PDF(Pubmed)
Abstract：
Severe acute respiratory syndrome-2 (SARS-CoV-2) infection in immunocompromised patients presents a challenge, as patients with such conditions may have severe courses. Identifying modalities to shorten the course or lessen the severity of infection could be potentially beneficial. A 76-year-old male with follicular lymphoma on rituximab and lenalidomide presented with COVID-19 pneumonia requiring intensive care unit (ICU) level care for persistent hypoxemia. He was treated with an extended course of remdesivir, as recommended by the Infectious Diseases service, but he maintained a persistently high viral load, necessitating a delay of his cancer treatment until he had recovered from his infection. On hospital day 31, he was given one dose of convalescent plasma with improvement in his SARS-CoV-2 viral load. He was able to be discharged and resumed cancer treatment soon thereafter. Convalescent plasma is a potential therapeutic option for immunocompromised patients with SARS-CoV-2 infection and should be considered early in the hospital course. Additionally, cycle threshold monitoring may be beneficial in certain scenarios: for instance to guide consideration of alternative therapies in patients with severe COVID-19 who have persistent symptoms and viremia while on guideline-directed therapy.
摘要：
严重急性呼吸综合征-2（SARS-CoV-2）感染对免疫功能低下患者提出了挑战，因为患有这种疾病的患者可能会有严重的病程。确定缩短病程或减轻感染严重程度的方法可能是有益的。一名76岁男性患有滤泡性淋巴瘤，在利妥昔单抗和来那度胺治疗时出现COVID-19肺炎，需要重症监护病房（ICU）级别的护理以治疗持续性低氧血症。他接受了延长疗程的Remdesivir治疗，根据传染病服务的建议，但他的病毒载量一直很高,必须推迟他的癌症治疗，直到他从感染中康复。在医院第31天，他被给予一剂恢复期血浆，其SARS-CoV-2病毒载量得到改善。此后不久，他得以出院并恢复癌症治疗。恢复期血浆是SARS-CoV-2感染的免疫功能低下患者的潜在治疗选择，应在住院早期考虑。此外,在某些情况下,周期阈值监测可能是有益的:例如,对于在指南指导治疗期间有持续症状和病毒血症的重度COVID-19患者,指导考虑替代疗法.
