Evaluating Photopheresis Regimens for Advanced CTCL: The Role of the SARS-CoV-2 Pandemic-A Single-Center Retrospective Study

Extracorporeal photopheresis (ECP) is an established, safe, and effective treatment for cutaneous T-cell lymphoma (CTCL). There is no published literature reviewing the clinical efficacy of ECP at varying frequencies or the ideal duration of therapy. The SARS-CoV-2 pandemic necessitated a reduced frequency of ECP for patients with CTCL at our center. We performed a retrospective chart review of patients with CTCL receiving ECP at the Penn Dermatology Photopheresis Service (PDPS) on March 1, 2020, and followed up their course until January 31, 2021. Our retrospective cohort study suggests that one day of ECP with extending duration between treatments can be considered an alternative maintenance regimen in appropriate patients with stable disease on concomitant multimodality immunomodulatory therapy.

Longitudinal humoral immune response against COVID-19 adenovirus-based vaccines in patients with multiple sclerosis from Argentina undergoing immunosuppressive treatment

Introduction: Most reports related to humoral immune response to COVID 19 vaccines in people with Multiple Sclerosis (pwMS) were performed on mRNA-based vaccines. Objective(s): to analyze the longitudinal humoral immune responses to adenovirus-based vaccines (Sputnik V and AZD1222) in pwMS under different diseases modifying therapies (DMTs) Methods: IgG anti- SARS-COV-2 spike titers in a cohort of 101 pwMS and 28 healthy controls (HC) were measured 6 weeks after vaccination using the COVID-AR kit according to the manufacture instructions. Both patients and controls received two or three doses of Sputnik, AZD1222 or a mixed schedule (MS) of both vaccines. The neutralizing capacity was evaluated by measuring antibody neutralizing titers using SARS COV-2 pseudotyped particles. Result(s): 60.5% of pwMS were female, mean EDSS: 2.49 +/-1.5, age: 36.6 +/-10.7, disease duration 7.6 +/- 5.1 years. DMTs: 45 pwMS were under fingolimod, 23 under dimethyl fumarate, 14 under cladribine and 19 under antiCD20 monoclonal antibodies. Vaccines: 35.7% Sputnik V, 51.9% AZD1222 and 12.4 % MS. No antibody response to a 2nd dose was found in 41.3% of pwMS under fingolimod and 73.6% under antiCD20. We found a correlation between lower lymphocyte count and lower antibody titers in pwMS under fingolimod (r: 0.67, 95% CI: 0.46-0.81, p=<=0.0001). A correlation was also found between the antibody titer and the last dose of antiCD20 (r: 0.49, 95% CI: 0.03-0.7, p=0.03). In March 2022, 57 pwMS received their 3nddose, 6 patients under fingolimod and 7 under antiCD20 remained without any antibody response. We did not find differences in the neutralization capacity with different DMT and or vaccines. Multivariate regression analysis showed antiCD20 (beta= -,349, 95% CI: -3655.6-369.01, p=0.017) and fingolimod (beta=-,399, 95% CI: -3363.8-250.9, p=0.023) treatments as independent factor associated with low antibody response (r2 adjusted=0.157). Conclusion(s): This is the first report of longitudinal humoral immune response of patients under adenovirus-based vaccines, specially Sputnik V, that demonstrate that these vaccines have similar results to those obtained with mRNA-based vaccines.

Impact of the coronavirus SARS COV-2 (COVID19) pandemic on the quality of life and mood of patients with multiple sclerosis

Introduction: Multiple Sclerosis (MS) is a disabling chronic disease with clinical heterogeneity and uncertain prognosis. Evaluating the health-related quality of life (HRQoL) of patients is important for the multidisciplinary therapeutic approach including physical, psychic and social aspects that influence the wellbeing of people with consequences in the course of the disease. As of March 2020 due to the Coronavirus 2019 (COVID-19) pandemic and quarantine measures, habits and access to the health system have been substantially modified. Objective(s): Our aim was to evaluate depression level and HRQoL of MS patients and compare this results with pre-pandemic assessment (2019). Patients and Methods: A cross-sectional study was conducted between March and July 2021. Measuring instruments: Clinical, HRQoL: Multiple Sclerosis International Quality of Life questionnaire (MusiQol), Depression: Beck Depression Inventory II (BDI-II), and pandemic-related aspects using a ad-hoc questionnaire. The results of MusiQol and BDI-II were compared with those obtained from the 2019 evaluations. Parametric and nonparametric statistics were used, to define significance a value of p <0.05 was accepted. Result(s): We evaluated 62 patients. In the comparative analysis with 2019, a significant decrease in HRQoL was observed (z=- 2.21, p=0.03). The affected domains were activities of daily living, psychological well-being, and sexual and sentimental life. In contrast, no significant changes were observed in the assessment of depression using BDI-II (z=-0.39, p=0.69). Conclusion(s): HrQoL of MS patients is decreased compared to 2019. The pandemic itself, health and quarantine measures have negatively impacted on HRQoL, substantially impairing patients' performance in activities of daily living, psychological wellbeing, and sexual and sentimental life.

