Casarola Genni, D'Abbondanza Marco, Curcio Rosa, Alcidi Riccardo, Campanella Tommaso, Rossi Rachele, Fusaro Jessica, Gandolfo Vito, Di Giuli Cinzia, Laoreti Chiara, Veca Vito, Leone Maria Comasia, Pucci Giacomo, Vaudo Gaetano
Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
COVID-1 Unit, Terni University Hospital, Terni, Italy.
Clin Infect Pract. 2021 Nov;12:100096. doi: 10.1016/j.clinpr.2021.100096. Epub 2021 Sep 1.
Management of immunocompromised COVID-19 patients is the object of current debate. Accumulating evidence suggest that treatment with high-titer COVID-19 convalescent plasma (CCP) may be effective in this characteristic clinical scenario.
A 52-years old immunocompromised female patient, previously treated with rituximab for low grade B-cell lymphoma, showed prolonged SARS-CoV-2 shedding and a long-term course of signs of severe COVID-19. A first cycle of treatment with remdesivir, a nucleotide analogue prodrug effective in inhibiting SARS-CoV-2 replication, did not provide fully and sustained clinical remission. A second hospitalization was deemed necessary after 10 days from the first hospital discharge due to recrudescence of symptoms of severe COVID-19 and the evidence of bilateral interstitial pneumonia at the chest-CT scan. Clinical and radiological findings completely disappeared after CCP administration. The viral culture confirmed the absence of SARS-CoV-2-related cytopathic effect. The clinical evaluation, performed two months after hospital discharge, was unremarkable.
Findings from our case report suggest that the host T-cell specific response to SARS-CoV-2 is not sufficient to reduce viral load in the absence of neutralizing antibodies. Acquired immune antibodies and/or related components passively infused with CCP might help in boosting the plasma recipient response to the virus and promoting complete viral clearance.
Independently from negative results in immunocompetent individuals, the potential effectiveness of CCP infusion in selected cohorts of patients with primary or secondary impaired immune response should be tested. Further research about mechanisms of host response in immunocompromised patients with SARS-CoV-2 infection is required.
免疫功能低下的新冠肺炎患者的管理是当前争论的焦点。越来越多的证据表明，在这种特殊的临床情况下，使用高滴度新冠康复期血浆（CCP）进行治疗可能有效。
一名52岁的免疫功能低下女性患者，此前因低度B细胞淋巴瘤接受利妥昔单抗治疗，出现了SARS-CoV-2长期脱落以及严重新冠肺炎症状的长期病程。使用瑞德西韦进行的第一个疗程治疗，瑞德西韦是一种有效抑制SARS-CoV-2复制的核苷酸类似物前药，但并未实现完全且持续的临床缓解。首次出院10天后，由于严重新冠肺炎症状复发以及胸部CT扫描显示双侧间质性肺炎，患者被认为有必要再次住院。输注CCP后，临床和影像学表现完全消失。病毒培养证实不存在与SARS-CoV-2相关的细胞病变效应。出院两个月后进行的临床评估结果正常。
我们的病例报告结果表明，在缺乏中和抗体的情况下，宿主对SARS-CoV-2的特异性T细胞反应不足以降低病毒载量。通过CCP被动输注获得的免疫抗体和/或相关成分可能有助于增强血浆接受者对病毒的反应并促进病毒的完全清除。
无论在免疫功能正常个体中得到的阴性结果如何，都应测试CCP输注在原发性或继发性免疫反应受损的特定患者群体中的潜在有效性。需要对免疫功能低下的SARS-CoV-2感染患者的宿主反应机制进行进一步研究。
