Marcacci Gianpaolo, Fiorentino Giuseppe, Volzone Francesco, Falcone Umberto, Parrella Roberto, Donnarumma Daniela, D'Ovidio Silvia, Annunziata Anna, Micallo Giovanni, Portella Giuseppe, De Chiara Annarosaria, De Filippi Rosaria, Crisci Stefania, Pinto Antonio
Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione 'G. Pascale', IRCCS, Naples, Italy.
Respiratory Physiopathology and Rehabilitation Unit, AORN dei Colli, Naples, Italy.
Infect Agent Cancer. 2021 Jun 2;16(1):38. doi: 10.1186/s13027-021-00376-1.
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 2 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. 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 available SARS-CoV-2 vaccines and novel vaccinomics developments.
在当前新型冠状病毒肺炎（COVID-19）大流行期间，非霍奇金淋巴瘤（NHL）患者是一类特别受关注的人群。NHL与疾病及治疗相关的免疫缺陷有关，这可能导致COVID-19出现异常动态，并带来独特的管理挑战。我们报告了1例套细胞淋巴瘤（MCL）患者在感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）前不久接受了9剂利妥昔单抗治疗后COVID-19的异常临床过程。他有一个较长的无症状期，SARS-CoV-2的分子检测和抗体检测均为阴性，随后迅速进展为重症COVID-19。尽管在首次出现症状时检测到病毒RNA，但抗SARS-CoV-2抗体呈现出不同步的模式，IgG在RNA阳性后2天首次出现，而在整个临床过程中从未检测到IgM。虽然疾病相关的免疫紊乱和/或先前涉及抗CD20抗体的治疗可能导致了我们患者的COVID-19动态变化，但数据表明，在当前大流行期间，对于MCL患者以及一般而言大量接触抗CD20抗体的NHL患者，若不进行SARS-CoV-2的同步分子评估，抗体检测可能不足以用于监测。我们建议，尽管这些受试者血清学检测为阴性且没有SARS-CoV-2感染症状，但仍应对其进行鼻咽拭子的重复分子检测。出于同样的原因，需要根据可用的SARS-CoV-2疫苗的不同特征和作用机制以及新型疫苗组学的发展，为接触抗CD20抗体的患者制定定制化策略。
