PDF(Pubmed)
Abstract：
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.
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.
Twenty-one inpatients with B-cell depletion and SARS-COV-2 infection were enrolled. A median of 1 B cells/mm3 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.
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.
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.
Twenty-one inpatients with B-cell depletion and SARS-COV-2 infection were enrolled. A median of 1 B cells/mm3 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.
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.
摘要：
使用B细胞消耗剂的免疫功能低下的患者有持续和/或严重的SARS-COV-2感染的风险。我们描述了21例接受B细胞耗竭治疗的COVID-19患者的病例系列，主要使用基于静脉内雷米塞韦（RDV）和类固醇的联合疗法，该疗法与针对Spike糖蛋白和/或超免疫恢复期血浆的SARS-CoV-2单克隆抗体相关。
这是一项单中心纵向研究。我们回顾性地在LazzaroSpallanzani国家传染病研究所招募了21名B细胞耗尽的COVID-19连续住院患者，罗马,意大利,从2020年11月到2021年12月。人口特征，病史,临床表现,治疗,药物不良反应,收集所有患者的临床和病毒学结果.在子组中，我们探索免疫T细胞活化，T细胞特异性抗SARS-COV-2反应，和中和抗体。
纳入21例B细胞耗竭和SARS-COV-2感染的住院患者。检测到1个B细胞/mm3的中位数。18例患者出现低丙种球蛋白血症。所有患者均出现静脉内RDV和类固醇治疗的间质性肺炎。16例患者接受抗SARS-CoV-2Spike蛋白单克隆抗体治疗,4例患者接受SARS-CoV-2超免疫恢复期血浆输注治疗，三名患者接受了两种治疗。观察到T细胞活化的可变动力学在免疫疗法输注后第30天恢复到正常水平。所有接受治疗的患者都康复了。
在COVID-19免疫抑制受试者中，建立提示是强制性的，有效,包括氧气在内的多靶点联合治疗，抗病毒，类固醇,和基于抗体的疗法，根据患者的临床需求量身定制。
这是一项单中心纵向研究。我们回顾性地在LazzaroSpallanzani国家传染病研究所招募了21名B细胞耗尽的COVID-19连续住院患者，罗马,意大利,从2020年11月到2021年12月。人口特征，病史,临床表现,治疗,药物不良反应,收集所有患者的临床和病毒学结果.在子组中，我们探索免疫T细胞活化，T细胞特异性抗SARS-COV-2反应，和中和抗体。
纳入21例B细胞耗竭和SARS-COV-2感染的住院患者。检测到1个B细胞/mm3的中位数。18例患者出现低丙种球蛋白血症。所有患者均出现静脉内RDV和类固醇治疗的间质性肺炎。16例患者接受抗SARS-CoV-2Spike蛋白单克隆抗体治疗,4例患者接受SARS-CoV-2超免疫恢复期血浆输注治疗，三名患者接受了两种治疗。观察到T细胞活化的可变动力学在免疫疗法输注后第30天恢复到正常水平。所有接受治疗的患者都康复了。
在COVID-19免疫抑制受试者中，建立提示是强制性的，有效,包括氧气在内的多靶点联合治疗，抗病毒，类固醇,和基于抗体的疗法，根据患者的临床需求量身定制。
