CLL and COVID-19: Case Report of Use of Convalescent Plasma Plus Remdesivir
Posted: Wednesday, October 27, 2021
Due to the impairment of humoral responses in patients with chronic lymphocytic leukemia (CLL), there appears to be a higher risk of death from COVID-19. Carla Schenker, MD, and colleagues from the University of Bern, Switzerland, described a patient with CLL and COVID-19 who experienced rapid clinical improvement followed by relapse after receiving convalescent plasma and the antiviral medication remdesivir. This case report was published in the British Journal of Haematology.
“This case highlights that long-term follow-up of such patients is important because combined therapy with remdesivir and convalescent plasma may not lead to immunity or complete viral elimination,” noted the authors.
A 61-year-old male patient diagnosed with CLL and a history of hypertension and prediabetes presented to his primary care physician with symptoms associated with COVID-19, with subsequent confirmation of SARS–CoV-2. After 21 days of quarantine, the patient was deteriorating with fever, elevated C-reactive protein, procalcitonin, severe lymphocytopenia, and low IgG level. A follow-up chest x-ray demonstrated right lower lung opacity. On day 24, the patient’s oxygen saturation deteriorated, and he was given 6 mg of dexamethasone daily and supplemental oxygen.
Upon continued deterioration, the patient was started on intravenous remdesivir (200 mg on day 1, followed by 100 mg daily) and a transfusion of 200 mL of convalescent plasma. The patient experienced complete resolution of symptoms and had positive SARS–CoV-2 antispike IgG antibodies.
However, the patient was readmitted 3.5 months later, with confirmed SARS–CoV-2 with the same viral strain. Complete resolution of symptoms was seen after treatment with ceftriaxone for 3 days and remdesivir for 5 days. No convalescent plasma was administered.
The authors commented: “Prolonged viral shedding has been reported in patients with hematological disorders receiving chemo- or immunotherapy, which supports the hypothesis that viral clearance in patients with an impaired immune system can take several weeks.”
Disclosure: The study authors reported no conflicts of interest.