Abstract
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.
Highlights
Shortly after emergence of the Coronavirus disease-19 (COVID-19) epidemics in China, it has been suggested that cancer patients may represent a highly vulnerable group to severe acute respiratory syndrome corona virus 2 (SARS-CoV-2)-related morbidity and mortality [1]
We have presented here a detailed description of the atypical COVID-19 dynamics occurred in a patient with mantle cell lymphoma (MCL)
Among risk factors for severe COVID-19, beyond age and male sex, our patient had mild hypertension, but never received angiotensin-converting enzyme inhibitors, and 1 week before admission his absolute lymphocyte count (ALC) was of 1.5 × 109/L
Summary
After emergence of the Coronavirus disease-19 (COVID-19) epidemics in China, it has been suggested that cancer patients may represent a highly vulnerable group to severe acute respiratory syndrome corona virus 2 (SARS-CoV-2)-related morbidity and mortality [1].Some investigators, challenged such a view highlighting that age, gender and comorbidities, rather cancer diagnosis itself and/or recent exposure to anticancer treatments, may act as major drivers for increased mortality risk upon SARS-CoV-2 infection [2, 3].While efforts are ongoing to further elucidate the association between malignancies and COVID-19, specific data on outcomes of patients with non-Hodgkin lymphoma (NHL) are still limited. We describe the unusual features of SARS-CoV2 infection occurred in a patient with mantle cell lymphoma (MCL), a rare NHL lymphoma subtype whose biologic features along with a significant previous exposure to Rituximab might have concurred, at least in part, to the atypical COVID-19 dynamics, evolution and antiviral immune responses.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
