Successful treatment with a short course of remdesivir in a case of prolonged COVID-19 in a lymphoma patient

Figures & data

Figure 1. Clinical course of the SARS-CoV-2 infection following chemotherapy and rituximab treatment for lymphoma. CFP, cefepim; CFX, ciprofloxacin; VAN, vancomycin; LVX, levofloxacin; RDV, remdesivir. Neutropaenia: neutrophils <1.0 × 10⁹/l; Lymphopaenia: lymphocytes <1.0 × 10⁹/l. RT-PCR cycle threshold (ct) values representing an inverse of viral load given for nasopharyngeal swab samples taken on days 5 and 20.

Table 1. Previously reported lymphoma patients treated with remdesivir for COVID-19.

References	Age (years)	Sex	Lymphoma subtype	Ongoing lymphoma treatment	Approx. clinical duration of COVID-19 (days)	COVID-19 treatments (initiation day from symptom onset)	SARS-CoV-2 serology (days from symptom onset)^a	Latest positive RT-PCR or culture (days from symptom onset)	Outcome
[7]	60	M	MCL	CYC, DOX, PRD, anti-CD20 and B-cell antibodies	131	RDV (30 and 122)	Negative (30, 120,124,127)	119 (culture)	Resolved
						CP (31 & 122)	Positive (66, 88,122)
[8]	37	F	FL	ETO, CIS, CYT, MET, RIT	60	LOP/RIT, HCQ, AZM, DAR/COB, RDV (28, 55), MET, ANA, IVIG (46, 61), CP (64)	Negative (42, 64)	60 (PCR)	Resolved
[9]	53	F	FL	OBI maintenance	90	RDV (63, 81), CP (86)	Negative (approx. 90)	90 (PCR)	Resolved
[10]	60	M	MCL	RIT maintenance	>100	HCQ, LOP/RIT, MET, TOC, ANA, RDV, CP (78)	Negative	Approx. 100	Resolved
							(approx. 100)	(PCR)
[11]	43	M	MCCHL	BRE, DOX, VIN, DAC	29	FAV, CIC, RDV (21)		14 (PCR)	Resolved
[12]	53	M	DLBCL	RIT maintenance	109	DXM,CP (48, 105),RDV (55)	Negative (98)	129 (PCR)	Resolved
[13]	51	F	NHL	RIT maintenance	230	TCZ, HCQ, IVIG, COR, RDV	Negative (NA)	230 (PCR)	Deceased
	67	M	NHL	NA	45	IVIG, RDV, CP, COR	Negative (NA)	43 (PCR)	Deceased
[14]	47	F	BL	RIT	47	AZM, RDV, CP (45)	Negative (NA)	45 (PCR)	Resolved
[15]	58	F	LBL	None	NA	PRD, RDV	NA	NA	Resolved
[16]	56	F	FL	RIT, BEN	160	RDV, CP, INF	Negative (37)	Approx. 140 (PCR)	Resolved
							Negative (approx. 140)

RT-PCR: reverse transcription-polymerase chain reaction; MCL: mantle-cell lymphoma; CYC: cyclophosphamide; DOX: doxorubicin; PRD: prednisone; COR: low-dose corticosteroid; RDV: remdesivir, CP: convalescent plasma; FL: follicular lymphoma, RIT: rituximab; ETO: etoposide; CIS: cisplatin; CYT: cytarabine; MET: methylprednisolone; LOP/RIT: lopinavir/ritonavir; HCQ: hydroxychloroquine; AZM: azithromycin; DAR/COB: darunavir/cobistat; ANA: anakinra; IVIG: intravenous immunoglobulins; OBI: obinutuzumab; TOC: tocilizumab; MCCHL: mixed cellularity classical Hodgkin lymphoma; BRE: brentuximab vedotin; VIN: vinblastine; DAC: dacarbazine; FAV: favipiravir; CIC: ciclesonide; DLBCL: diffuse large B-cell lymphoma; DXM: dexamethasone; NHL: non-Hodgkin lymphoma; NA: not available; BL: Burkitt’s lymphoma; LBL: T-lymphoblastic lymphoma; BEN: bendamustine; INF: infliximab.

^aPositive serology results are not shown if antibodies were detected only after administration of convalescent plasma.

Baang JH, Smith C, Mirabelli C, et al. Prolonged severe acute respiratory syndrome coronavirus 2 replication in an immunocompromised patient. J Infect Dis. 2021;223(1):23–27.

 PubMed Web of Science ®Google Scholar

Camprubí D, Gaya A, Marcos MA, et al. Persistent replication of SARS-CoV-2 in a severely immunocompromised patient treated with several courses of remdesivir. Int J Infect Dis. 2021;104:379–381.

 PubMed Web of Science ®Google Scholar

Malsy J, Veletzky L, Heide J, et al. Sustained response after remdesivir and convalescent plasma therapy in a B-cell depleted patient with protracted COVID-19. Clin Infect Dis. 2020;73:e4020–e4024.

 Web of Science ®Google Scholar

Ormazabal Vélez I, Induráin Bermejo J, Espinoza Pérez J, et al. Two patients with rituximab associated low gammaglobulin levels and relapsed covid-19 infections treated with convalescent plasma. Transfus Apher Sci. 2021;60(3):103104.

 PubMed Web of Science ®Google Scholar

Fujii H, Tsuji T, Sugitani M, et al. Prolonged persistence of SARS-CoV-2 infection during a + AVD therapy for classical hodgkin’s lymphoma: a case report. Curr Probl Cancer. 2021;45(6):100739.

 PubMed Web of Science ®Google Scholar

Rnjak D, Ravlić S, Šola AM, et al. COVID-19 convalescent plasma as long-term therapy in immunodeficient patients? Transfus Clin Biol. 2021;28:264–270.

 PubMed Web of Science ®Google Scholar

Simioli F, Martino M, Annunziata A, et al. Therapeutic approach for severe COVID-19 and immunocompromised patients. A case series. Respir Med Case Rep. 2021;33:101397.

 PubMed Web of Science ®Google Scholar

Kenig A, Ishay Y, Kharouf F, et al. Treatment of B-cell depleted COVID-19 patients with convalescent plasma and plasma-based products. Clin Immunol. 2021;227:108723.

 PubMed Web of Science ®Google Scholar

Pelcovits A, Pandita A, Farmakiotis D, et al. Lymphocyte-depleting chemotherapy for aggressive hematologic malignancies in two patients with positive SARS-CoV-2 PCR. Leuk Res. 2021;100:106473.

 PubMed Web of Science ®Google Scholar

Reuken PA, Stallmach A, Pletz MW, et al. Severe clinical relapse in an immunocompromised host with persistent SARS-CoV-2 infection. Leukemia. 2021;35(3):920–923.

 PubMed Web of Science ®Google Scholar