Managing and treating COVID-19 in patients with hematological malignancies: a narrative review and expert insights DOI Creative Commons

Heng Joo Ng,

Maaz Kamal Alata,

Quang The Nguyen

et al.

Clinical and Experimental Medicine, Journal Year: 2024, Volume and Issue: 24(1)

Published: June 4, 2024

Abstract Patients with hematologic malignancies (HMs) are at a significantly higher risk of contracting COVID-19 and experiencing severe outcomes compared to individuals without HMs. This heightened is influenced by various factors, including the underlying malignancy, immunosuppressive treatments, patient-related factors. Notably, regimens commonly used for HM treatment can lead depletion B cells T cells, which associated increased COVID-19-related complications mortality in these patients. As pandemic transitions into an endemic state, it remains crucial acknowledge address ongoing In this review, we aim summarize current evidence enhance our understanding impact HMs on risks outcomes, identify particularly vulnerable individuals, emphasize need specialized clinical attention management. Furthermore, impaired immune response vaccination observed patients underscores importance implementing additional mitigation strategies. may include targeted prophylaxis antivirals monoclonal antibodies as indicated. To provide practical guidance considerations, present two illustrative cases highlight real-life challenges faced physicians caring HMs, emphasizing individualized management based disease severity, type, unique circumstances each patient.

Language: Английский

COVID-19 Convalescent Plasma for the Treatment of Immunocompromised Patients: A Systematic Review and Meta-analysis DOI Creative Commons
Jonathon W. Senefeld, Massimo Franchini, Carlo Mengoli

et al.

JAMA Network Open, Journal Year: 2023, Volume and Issue: 6(1), P. e2250647 - e2250647

Published: Jan. 12, 2023

Importance Patients who are immunocompromised have increased risk for morbidity and mortality associated with coronavirus disease 2019 (COVID-19) because they less frequently mount antibody responses to vaccines. Although neutralizing anti-spike monoclonal-antibody treatment has been widely used treat COVID-19, evolutions of SARS-CoV-2 monoclonal antibody-resistant variants greater virulence transmissibility SARS-CoV-2. Thus, the therapeutic use COVID-19 convalescent plasma on presumption that such contains potentially antibodies can be passively transferred recipient. Objective To assess growing number reports clinical experiences patients treated specific via transfusion. Data Sources On August 12, 2022, a systematic search was performed studies in immunocompromised. Study Selection Randomized trials, matched cohort studies, case report or series were included. The electronic yielded 462 unique records, which 199 considered full-text screening. Extraction Synthesis study followed Preferred Reporting Items Systematic Reviews Meta-Analyses guidelines. extracted by 3 independent reviewers duplicate pooled. Main Outcomes Meaures prespecified end point all-cause after transfusion; exploratory subgroup analyses based putative factors potential benefit plasma. Results This review meta-analysis included randomized trials enrolling 1487 participants 5 controlled studies. Additionally, 125 265 13 uncontrolled large 358 Separate meta-analyses, using models both stratified pooled type (ie, studies), demonstrated transfusion decrease compared control amalgam (risk ratio [RR], 0.63 [95% CI, 0.50-0.79]). Conclusions Relevance These findings suggest is COVID-19.

Language: Английский

Citations

130
Acute graft-versus-host disease DOI Open Access
Florent Malard, Ernst Holler, Brenda M. Sandmaier

et al.

Nature Reviews Disease Primers, Journal Year: 2023, Volume and Issue: 9(1)

Published: June 8, 2023

Language: Английский

Citations

106
Triple Combination Therapy With 2 Antivirals and Monoclonal Antibodies for Persistent or Relapsed Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Immunocompromised Patients DOI Open Access
Małgorzata Mikulska, Chiara Sepulcri, Chiara Dentone

et al.

