Atypical COVID-19 dynamics in a patient with mantle cell lymphoma exposed to rituximab

• Published in: Infectious agents and cancer Vol. 16; no. 1; pp. 38 - 6
• Main Authors: Marcacci, Gianpaolo, Fiorentino, Giuseppe, Volzone, Francesco, Falcone, Umberto, Parrella, Roberto, Donnarumma, Daniela, D’Ovidio, Silvia, Annunziata, Anna, Micallo, Giovanni, Portella, Giuseppe, De Chiara, Annarosaria, De Filippi, Rosaria, Crisci, Stefania, Pinto, Antonio
• Format: Journal Article
• Language: English
• Published: London BioMed Central 02.06.2021; BioMed Central Ltd; Springer Nature B.V; BMC
• Subjects: Anti-CD20 antibodies; Antibodies; B cells; Biomedical and Life Sciences; Biomedicine; Cancer Research; Cancer therapies; CD20 antigen; Chemotherapy; Coronaviruses; COVID-19; COVID-19 vaccines; Disease; Fever; Health aspects; Hypertension; Immunoglobulin G; Immunoglobulin M; Impact of COVID-19 in Cancer; Infections; Infectious Diseases; Influenza; Laboratories; Lymphoma; Mantle cell lymphoma; Mortality; Non-Hodgkin's lymphomas; Oncology; Pandemics; Patients; Rituximab; Serology; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Short Report; Tropical Medicine; COVID-19; Rituximab; Anti-CD20 antibodies; Mantle cell lymphoma
• ISSN: 1750-9378; 1750-9378
• DOI: 10.1186/s13027-021-00376-1

Patients with non-hodgkin lymphomas (NHL) represent a population of special interest during the current Coronavirus disease-19 (COVID-19) pandemics. NHLs are associated with disease- and treatment-related immunodeficiencies which may generate unusual COVID-19 dynamics and pose unique management challenges. We report the unusual clinical course of COVID-19 in a patient with mantle cell lymphoma (MCL) exposed to nine doses of Rituximab shortly before infection with severe acute respiratory syndrome corona virus 2 (SARS-CoV-2). He had a prolonged asymptomatic phase, with negative molecular and antibody testing for SARS-CoV-2, followed by a rapidly progressive evolution to severe COVID-19. Despite detection of viral RNA overlapped with first symptoms occurrence, anti-SARS-CoV-2 antibodies displayed an asynchronous pattern, with IgG first appearing 2 days after RNA positivity and IgM never being detected throughout the entire clinical course. While disease-associated immune derangements and/or previous treatments involving anti-CD20 antibodies might have contributed to COVID-19 dynamics in our patient, data suggests that antibody testings, without concurrent molecular assessment for SARS-CoV-2, may turn inadequate for monitoring of MCL patients, and in general NHL patients heavily exposed to anti-CD20 antibodies, during the current pandemics. We suggest that repeated molecular testing of nasopharyngeal swab should be implemented in these subjects despite a negative serology and absence of symptoms of SARS-CoV-2 infection. For the same reasons, a customized strategy needs to be developed for patients exposed to anti-CD20 antibodies, based on different features and mechanism of action of available SARS-CoV-2 vaccines and novel vaccinomics developments.