CLL and COVID-19: When May Humoral Immunity Therapy Be Indicated?
Posted: Wednesday, July 29, 2020
Limited data exist on the effects of SARS-CoV-2 infections in patients with chronic lymphocytic leukemia (CLL) with more than 60 days of follow-up. Jian Huang, MD, of Zhejiang University, School of Medicine, China, and colleagues completed a recent clinical evaluation of a patient with CLL who was infected with the virus that causes COVID-19. Immune deficiency led to a recurrence of COVID-19 infection twice during the 69-day follow-up, and clinical characteristics were consistent with the features of severe cases. Their case study appeared in Frontiers in Oncology.
A 72-year-old woman was admitted to the hospital with COVID-19 symptoms after exposure within a family cluster. She presented with 2019-nCoV-specific IgM and IgG antibodies and the highest viral load within her family. Cytology results identified an abnormal distribution of T lymphocytes, small blue lymphocytes with scant cytoplasm, and high levels of circulating clonal B cells. She was diagnosed with COVID-19 and CLL. Lung injury progressed rapidly, and she developed severe pneumonia. The patient was given a combination of antiviral drugs and immunostimulants.
After 20 days and two consecutive negative tests for COVID-19, the patient was discharged. Over the next 49 days, she tested positive for COVID-19 twice and was readmitted to the hospital both times. During each subsequent hospital stay, she was treated with immunostimulants and discharged after testing negative for COVID-19 over two consecutive days. Over a 2-month period, researchers observed significantly lower white blood cell counts and higher cytokine levels in this woman than in her family members, which they believe contributed to the delay in clearance of the virus and its repeated recurrence.
“For those patients who are prone to progression to severe disease, administering humoral immunity therapies can help to prevent disease progression and quickly meet the cure criteria,” the authors concluded.
Disclosure: The study authors’ disclosures can be found at www.frontiersin.org.