Clinical Infectious Diseases, Journal Year: 2023, Volume and Issue: 77(2), P. 280 - 286

Published: March 28, 2023

Severely immunocompromised patients are at risk for prolonged or relapsed Coronavirus Disease 2019 (COVID-19), leading to increased morbidity and mortality. We aimed evaluate efficacy safety of combination treatment in COVID-19 patients.We included all with prolonged/relapsed treated therapy 2 antivirals (remdesivir plus nirmatrelvir/ritonavir, molnupiravir case renal failure) plus, if available, anti-spike monoclonal antibodies (mAbs), between February October 2022. The main outcomes were virological response day 14 (negative Severe Acute Respiratory Syndrome [SARS-CoV-2] swab) clinical (alive, asymptomatic, negative SARS-CoV-2 30 the last follow-up.Overall, 22 (Omicron variant 17/18) included: 18 received full mAbs 4 only; 20 (91%) patients, nirmatrelvir/ritonavir remdesivir. Nineteen (86%) had hematological malignancy, 15 (68%) anti-CD20 therapy. All symptomatic; 8 (36%) required oxygen. Four a second course treatment. rate 14, 30, follow-up was 75% (15/20 evaluable), 73% (16/22), 82% (18/22), respectively. Day rates significantly higher when mAbs. Higher number vaccine doses associated better final outcome. Two (9%) developed severe side effects (bradycardia remdesivir discontinuation myocardial infarction).Combination including (mainly nirmatrelvir/ritonavir) high COVID-19.

Language: Английский

Citations

99
Vaccines and therapeutics for immunocompromised patients with COVID-19 DOI Creative Commons
Shmuel Shoham, Carolina Batista, Yanis Ben Amor

et al.

EClinicalMedicine, Journal Year: 2023, Volume and Issue: 59, P. 101965 - 101965

Published: April 12, 2023

Language: Английский

Citations

88
Breakthrough COVID-19 in vaccinated patients with hematologic malignancies: results from the EPICOVIDEHA survey DOI Creative Commons
Livio Pagano, Jon Salmanton‐García, Francesco Marchesi

et al.

Blood, Journal Year: 2022, Volume and Issue: 140(26), P. 2773 - 2787

Published: Sept. 20, 2022

Limited data are available on breakthrough COVID-19 in patients with hematologic malignancy (HM) after anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. Adult HM, ≥1 dose of anti-SARS-CoV-2 vaccine, and between January 2021 March 2022 were analyzed. A total 1548 cases included, mainly lymphoid malignancies (1181 cases, 76%). After viral sequencing 753 (49%), the Omicron variant was prevalent (517, 68.7%). Most received ≤2 vaccine doses before (1419, 91%), mostly mRNA-based (1377, 89%). Overall, 906 (59%) COVID-19-specific treatment. 30-day follow-up from diagnosis, 143 (9%) died. The mortality rate 7.9%, comparable to other variants, a significantly lower than prevaccine era (31%). In univariable analysis, older age (P < .001), active HM severe critical = .007 P .001, respectively) associated mortality. Conversely, receiving monoclonal antibodies, even for or COVID-19, had .001). multivariable model, age, disease, 2-3 comorbidities correlated higher mortality, whereas antibody administration, alone .001) combined antivirals .009), protective. Although is prevaccination era, still considerable Death who combination antivirals.

Language: Английский

Citations

73
Infectious Diseases Society of America Guidelines on the Diagnosis of COVID-19: Serologic Testing DOI Creative Commons
Mary K. Hayden, Ibrahim K El Mikati, Kimberly E. Hanson

et al.

Clinical Infectious Diseases, Journal Year: 2024, Volume and Issue: unknown

Published: March 13, 2024

The role of serologic testing for SARS-CoV-2 has evolved during the pandemic as seroprevalence in global populations increased. Infectious Diseases Society America (IDSA) convened an expert panel to perform a systematic review coronavirus disease 2019 (COVID-19) serology literature and construct updated best practice guidance related testing. This guideline is update fourth series rapid, frequently COVID-19 guidelines developed by IDSA.

