ABSTRACT
Background: Patients with oncohematological diseases represent a particularly vulnerable population in the course of COVID-19 infection. Monoclonal antibody therapy (MAT) may represent, in addition to the vaccine, a strategic weapon in the management of these patients. Materials and Methods: We retrospectively studied 20 patients with oncohematological disease related to our Internal Medicine Ward for COVID-19 infection. Ten females and eleven males, mean age 65 years distributed as follows: 7 Non-Hodgkin's Lymphoma, 5 Multiple Myeloma, 4 Hodgkin's Lymphoma, 2 Chronic Lymphocytic Leukemia, 2 Acute Myeloid Leukemia, 1 Myelofibrosis. All patients had been vaccinated with at least two doses. Eleven patients underwent to MAT therapy in early treatment after COVID-19 infection (four patients casirivimab/indevimab and seven sotrovimab). Nine patients were hospitalized for interstitial pneumonia Results: Among the eleven patients undergoing MAT in early treatment, ten didn't develop disease progression;only a 33 y.o. patient with DLBCL was hospitalized and died of septic shock but in absence of pneumonia. Among nine patients hospitalized for interstitial pneumonia, 5 died and 4 were discharged home. Among the five who died, three patients didn't practice MAT because they arrived at observation ten days after the symptoms onset. Among the 4 discharged at home, only one didn't practice MAT for the same reason. Conclusions: Our data confirm the effectiveness of early treatment with monoclonals in reducing disease progression in oncohematological patients after COVID-19 infection.
ABSTRACT
Background: Available studies suggest that patients treated with monoclonal antibodies therapy (MAT) for CoViD-19 show a significant reduction of the viral load in nasopharinx. Studies are ongoing to better define clinical benefits of this therapy. Materials and Methods:We retrospectively studied the seventeen patients (seven females mean age 71.14 and ten males mean age 63.7) treated with MAT between April and May 2021 in our Internal Medicine ward. We followed the national guidelines for the administration of MAT. All patients were treated within five days after their first positive swab samples (RT-PCR). 10 patients presented hypertensive cardiomiopathy, 4 type 2 diabetes mellitus, 3 asthma, 1 end stage renal disease and 1 Shawcman diamond syndrome. Ten patients were treated with casirivimab/indevimab, six patients with bamlanivimab/etesevimab, one patient with bamlanivimab only. Results: 30 days after MAT, we contacted the patients to evaluate side effects and disease development. The symptoms referred were diarrhea (4 cases), fever (3 cases) and fatigue (2 cases), probably due to CoViD infection more than MAT. The only patient hospitalized for CoViD-19 pneumonia was that one treated with bamlanivimab alone, a 60-year-old man with severe previous conditions such as triple ischemic stroke and triple acute coronaric syndrome. Anyway he underwent non-invasive ventilation and didn't need intensive therapy. Conclusions: Our data suggest that MAT for CoViD-19 infection is safe and can avoid the worsening of symptoms and hospitalization in frail patients with recent infections.
ABSTRACT
OBJECTIVE: Platelets, blood coagulation along with fibrinolysis are greatly involved in the pathophysiology of infectious diseases induced by bacteria, parasites and virus. This phenomenon is not surprising since both the innate immunity and the hemostatic systems are two ancestral mechanisms which closely cooperate favoring host's defense against foreign invaders. However, the excessive response of these systems may be dangerous for the host itself. MATERIALS AND METHODS: We searched and retrieved the articles, using the following electronic database: MedLine and Embase. We limited our search to articles published in English, but no restrictions in terms of article type, publication year, and geography were adopted. RESULTS: The hemostatic phenotype of the infectious diseases is variable depending on the points of attack of the different involved pathogens. Infectious diseases which show a prothrombotic phenotype are bacterial sepsis, SARS-CoV-2 and malaria. However, among the bacterial sepsis, Yersinia Pestis is characterized by a profibrinolytic behavior. On the contrary, the hemorrhagic fevers, due to Dengue and Ebola virus, mainly exploit the activation of fibrinolysis secondary to a huge endothelial damage which can release a large amount of t-PA in the early phase of the diseases. CONCLUSIONS: Blood coagulation and fibrinolysis are greatly activated based on the strategy of the different infectious agents which exploit the excess of response of both systems to achieve the greatest possible virulence.