Procedural Motor Learning in Long COVID

Background: Early in the Covid pandemic, reports started to emerge of patients with lingering symptoms following recovery from acute infection, so called Long Covid (Miners, 2020;Nath, 2020;Troyer, 2020). Despite the high prevalence of neurological symptoms like brain fog and memory dysfunction (Davis, 2020), most research has relied on surveys or clinical tools typically used to assess declarative memory (Alemanno, 2021;Mendez 2021;Taquet, 2021). To our knowledge, no studies have examined Long Covid patients' ability to learn and consolidate a procedural motor skill. Method(s): We addressed this question in a group of 108 patients with Long Covid and 108 age-and sex-matched controls. Participants performed a well-characterized motor sequence typing task alternating 10-second practice with 10-second rest for 36 trials over 12 minutes (Bonstrup, 2020;Bonstrup, 2019;Buch, 2021). The following day, performance was tested to evaluate overnight consolidation. The behavioral endpoint measure was correct sequence typing speed (Buch, 2021) . Data were fitted to a 3-parameter model (initial performance, maximum performance, learning rate). Simple reaction times (RT) were measured twice: at the beginning and the end of the experimental session. Result(s): On average, patients had experienced 50 weeks of symptoms at time of testing. Long Covid patients' typing speed was slower than healthy controls at the beginning of the session (p=0.00075). While learning rates were comparable across groups (p=0.142), at the end of training Long Covid patients had not reached the same performance level as controls (p=0.046). Overnight consolidation was not statistically different between groups (p=0.58). Fourteen patients were hospitalized during their acute infection;they did not perform differently to patients who were not hospitalized. There were no sex differences when comparing healthy, long covid or combined groups. Pre-task RT was slower in Long Covid patients than in healthy controls (Covid 373+/-131ms, controls 317+/-43ms) but did not predict initial or final typing speed, nor learning rate in either group. Post-task RT was also faster in both groups, marginally more so in patients (Covid 353+/-117ms, controls 314+/-51ms). Conclusion(s): Long Covid patients exhibited slower starting performance. While they learned the skill at about the same pace, they failed to reach the same typing speed as healthy controls by the end of the task. Reaction times, here used as a measure of attention, did not exhibit a direct link with learning metrics.

Impact of the coronavirus SARS COV-2 (COVID19) pandemic on the quality of life and mood of patients with multiple sclerosis

Objective: Our objective was to assess the level of depression and HRQoL of MS patients and compare it with the 2019 pre-pandemic assessment. Background: Multiple Sclerosis (MS) is a disabling chronic disease with clinical heterogeneity and uncertain prognosis. Evaluating the health-related quality of life (HRQoL) of patients is important for the multidisciplinary therapeutic approach including physical, psychic and social aspects that influence the well-being of people with consequences in the course of the disease. As of March 2020 due to the Coronavirus 2019 (COVID-19) pandemic and quarantine measures, habits and access to the health system have been substantially modified. Design/Methods: A cross-sectional study was conducted. A virtual survey assessed HRQoL with the “Multiple Sclerosis International Quality of Life questionnaire” (MusiQol), depression with the Beck Depression Inventory II (BDI-II), and pandemic-related aspects using a questionnaire designed for this study. The results of MusiQol and BDI-II were compared with those obtained from the 2019 evaluations. Results: We evaluated 62 patients. In the comparative analysis with 2019, a significant decrease in HRQoL was observed (z=-2.21, p=0.03). The affected domains were activities of daily living, psychological well-being, and sexual and sentimental life. In contrast, no significant changes were observed in the assessment of depression using BDI-II (z=-0.39, p=0.69). Conclusions: HrQoL of MS patients is decreased compared to 2019. The pandemic itself, health and quarantine measures have negatively impacted HRQoL, substantially impairing patients' performance in activities of daily living, psychological well-being, and sexual and sentimental life.

