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. 2022 May 27:13:911339.
doi: 10.3389/fimmu.2022.911339. eCollection 2022.

Clinical Management of Patients With B-Cell Depletion Agents to Treat or Prevent Prolonged and Severe SARS-COV-2 Infection: Defining a Treatment Pathway

Alessandra D'Abramo  1 , Serena Vita  1 , Gaetano Maffongelli  1 , Alessia Beccacece  1 , Chiara Agrati  1 , Eleonora Cimini  1 , Francesca Colavita  1 , Maria Letizia Giancola  1 , Alessandro Cavasio  2 , Emanuele Nicastri  1 ; Spallanzani COVID-19 Case Investigation Team
Collaborators, Affiliations

Clinical Management of Patients With B-Cell Depletion Agents to Treat or Prevent Prolonged and Severe SARS-COV-2 Infection: Defining a Treatment Pathway

Alessandra D'Abramo et al. Front Immunol. .

Abstract

Introduction: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: B-cells depletion; COVID-19; anti-CD20 agent; anti-SARS-CoV-2 monoclonal antibody; convalescent plasma; immunosuppressed patients; passive immunotherapy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Impact of hyperimmune convalescent plasma (A) anti-SARS-CoV-2 monoclonal antiboby (B) and hyperimmune convalescent plasma plus anti-SARS-CoV-2 monoclonal antibody (C) therapy on immune parameters and specific T cell response in peripheral blood before and after treatment.
See this image and copyright information in PMC

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