Resolution of One-Year Persisting COVID-19 Pneumonia and Development of Immune Thrombocytopenia in a Follicular Lymphoma Patient With Preceding Rituximab Maintenance Therapy: A follow-up Report and Literature Review of Cases With Prolonged Infections

Yasuda, Hajime; Mori, Yosuke; Chiba, Asako; Bai, Jie; Murayama, Goh; Matsushita, Yasuyuki; Miyake, Sachiko; Komatsu, Norio

doi:10.1016/j.clml.2021.07.004

Cited by 26 publications

(31 citation statements)

References 28 publications

(29 reference statements)

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“…Several reports indicated that strong T cell responses were associated with milder COVID-19 ( 4 , 5 , 8 – 10 ), and that poor T cell responses were associated with disease severity in male patients ( 11 ). In patients with impaired B cell function caused by hematologic cancer, including those receiving anti-CD20 therapy, T cell responses were important for the improved outcome of COVID-19 ( 12 , 13 ). Thus, the induction of adequate T and B cell responses by vaccination is desired for protection against SARS-CoV-2 infection.…”

Section: Introductionmentioning

confidence: 99%

Sex, Age, and Ethnic Background Shape Adaptive Immune Responses Induced by the SARS-CoV-2 mRNA Vaccine

et al. 2022

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccine-induced adaptive responses have been well investigated. However, the effects of sex, age, and ethnic background on the immune responses elicited by the mRNA vaccine remain unclear. Here, we performed comprehensive analyses of adaptive immune responses elicited by the SARS-CoV-2 mRNA vaccine. Vaccine-induced antibody and T cell responses declined over time but persisted after 3 months, and switched memory B cells were even increased. Spike-specific CD4+ T and CD8+ T cell responses were decreased against the B.1.351 variant, but not against B.1.1.7. Interestingly, T cell reactivity against B.1.617.1 and B.1.617.2 variants was decreased in individuals carrying HLA-A24, suggesting adaptive immune responses against variants are influenced by different HLA haplotypes. T follicular helper cell responses declined with increasing age in both sexes, but age-related decreases in antibody levels were observed only in males, and this was associated with the decline of T peripheral helper cell responses. In contrast, vaccine-induced CD8+ T cell responses were enhanced in older males. Taken together, these findings highlight that significant differences in the reactogenicity of the adaptive immune system elicited by mRNA vaccine were related to factors including sex, age, and ethnic background.

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Section: Introductionmentioning

confidence: 99%

Sex, Age, and Ethnic Background Shape Adaptive Immune Responses Induced by the SARS-CoV-2 mRNA Vaccine

et al. 2022

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“…Finally, we examined the effect of prolonged infection on affinity maturation in an immunocompromised patient who developed COVID-19 pneumonia during rituximab maintenance treatment for follicular lymphoma, with lung lesions persisting for one year. Notably, the patient failed to develop anti-SARS-CoV-2 antibodies throughout the disease course (Supplemental Figure 7A), and the products used for immunoglobulin replacement therapy contained no anti-SARS-CoV-2 antibodies, suggesting that recovery from COVID-19 pneumonia was not due to patient-derived humoral immunity or external antibody supplementation (22, 36). To gain deeper insight into the effect of immunocompromise on affinity maturation, we performed sequencing of the antibody genes expressed during recovery in this patient and compared them to those from a WT-infected patient observed over time.…”

Section: Resultsmentioning

confidence: 99%

“…Compared with naïve individuals, infected individuals who receive repeat vaccinations have been reported to exhibit a more potent antibody response to VOCs (21). By contrast, some immunocompromised individuals receiving immunosuppressive therapy such as rituximab, fail to develop anti-SARS-CoV-2 antibodies at the symptom onset and following repeated vaccinations (22). However, the molecular basis of these immunological processes and the B-cell receptor (BCR) repertoire after infection or vaccination remains unclear, particularly in patients with immunodeficiency.…”

Section: Introductionmentioning

confidence: 99%

Longitudinal analyses after COVID-19 recovery or prolonged infection reveal unique immunological signatures after repeated vaccinations

