVID-19 has become the biggest public health problem and one of the most important causes of death in many countries in the world. SARS-CoV-2 infection is most likely to be fatal in elderly patients with concomitant diseases. In this article we present two cases of asymptomatic SARS-CoV-2-positive patients suffering from cancer who were treated with chemotherapy. The first case, a patient with primary mediastinal B-cell lymphoma, shows that confirmed SARS-CoV-2 infection does not have to be a contraindication to chemotherapy. We describe the course of disease and discuss doubts related to the choice of chemotherapy regimen. The second patient was a male with metastatic sigmoid cancer treated with FOLFOX4 as first-line palliative chemotherapy. This case draws attention to asymptomatic SARS-CoV-2 carriers who underwent chemotherapy. Our patient was safely treated with chemotherapy without long break caused by viral infection. It should be remembered that there are asymptomatic carriers among cancer patients and that they may spread infection to others. On the other hand, delaying chemotherapy can cause rapid disease progression and reduce overall survival of our patients.

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Section: Discussionmentioning

confidence: 99%

Chemotherapy During Active SARS-CoV2 Infection: A Case Report and Review of the Literature

et al. 2021

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“…It seems that our case may indirectly be in line with the hypothesis about the positive influence of immunosuppressive treatment in COVID-19. 6 Although IVIG and plasmapheresis therapy was not meaningless, this treatment alone would not lead to remission. We suspect that it was in fact cyclophosphamide, the drug of choice in p-ANCA vasculitis, that could be a potential factor providing regression of the radiological changes in the lungs and it could have prevented the patient from developing acute respiratory distress syndrome (ARDS).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Cyclophosphamide in COVID-19 – when an absolute contraindication is an absolute necessity

et al. 2021

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Background: Despite many studies on COVID-19, our knowledge of it remains incomplete. In some cases, treating SARS-CoV-2 infection concomitant with other diseases can be particularly challenging, as finding an appropriate treatment may involve some risks. Case presentation: A 34-year-old SARS-CoV-2 positive patient admitted due to fever, dyspnoea, haemoptysis and pneumonia, developed alveolar haemorrhage and acute kidney injury. Due to his severe state, abnormalities in laboratory tests and rapidly progressing loss of kidney function, kidney biopsy, as well as antibody panel were carried out, in which perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA) were found with a high titer (>200; N: <1:20). The results of kidney biopsy, combined with clinical manifestation and laboratory findings prompted the diagnosis of rapidly progressing glomerulonephritis (RPGN) in the course of p-ANCA vasculitis. Initial treatment consisted of heamodialyses, remdesivir, plasmaphereses, intravenous immunoglobulins, antibiotics, corticosteroids and fraxiparine. Once the haemorrhage had subsided, kidney function had been partially retrieved and heamodialyses had no longer been necessary, cyclophosphamide treatment was initiated, despite being contraindicated in COVID-19 according to its summary of product characteristics. Immunotherapy is still continued. The patient has already received a total of 2.4g of cyclophosphamide (4 cycles of 600mg each every three weeks). Pulmonary and radiological regression, as well as improvement of renal parameters have been achieved. Conclusions: We suspect that cyclophosphamide, the drug of choice in p-ANCA vasculitis, could be a potential factor providing regression of the radiological changes in the lungs and it could have prevented the patient from developing acute respiratory distress syndrome. COVID-19 diagnosis should not exclude searching for other diseases which can have a similar course. When treating a patient in a life-threatening condition, a departure from trying to find the perfect timing of cyclophosphamide delivery should be considered, as delaying it could cause potentially greater harm.

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“…It has been reported that prednisone used in the management of Juvenile Systemic Lupus Erythematosus (JSLE) resulted in amenorrhea with marked decrease in FSH and LH levels [ 53 ]. The high doses of steroids used to treat severe COVID-19 may have similar effect on the menstrual cycle.…”

Section: Effect Of Covid-19 On Sexual Health From An Immunologic Perspectivementioning

confidence: 99%

“…The high doses of steroids used to treat severe COVID-19 may have similar effect on the menstrual cycle. Also, considering COVID-19 is likely an autoimmune disease, it was proposed to use immunosuppressants for its management [ 53 ], which may potentially impact fertility and/or pregnancy outcomes [ 54 ].…”

Section: Effect Of Covid-19 On Sexual Health From An Immunologic Perspectivementioning

confidence: 99%

COVID-19 and fertility—at the crossroads of autoimmunity and thrombosis

et al. 2021

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The SARS-CoV-2 virus is known to mediate attack via ACE-2 Receptor, thus having adverse effects on cardiovascular, respiratory, digestive and reproductive systems, the latter being an area of emerging concern, due to the associated impact on fertility, with potential for an outsized effect on population distribution and socioeconomic road map in subsequent years. This narrative review aims to put forth the current evidence of effect of SARS-CoV-2 on human fertility from a multipronged immunologic, haematologic, and gynaecologic perspective; highlighting the areas of contradiction and potential future measures. A literature search was conducted through the MEDLINE and SCOPUS databases to identify articles on the subject in English. Relevant information was extracted from around 300 articles for this review. The existing data give non-conclusive evidence about the impact of SARS-CoV-2 infection on fertility; however, a greater impact on male fertility as compared to females merits further exploration. However, reproduction and fertility is a key concern and considering the pandemic is prolonged, natural conception or ART require extra precautions. Supplementary Information The online version contains supplementary material available at 10.1007/s00296-021-04977-2.

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A potential role for cyclophosphamide in the mitigation of acute respiratory distress syndrome among patients with SARS-CoV-2

Cited by 19 publications

References 17 publications

Chemotherapy During Active SARS-CoV2 Infection: A Case Report and Review of the Literature

Chemotherapy During Active SARS-CoV2 Infection: A Case Report and Review of the Literature

Case Report: Cyclophosphamide in COVID-19 – when an absolute contraindication is an absolute necessity

COVID-19 and fertility—at the crossroads of autoimmunity and thrombosis

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