Sequential Treatment by Antiviral Drugs Followed by Immunosuppressive Agents for COVID-19 Patients with Hematological Malignancy

Figures & data

Table 1 The Clinical Timeline of Case 1 and 2

Date	Patient 1				Patient 2
	Events	Antigens	Xp/CT	Treatments	Events	Antigens	Xp/CT	Treatments
1 year ago				CHOP+ obinutuzumab				LD
7 months ago	1st vaccine
6 months ago	2nd vaccine				1st Vaccine
5 months ago					2nd Vaccine
Day 0	PCR (+)				PCR (+)
Day 2	1st admission	>5000	None	Sotrovimab	Home
Day 9	Discharge
Day 10					University Hospital	217	GGOs	RDV, DEX start
Day 11					HFNC			DEX off
Day 12	Bell’s palsy			PSL 50 mg start		2.18		Sotorovimab, g-glb
Day 15						None		DEX restart
Day 20								mPSL 50 mg start
Day 23						482		MPV start
Day 28	2nd admission	3024	IP shadows	RDV start
Day 30						1.36	Improved
Day 32	Fever up			DEX start	O2 off
Day 34		126
Day 40	University hospital	2237	GGOs		Survived, discharge
Day 41		>5000		G-CSF, MPV start
Day 45		2454	IP shadows	mPSL 500 mg start
Day 48				mPSL 50 mg start
Day 52	HFNC	>5000	GGOs
Day 60	Dead

Abbreviations: GGOs, ground glass opacities; CHOP, cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisolone; DEX, dexamethasone; G-CSF, granulocyte-colony stimulating factor; HFNC, high flow nasal cannula; IP, interstitial pneumonitis; LD, lenalidomide and dexamethasone; mPSL, methylprednisolone; MPV, molnupiravir; PCR, polymerase chain reaction; RDV, remdesivir, respectively.

Table 2 The Antibody Titers for SARS-CoV-2 Nucleocapsid (N) and Spike (S) Proteins in Case 1 and 2

	Case 1	Case 2
SARS-CoV-2 antibodies
IgM (COI)	0.1< (–)	5.7
IgG-Spike protein (AU/mL)	49	334
IgG-Nucleocapsid (AU/mL)	1.0<(~)	5

Figure 1 Chest X-ray (A and B) and computed tomography (C and D) of the case 1 patient on admission to our hospital on day 40 (A and C) and day 52 (B and D). Interstitial shadows in X ray and Ground-glass opacities (GGOs) in CT are found in both lung fields on admission to our hospital on day 40 (A and C). These interstitial shadows and GGOs were increased 12 days later on day 52 (B and D). Both of the lung volumes were also reduced on day 52 (B), compared with on day 40 (A). Arrows indicated the abnormal shadows in chest X-ray and CT, such as interstitial shadows and GGO.

Figure 2 Chest X-ray (A–C) and computed tomography (D–F) of the case 2 patient on day 10 (A and D), day 15 (B and E), and day 30 (C and F). GGOs are found in both lung fields on day 10 (A and D). They were worse and lesions, including the densities were increased on day 15 (B and E), but they have finally improved on day 30 (D and F). Arrows indicated the abnormal shadows in chest X-ray and CT, such as interstitial shadows and GGO.