Hisamatsu

Ikeda

Ito

et al. 2022

Preprint

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Background: To strategically develop preventive and therapeutic measures against coronavirus disease 2019 and its causative virus, SARS-CoV-2, it is critical to fully characterize immune response and sustained immune activation following viral infection and vaccination. However, the mechanisms controlling intrapersonal variation in antibody titers against SARS-CoV-2 antigens remain unclear. To gain further insights into how we can optimize therapeutic and preventive care, we performed a robust molecular and cellular investigation of immune responses in infected, recovered, and vaccinated individuals. Methods: We evaluated the expression of 29 cytokines and assessed their correlation with neutralizing potency. We further investigated memory B-cell response in patients infected with the original SARS-CoV-2 strain or other variants of concern, and in vaccinated individuals. Results: Correlation analyses showed that the relationship between neutralizing activity and cytokine expression differed according to disease severity and viral strain. Furthermore, long-term longitudinal analyses revealed that post-vaccination neutralizing potential was more strongly associated with various cytokine expression levels in recovered patients than in naive individuals. Notably, we found a similar distribution of virus-specific antibody gene families in triple-vaccinated individuals and a patient with COVID-19 pneumonia for one year. Conclusion: Our results showed that distinct immune responses occur depending on the viral strain suggesting that therapeutic options should be selected on a case-by-case basis. Furthermore, longitudinal analyses revealed biomarker candidates that correlated with repeated vaccination that may be applicable to therapies regulating specific immune responses and novel monoclonal antibodies.

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“…Besides, several complications have been described after the acute phase of COVID-19, such as the appearance of pulmonary tromboembolism and other thrombotic events [24,25], SARS-CoV-2 organizing pneumonia [26], protracted COVID-19 in immunocompromised patients [27], myopericarditis [28], and bacterial superinfection, among others. One study performed in our setting described a readmission cumulative incidence of 5.4% being patients with prior diagnosis of heart failure, length of stay >13 days, treated with corticosteroids, or who developed pulmonary thromboembolism, putting them at higher risk of readmission [29].…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Follow-App. Mobile App-Based Monitoring of COVID-19 Patients after Hospital Discharge: A Single-Center, Open-Label, Randomized Clinical Trial

Márquez-Algaba

Sánchez

Baladas

et al. 2022

JPM

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Introduction: In the midst of a pandemic, apps can be used to provide close follow-up, ensure that patients are monitored at home, avoid excessive pressure on medical facilities, prevent the movement of people (both patients and health professionals), and reduce the risk of infection. Objective: To adapt and validate the use of a smartphone application for outpatient follow-up of COVID-19 patients after hospital discharge. Methods: We conducted an open-label clinical trial at Hospital Universitari Vall d’Hebron in Barcelona, Spain. Patients were randomly assigned in a 1:1 ratio to be followed by the Farmalarm app or by their primary care center. The primary endpoint was the reduction in the need for in-person return visits. Results: From 31 March to 4 May 2020, 150 patients were enrolled in the study at hospital discharge: 74 patients were randomized to the experimental group, and 76 to the control group. All patients in the control group and all except for six in the experimental group completed the study. During hospitalization, before study inclusion, all but 4 (97.3%) had viral pneumonia, 91 (60.7%) required supplemental oxygen, and 16 (10.7%) required intensive care unit (ICU) admission. COVID-19–related return visits to the emergency department were significantly higher in the control group (7.9% vs. 0%; p = 0.028) in the per-protocol analysis. Telephone consultations with the emergency department were performed by 12 (15.8%) patients in the control group and 0 (0%) in the experimental group (p < 0.001). Satisfaction with outpatient monitoring was rated higher by the experimental group (5 vs. 4 points; p < 0.001). Conclusions: Following COVID-19 hospital discharge, home follow-up via a mobile app was effective in reducing in-person return visits without undermining patient satisfaction or perception of health, compared with standard follow-up.

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Resolution of One-Year Persisting COVID-19 Pneumonia and Development of Immune Thrombocytopenia in a Follicular Lymphoma Patient With Preceding Rituximab Maintenance Therapy: A follow-up Report and Literature Review of Cases With Prolonged Infections

Cited by 26 publications

References 28 publications

Sex, Age, and Ethnic Background Shape Adaptive Immune Responses Induced by the SARS-CoV-2 mRNA Vaccine

Sex, Age, and Ethnic Background Shape Adaptive Immune Responses Induced by the SARS-CoV-2 mRNA Vaccine

Longitudinal analyses after COVID-19 recovery or prolonged infection reveal unique immunological signatures after repeated vaccinations

COVID-19 Follow-App. Mobile App-Based Monitoring of COVID-19 Patients after Hospital Discharge: A Single-Center, Open-Label, Randomized Clinical Trial

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