Language: Английский

Citations

63
Guidance on the Use of Convalescent Plasma to Treat Immunocompromised Patients With Coronavirus Disease 2019 DOI Creative Commons
Evan M. Bloch, Daniele Focosi, Shmuel Shoham

et al.

Clinical Infectious Diseases, Journal Year: 2023, Volume and Issue: 76(11), P. 2018 - 2024

Published: Feb. 6, 2023

Coronavirus disease 2019 (COVID-19) convalescent plasma (CCP) is a safe and effective treatment for COVID-19 in immunocompromised (IC) patients. IC patients have higher risk of persistent infection, severe disease, death from COVID-19. Despite the continued clinical use CCP to treat patients, optimal dose, frequency/schedule, duration has yet be determined, related best practices guidelines are lacking. A group individuals with expertise spanning infectious diseases, virology transfusion medicine was assembled render an expert opinion statement pertaining For effect, should recently locally collected match circulating variant. considered acute protracted COVID-19; dosage depends on setting (acute vs COVID-19). containing high-titer respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies, retains activity against SARS-CoV-2 variants, which otherwise rendered monoclonal antibodies ineffective.

Language: Английский

Citations

38
Outcome of early treatment of SARS‐CoV‐2 infection in patients with haematological disorders DOI Creative Commons
Małgorzata Mikulska,

Diletta Testi,

Chiara Russo

et al.

British Journal of Haematology, Journal Year: 2023, Volume and Issue: 201(4), P. 628 - 639

Published: Feb. 20, 2023

Summary Outcome of early treatment COVID‐19 with antivirals or anti‐spike monoclonal antibodies (MABs) in patients haematological malignancies (HM) is unknown. A retrospective study HM treated for mild/moderate between March 2021 and July 2022 was performed. The main composite end‐point failure (severe COVID‐19‐related death). We included 328 consecutive who received MABs ( n = 120, 37%; sotrovimab, 73) 208, 63%; nirmatrelvir/ritonavir, 116) over a median two days after symptoms started; 111 (33.8%) had non‐Hodgkin lymphoma (NHL); 89 (27%) were transplant/CAR‐T (chimaeric antigen receptor T‐cell therapy) recipients. Most infections 309, 94%) occurred during the Omicron period. Failure developed 31 (9.5%). Its independent predictors older age, fewer vaccine doses, MABs. Rate lower versus pre‐Omicron period (7.8% 36.8%, p < 0.001). During period, doses diagnosis acute myeloid leukaemia/myelodysplastic syndrome (AML/MDS). Independent longer viral shedding comorbidities, hospital admission at diagnosis, NHL/CLL, COVID‐19‐associated mortality 3.4% 11). those severe 26% Patients significant risk treatment, even high rate.

Language: Английский

Citations

31
Case report: Sotrovimab, remdesivir and nirmatrelvir/ritonavir combination as salvage treatment option in two immunocompromised patients hospitalized for COVID-19 DOI Creative Commons

Federico Baldi,

Chiara Dentone, Małgorzata Mikulska

et al.

Frontiers in Medicine, Journal Year: 2023, Volume and Issue: 9

Published: Jan. 9, 2023

COVID-19 in immunocompromised patients is difficult to treat. SARS-CoV-2 interaction with the host immune system and role of therapy still remains only partly understood. There are no data regarding use monoclonal antibodies combination two antivirals fighting viral replication disease progression. We report cases patients, both treated rituximab for non-Hodgkin lymphoma granulomatosis polyangiitis, respectively, hospitalized positive RNAemia, who were successfully a salvage sotrovimab, remdesivir nirmatrelvir/ritonavir.

Language: Английский

Citations

30
Nirmatrelvir/ritonavir in COVID-19 patients with haematological malignancies: a report from the EPICOVIDEHA registry DOI Creative Commons
Jon Salmanton‐García, Francesco Marchesi, María Gomes da Silva

et al.

EClinicalMedicine, Journal Year: 2023, Volume and Issue: 58, P. 101939 - 101939

Published: April 1, 2023

Language: Английский

Citations

27