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.
【저자키워드】 COVID-19, rituximab, Anti-CD20 antibodies, mantle cell lymphoma, 【초록키워드】 Treatment, Evolution, SARS-CoV-2, IgG, IgM, Antibody testing, severe COVID-19, serology, antibody, SARS-COV-2 infection, Infection, immunodeficiency, Symptom, virus, immune, SARS-CoV-2 vaccine, RNA, Nasopharyngeal swab, Clinical course, anti-SARS-CoV-2 antibody, lymphoma, management, Patient, Pandemics, Viral RNA, molecular, mechanism of action, disease, patients, Anti-CD20 antibody, dose, acute respiratory syndrome, subject, while, repeated, feature, Occurrence, generate, nine, absence, unique, contributed, turn, disease-associated, asymptomatic phase, first symptom, mantle cell, NHL, overlapped, 【제목키워드】 lymphoma, Patient, mantle cell,