PDF(Sci-hub)
Abstract：
A 59-year-old male with follicular lymphoma treated by anti-CD20-mediated B-cell depletion and ablative chemotherapy was hospitalized with a COVID-19 infection. Although the patient did not develop specific humoral immunity, he had a mild clinical course overall. The failure of all therapeutic options allowed infection to persist nearly 300 days with active accumulation of SARS-CoV-2 virus mutations. As a rescue therapy, an infusion of REGEN-COV (10933 and 10987) anti-spike monoclonal antibodies was performed 270 days from initial diagnosis. Due to partial clearance after the first dose (2.4 g), a consolidation dose (8 g) was infused six weeks later. Complete virus clearance could then be observed over the following month, after he was vaccinated with the Pfizer-BioNTech anti-COVID-19 vaccination. The successful management of this patient required prolonged enhanced quarantine, monitoring of virus mutations, pioneering clinical decisions based upon close consultation, and the coordination of multidisciplinary experts in virology, immunology, pharmacology, input from REGN, the FDA, the IRB, the health care team, the patient, and the patient\'s family. Current decisions to take revolve around patient\'s follicular lymphoma management, and monitoring for virus clearance persistence beyond disappearance of REGEN-COV monoclonal antibodies after anti-SARS-CoV-2 vaccination. Overall, specific guidelines for similar cases should be established.
摘要：
一名59岁男性，患有滤泡性淋巴瘤，接受抗CD20介导的B细胞耗竭和消融性化疗，因感染COVID-19而住院。尽管患者没有产生特异性体液免疫，他的临床过程总体温和。所有治疗方法的失败使感染持续了近300天，并活跃地积累了SARS-CoV-2病毒突变。作为一种救援疗法，在初次诊断后270天,我们进行了REGEN-COV(10933和10987)抗标单克隆抗体的输注.由于第一次给药后的部分清除（2.4g），6周后输注巩固剂量(8g).然后可以在接下来的一个月内观察到完全的病毒清除，在他接种了辉瑞-BioNTech抗COVID-19疫苗后。这个病人的成功管理需要长期加强隔离，监测病毒突变，基于密切咨询的开创性临床决策，以及病毒学多学科专家的协调，免疫学,药理学,来自REGN的输入，FDA,IRB,医疗团队,病人,和病人的家人。当前的决定围绕患者的滤泡性淋巴瘤管理，并监测抗SARS-CoV-2疫苗接种后REGEN-COV单克隆抗体消失后的病毒清除持久性。总的来说,应该为类似案件制定具体的指导方针。