Feasibility of a Pilot Randomized Trial of Virtual and In-Person Qigong for Cancer Caregivers

Methods: A three-arm, pilot, randomized controlled, mixed-methods clinical trial design was used to randomize cancer caregivers to: 1) virtual Qigong classes;2) in-person Qigong classes;or 3) a self-care control. Feasibility goals included recruiting 54 caregivers over 12 months, ≥ 50% of screened individuals study eligible, ≥ 50% of eligible individuals enrolled, and < 20% lost to follow-up at 12 weeks. Participants were considered adherent to the intervention if they attended ≥ 70% of all Qigong classes. Results: A total of 47 caregivers were recruited (in-person group: n=15;virtual group: n=16;control group: n=16), thus falling short of the recruitment goal by 13%. All other feasibility metrics were met: 1) out of total individuals screened, 72% were eligible;2) 64% of those eligible enrolled in the study;3) 13% were lost to follow-up;and 4) 63% and 73% of participants in the virtual group and in person group attended ≥ 70% of all Qigong classes, respectively. Background: Caregiving for someone with cancer can cause significant psychological and physical distress, leading to lower overall quality of life. Although mind-body interventions offer a solution for caregiver distress and to improve quality of life, current research has not evaluated the virtual delivery of mind-body programs for caregivers in the home. The purpose of this study was to examine and compare the feasibility of providing a virtual Qigong program, an in-person Qigong program, and a self-care control for cancer caregivers. Conclusion: Findings indicate that a virtual Qigong intervention for cancer caregivers is feasible. Not meeting the recruitment goal was partially explained by the COVID-19 pandemic occurring during the study time period. Ongoing analyses of qualitative and quantitative data will inform facilitators and barriers related to meeting the feasibility metrics, as well as providing initial data regarding the effectiveness of Qigong programs for subsequent clinical trials.

Puede el COVID-19 exacerbar los síntomas de la esclerosis múltiple? análisis de una serie de casos

Introduction: Las inflamaciones periféricas pueden exacerbar lesiones pre-existentes en el Sistema Nervioso Central en contexto de enfermedades neurodegenerativas, incluyendo la Esclerosis Múltiple (EM). Objetives: Analizar el efecto de la infección por COVID-19 como generador de inflamación periférica en un grupo de pacientes con EM. Methods: Análisis retrospectivo de 400 historias clínicas de pacientes con EM de un centro de referencia. A los pacientes que presentaron COVID-19 se les realizó una encuesta sobre la presencia o ausencia de exacerbación de síntomas previos de EM durante la infección y hasta tres meses posterior a ella. Se incluyó: tipo de síntoma, duración y comienzo de la exacerbación, vacunación previa contra COVID-19 y severidad de la enfermedad. Además, se incluyó información clínica y demográfica de las historias clínicas. Se realizó un análisis descriptivo e inferencial utilizando el GraphPad Prism V6. Results: 41 pacientes fueron incluidos, 58,5% fueron mujeres y la edad promedio fue de 42.9 ± 11.3. 90,2% presentaban la forma remitente-recurrente (EMRR), el promedio de años de evolución de EM fue de 9.6 ± 6.60 y el EDSS promedio fue de 2.4 ± 2.1. 25 pacientes (61%) tuvieron exacerbaciones de EM, 9,7% (n=4) presentaron síntomas compatibles con recaídas y 7,3% (n=3) requirieron corticoides. Encontramos diferencias significativas en el EDSS entre los pacientes que exacerbaron sus síntomas de EM y los que no (p=0,03). Al efectuar un análisis de regresión multivariada encontramos que el EDSS se asoció de forma independiente a la presencia de exacerbaciones de la EM en contexto de infección por SARS CoV2 (OR= 2.44, p =0.022). Conclusions: Este estudio preliminar sugiere que la infección por COVID-19 podría desencadenar exacerbaciones de síntomas de la EM. Se necesitan nuevos estudios que diluciden la relación entre COVID-19 y EM.