COVID-19 in Patients Receiving CD20-depleting Immunochemotherapy for B-cell Lymphoma

Gaitzsch, Erik; Passerini, Verena; Khatamzas, Elham; Strobl, Carolin D.; Muenchhoff, Maximilian; Scherer, Clemens; Osterman, Andreas; Heide, Michael; Reischer, Anna; Subklewe, Marion; Leutbecher, Alexandra; Tast, Benjamin; Ruhle, Adrian; Weiglein, Tobias; Stecher, Stephanie-Susanne; Stemmler, Hans J.; Dreyling, Martin; Girl, Philipp; Georgi, Enrico; Woelfel, Roman; Mateyka, Laura; D'Ippolito, Elvira; Schober, Kilian; Busch, Dirk H.; Kager, Juliane; Spinner, Christoph D.; Treiber, Matthias; Rasch, Sebastian; Lahmer, Tobias; Iakoubov, Roman; Schneider, Jochen; Protzer, Ulrike; Winter, Christof; Ruland, Jürgen; Quante, Michael; Keppler, Oliver T.; Bergwelt-Baildon, Michael von; Hellmuth, Johannes und Weigert, Oliver (2021): COVID-19 in Patients Receiving CD20-depleting Immunochemotherapy for B-cell Lymphoma. In: Hemasphere, Bd. 5, Nr. 7, e603

Abstract

The clinical and immunological impact of B-cell depletion in the context of coronavirus disease 2019 (COVID-19) is unclear. We conducted a prospectively planned analysis of COVID-19 in patients who received B-cell depleting anti-CD20 antibodies and chemotherapy for B-cell lymphomas. The control cohort consisted of age- and sex-matched patients without lymphoma who were hospitalized because of COVID-19. We performed detailed clinical analyses, in-depth cellular and molecular immune profiling, and comprehensive virological studies in 12 patients with available biospecimens. B-cell depleted lymphoma patients had more severe and protracted clinical course (median hospitalization 88 versus 17 d). All patients actively receiving immunochemotherapy (n = 5) required ICU support including long-term mechanical ventilation. Neutrophil recovery following granulocyte colony stimulating factor stimulation coincided with hyperinflammation and clinical deterioration in 4 of the 5 patients. Immune cell profiling and gene expression analysis of peripheral blood mononuclear cells revealed early activation of monocytes/macrophages, neutrophils, and the complement system in B-cell depleted lymphoma patients, with subsequent exacerbation of the inflammatory response and dysfunctional interferon signaling at the time of clinical deterioration of COVID-19. Longitudinal immune cell profiling and functional in vitro assays showed SARS-CoV-2-specific CD8(+) and CD4(+) T-effector cell responses. Finally, we observed long-term detection of SARS-CoV-2 in respiratory specimens (median 84 versus 12 d) and an inability to mount lasting SARS-CoV-2 antibody responses in B-cell depleted lymphoma patients. In summary, we identified clinically relevant particularities of COVID-19 in lymphoma patients receiving B-cell depleting immunochemotherapies.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• Sprache: Englisch