Abstract
Introduction: Immunocompromised patients with B-cell depletion agents are at risk for persistence and/or severe SARS-COV-2 infection. We describe a case series of 21 COVID-19 patients under B cell depletion therapy, mostly treated with a combined therapy based on intravenous remdesevir (RDV) and steroid associated with SARS-CoV-2 monoclonal antibodies against Spike glycoprotein and/or hyper-immune convalescent plasma.
Methods: This is a single-center longitudinal study. We retrospectively enrolled a total number of 21 B-cell depleted consecutive hospitalized patients with COVID-19 at the Lazzaro Spallanzani National Institute for Infectious Diseases, Rome, Italy, from November 2020 to December 2021. Demographic characteristics, medical history, clinical presentation, treatment, adverse drug reactions, and clinical and virological outcome were collected for all patients. In a subgroup, we explore immune T cells activation, T cells specific anti-SARS-COV-2 response, and neutralizing antibodies.
Results: Twenty-one inpatients with B-cell depletion and SARS-COV-2 infection were enrolled. A median of 1 B cells/mm 3 was detected. Eighteen patients presented hypogammaglobulinemia. All patients presented interstitial pneumonia treated with intravenous RDV and steroids. Sixteen patients were treated with monoclonal antibodies against SARS-CoV-2 Spike protein, four patients were treated with SARS-CoV-2 hyper-immune convalescent plasma infusion, and three patients received both treatments. A variable kinetic of T cell activation returning to normal levels at Day 30 after immunotherapy infusion was observed. All treated patients recovered.
Conclusion: In COVID-19 immunosuppressed subjects, it is mandatory to establish a prompt, effective, and combined multi-target therapy including oxygen, antiviral, steroid, and antibody-based therapeutics, tailored to the patient’s clinical needs.
Keywords: B-cells depletion; COVID-19; anti-CD20 agent; anti-SARS-CoV-2 monoclonal antibody; convalescent plasma; immunosuppressed patients; passive immunotherapy.
【저자키워드】 COVID-19, convalescent plasma, Passive immunotherapy, B-cells depletion, anti-CD20 agent, anti-SARS-CoV-2 monoclonal antibody, immunosuppressed patients, 【초록키워드】 Treatment, convalescent plasma, SARS-CoV-2, therapy, Infectious diseases, Antiviral, Neutralizing antibodies, spike, antibody, T cells, Immunotherapy, SARS-COV-2 infection, monoclonal antibody, spike glycoprotein, Infection, Immunocompromised patients, risk, oxygen, outcome, Italy, monoclonal antibodies, anti-SARS-CoV-2, Steroids, immune, Spike protein, B cell, Protein, T cell, Case series, Characteristics, longitudinal study, persistence, SARS-CoV-2 spike protein, Patient, Immunocompromised, glycoprotein, interstitial pneumonia, convalescent, demographic, patients, immunosuppressed patients, anti-CD20, T cell activation, monoclonal, Hypogammaglobulinemia, RDV, B-cell, Adverse drug reactions, Immunosuppressed, COVID-19 patient, kinetic, steroid, intravenous, demographic characteristics, medical history, Inpatient, Activation, Virological, Lazzaro Spallanzani, single-center, severe SARS, Combined therapy, Rome, effective, enrolled, collected, the patient, Day, case sery, median, treated, subjects, hospitalized patient, mandatory, treated patient, with COVID-19, 【제목키워드】 clinical, Prolonged, agent, Depletion,