Department of Hematology, Hospital Universitario Fundación Alcorcón, Madrid, Spain.
Department of Hematology, Hospital Universitario Fundación Alcorcón, Madrid, Spain,
Acta Haematol. 2022;145(4):384-393. doi: 10.1159/000521121. Epub 2021 Nov 26.
There is no consensus on the management of the coronavirus disease (COVID-19) in patients with secondary immunosuppression due to either an underlying hematological disease or to the effects of immunochemotherapy (ICT). Some of them may present persistent infection with multiple relapses of COVID-19, requiring several admissions. This study evaluated the clinical characteristics and outcomes after treatment of 5 patients with follicular lymphoma (FL), previously treated with ICT, who developed several episodes of COVID-19.
We analyzed the clinical evolution and response to treatment with antiviral agent, steroids, and convalescent plasma in 5 patients with FL and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) persistent infection. Reverse transcriptase polymerase chain reaction tests and peripheral blood immunophenotype were performed for all patients.
All patients required hospitalization due to pneumonia with severity criteria and were re-admitted after a median of 22 days (13-42) from the previous discharge. They all showed B-cell depletion by immunophenotyping, and no traces of immunoglobulin antibodies against SARS-CoV-2 were detected in any of the cases. The survival rate was 80%.
The combination therapy evidenced clinical benefits, demonstrating its capacity to control infection in immunosuppressed FL patients treated with ICT.
由于潜在的血液系统疾病或免疫化学疗法 (ICT) 的影响而导致继发性免疫抑制的 COVID-19 患者的管理尚无共识。他们中的一些人可能会持续感染 COVID-19 并多次复发，需要多次住院治疗。本研究评估了 5 例先前接受 ICT 治疗的滤泡性淋巴瘤 (FL) 患者发生多次 COVID-19 后治疗的临床特征和结局。
我们分析了 5 例 FL 伴严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 持续感染患者的抗病毒药物、类固醇和恢复期血浆治疗的临床演变和反应。对所有患者均进行逆转录酶聚合酶链反应检测和外周血免疫表型分析。
所有患者均因肺炎伴有严重程度标准而需要住院治疗，在前一次出院后中位数为 22 天（13-42 天）再次入院。免疫表型分析显示所有患者均出现 B 细胞耗竭，且在任何情况下均未检测到针对 SARS-CoV-2 的免疫球蛋白抗体。存活率为 80%。
联合治疗显示出临床获益，证明其能够控制接受 ICT 治疗的免疫抑制性 FL 患者的感染。
