Université Rennes-I, Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Rennes, France.
Service d'Hématologie clinique, Hospices Civils de Lyon, Pierre-Bénite, France.
Clin Microbiol Infect. 2023 Mar;29(3):332-337. doi: 10.1016/j.cmi.2022.10.030. Epub 2022 Nov 4.
COVID-19 has been extensively characterized in immunocompetent hosts and to a lesser extent in immunocompromised populations. Among the latter, patients treated for B-cell malignancies have immunosuppression generated by B-cell lymphodepletion/aplasia resulting in an increased susceptibility to respiratory virus infections and poor response to vaccination. The consequence is that these patients are likely to develop severe or critical COVID-19.
To examine the overall impact of COVID-19 in patients treated for a B-cell malignancy or receiving chimeric antigen receptor T (CAR-T) immunotherapy administered in case of relapsed or refractory disease.
We searched in the MEDLINE database to identify relevant studies, trials, reviews, or meta-analyses focusing on SARS-CoV-2 vaccination or COVID-19 management in patients treated for a B-cell malignancy or recipients of CAR-T cell therapy up to 8 July 2022.
The epidemiology and outcomes of COVID-19 in patients with B-cell malignancy and CAR-T cell recipients are summarized. Vaccine efficacy in these subgroups is compiled. Considering the successive surges of variants of concern, we propose a critical appraisal of treatment strategies by discussing the use of neutralizing monoclonal antibodies, convalescent plasma therapy, direct-acting antiviral drugs, corticosteroids, and immunomodulators.
For patients with B-cell malignancy, preventive vaccination against SARS-CoV-2 remains essential and the management of COVID-19 includes control of viral replication because of protracted SARS-CoV-2 shedding. Passive immunotherapy (monoclonal neutralizing antibody therapy and convalescent plasma therapy) and direct-active antivirals, such as remdesivir and nirmatrelvir/ritonavir are the best currently available treatments. Real-world data and subgroup analyses in larger trials are warranted to assess COVID-19 therapeutics in B-cell depleted populations.
COVID-19 在免疫功能正常的宿主中得到了广泛的描述，在免疫功能低下的人群中则描述得较少。在后一组人群中，接受 B 细胞恶性肿瘤治疗的患者因 B 细胞耗竭/发育不良而产生免疫抑制，从而导致呼吸道病毒感染的易感性增加和疫苗接种反应不佳。其结果是，这些患者可能会发展为重症或危重症 COVID-19。
研究 COVID-19 在接受 B 细胞恶性肿瘤治疗或因复发或难治性疾病而接受嵌合抗原受体 T（CAR-T）免疫治疗的患者中的总体影响。
我们在 MEDLINE 数据库中进行检索，以确定截至 2022 年 7 月 8 日专注于 SARS-CoV-2 疫苗接种或 COVID-19 管理的 B 细胞恶性肿瘤治疗患者或 CAR-T 细胞治疗患者的相关研究、试验、综述或荟萃分析。
总结了 B 细胞恶性肿瘤患者和 CAR-T 细胞接受者中 COVID-19 的流行病学和结局。总结了这些亚组中疫苗的疗效。考虑到关注的变异株的相继激增，我们通过讨论中和单克隆抗体、恢复期血浆治疗、直接作用抗病毒药物、皮质类固醇和免疫调节剂的使用，对治疗策略进行了批判性评估。
对于 B 细胞恶性肿瘤患者，预防接种 SARS-CoV-2 仍然至关重要，COVID-19 的管理包括控制病毒复制，因为 SARS-CoV-2 持续排出。被动免疫疗法（单克隆中和抗体治疗和恢复期血浆治疗）和直接抗病毒药物，如瑞德西韦和奈玛特韦/利托那韦，是目前最好的治疗方法。需要在更大的试验中进行真实世界数据和亚组分析，以评估 B 细胞耗竭人群中的 COVID-19 治疗方法。
