Convalescent plasma treatment of persistent severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) infection in patients with lymphoma with impaired humoral immunity and lack of neutralising antibodies

Betrains, Albrecht; Godinas, Laurent; Woei-A-Jin, F J Sherida H; Rosseels, Wouter; Herck, Yannick Van; Lorent, Natalie; Dierickx, Daan; Compernolle, Veerle; Meyfroidt, Geert; Vanderbeke, Lore; Vergote, Valentijn; Lagrou, Katrien; Verhamme, Peter; Wauters, Joost; Vermeersch, Pieter; Devos, Timothy; Maes, Piet; Vanderschueren, Steven

doi:10.1111/bjh.17266

Cited by 55 publications

(75 citation statements)

References 6 publications

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“…Unfortunately, no specific data on patients with NHL was presented. In contrast, a persisting SARS-CoV-2 viremia has been recently described in NHL patients exposed to rituximab, including one MCL case, while other reports have highlighted the possible association of protracted and complicated clinical course of COVID-19 in lymphoma patients who received anti-CD20 antibodies [21][22][23][24][25].…”

Section: Discussionmentioning

confidence: 99%

Atypical COVID-19 dynamics in a patient with Mantle Cell Lymphoma Exposed to Rituximab

Marcacci

Fiorentino

Volzone

et al. 2021

Preprint

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Patients with non-hodgkin lymphomas (NHL) represent a population of special interest during the current Coronavirus disease-19 (COVID-19) pandemics. NHLs are associated with disease- and treatment-related immunodeficiencies which may generate unusual COVID-19 dynamics and pose unique management challenges. We report the unusual clinical course of COVID-19 in a patient with mantle cell lymphoma (MCL) exposed to nine doses of Rituximab shortly before infection with severe acute respiratory syndrome corona virus 2 (SARS-CoV-2). He had a prolonged asymptomatic phase, with negative molecular and antibody testing for SARS-CoV-2, followed by a rapidly progressive evolution to severe COVID-19. Despite detection of viral RNA overlapped with first symptoms occurrence, anti-SARS-CoV-2 antibodies displayed an asynchronous pattern, with IgG first appearing two days after RNA positivity and IgM never being detected throughout the entire clinical course. While disease-associated immune derangements and/or previous treatments involving anti-CD20 antibodies might have contributed to COVID-19 dynamics in our patient, data suggests that antibody testings, without concurrent molecular assessment for SARS-CoV-2, may turn inadequate for monitoring of MCL patients, and in general NHL patients heavily exposed to anti-CD20 antibodies, during the current pandemics. Since these patients should not be denied or delayed effective treatments, we suggest that repeated molecular testing of nasopharyngeal swab should be implemented in these subjects despite a negative serology and absence of symptoms of SARS-CoV-2 infection. For the same reasons, a customized strategy needs to be developed for patients exposed to anti-CD20 antibodies, based on different features and mechanism of action of currently available SARS-CoV-2 vaccines.

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Section: Discussionmentioning

confidence: 99%

Atypical COVID-19 dynamics in a patient with Mantle Cell Lymphoma Exposed to Rituximab

Marcacci

Fiorentino

Volzone

et al. 2021

Preprint

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“…Immunocompromised patients suffering from oncohematological cancers, due to their inability to mount an appropriate humoral immune response to SARS-CoV-2, represent the ideal candidate for passive immunotherapy by means of CCP transfusion [35]. There is increasing interest toward the CCP use in patients with hematologic malignancies and several investigators have explored this therapeutic possibility [36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55]. Details about disease severity, timing of CCP administration, number of doses, pre-and post-treatment nAb titers were unfortunately not available for the vast majority of patients.…”

Section: Convalescent Plasma In Oncohematological Patientsmentioning

confidence: 99%

“…The authors concluded that CCP appeared to be a promising therapy for COVID-19 treatment in B-cell depleted patients unable to mount a specific humoral response against SARS-CoV-2. Interestingly, Betrains and colleagues [48] analyzed 5 patients with COVID-19 and B-cell lymphoma treated with anti-CD20 therapy and demonstrated that B-cell depletion was associated with decreased neutralized antibody formation, reduced viral clearance and protracted clinical manifestations of SARS-CoV-2 infection. Treatment with CCP was accompanied by an increase in neutralizing antibody titers in all patients and by a clinical response in all but one patient.…”

Section: Convalescent Plasma In Oncohematological Patientsmentioning

confidence: 99%

Potential use of convalescent plasma for SARS-CoV-2 prophylaxis and treatment in immunocompromised and vulnerable populations

Focosi¹,

Franchini

2021

Expert Review of Vaccines

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Introduction : The ongoing SARS-CoV-2 pandemic is a serious threat for the health of immunocompromised patients. Among neutralizing antibody-based therapeutics, convalescent plasma containing polyclonal anti-SARS-CoV-2 immunoglobulins has promising results in both congenital and iatrogenic immunodeficiencies in oncohematological and transplant patients. Areas covered : This article discusses case reports, case series and controlled studies detailing the efficacy of convalescent plasma in immunocompromised patients. Expert opinion : Convalescent plasma, when administered at high neutralizing antibody titers, is a safe and effective treatment for frail immunocompromised patients. Genetic monitoring of refractory patients is recommended to intercept intra-host emergence of SARS-CoV-2 variants.

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“…However, a recent randomized study has suggested that this “passive immunotherapy” can be effective if the right plasma is used for the right patients, with early administration of high-titer convalescent plasma against SARS-CoV-2 to mildly affected older adults reducing the progression of COVID-19[ 63 ]. While there have been no randomised studies investigating the use of convalescent plasma in patients with lymphoid malignancies, there have been several case reports and observational case series reporting efficacy in this patient group[ 64 - 70 ]. As a consequence, it seems reasonable to use convalescent plasma for high risk individuals in this patient group as long as the plasma contains high titers of SARS-CoV-2 antibodies and is given early enough in the patient’s course of infection.…”

Section: Interaction Of Covid-19 and Treatment Of Lymphomamentioning

confidence: 99%

Impact of COVID-19 in patients with lymphoid malignancies

Riches

2021

WJV

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The first cases of coronavirus disease 2019 (COVID-19) were detected in Wuhan, China, in December 2019. Since this time a concerted global effort of research and observational data gathering has meant that a great deal has been learnt about the impact of COVID-19 in patients with lymphoid malignancies. Approximately one-third of patients with lymphoid malignancies who acquire COVID-19 and have it severely enough to require hospital assessment will die from this infection. Major risk factors for a poor outcome are age and co-morbidities, but when these are taken into account lymphoma patients have a slightly greater than 2-fold increased risk compared to the general population. Notably, despite early concerns regarding the particular vulnerability of lymphoma patients due to the immunosuppressive effects of therapy, active treatment, including B-cell depleting agents such as rituximab, do not appear to be associated with an increased risk of a poorer outcome. Indeed, some treatments such as ibrutinib may be beneficial due to their modulation of the potential fatal hyperinflammatory phase of infection. There are risks associated with hemopoietic stem cell transplantation, but the collective experience is that these can be minimized by preventive strategies and that the majority of transplant recipients with COVID-19 infection will survive. Many questions remain including those regarding the outcome of COVID-19 infection in the rarer lymphoid malignancies and the efficacy of COVID-19 vaccines in lymphoma patients. This review aims to discuss these issues and present a summary of the current knowledge of the impact of COVID-19 in lymphoid malignancies.

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Convalescent plasma treatment of persistent severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) infection in patients with lymphoma with impaired humoral immunity and lack of neutralising antibodies

Cited by 55 publications

References 6 publications

Atypical COVID-19 dynamics in a patient with Mantle Cell Lymphoma Exposed to Rituximab

Atypical COVID-19 dynamics in a patient with Mantle Cell Lymphoma Exposed to Rituximab

Potential use of convalescent plasma for SARS-CoV-2 prophylaxis and treatment in immunocompromised and vulnerable populations

Impact of COVID-19 in patients with lymphoid malignancies

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