Pulmonary function and functional capacity at 3, 6 and 12 months in COVID-19 patients and effect of physical activity on recovery

BACKGROUND: Long-term sequelae due to Coronavirus disease 2019 (COVID-19) are now under investigation. Aim of this study was to evaluate the one-year clinical impact of COVID-19 on respiratory function and relation with physical activity. METHOD(S): One hundred four patients were evaluated 3, 6 and 12 months after SARS-CoV-2 diagnosis. Clinical conditions, symptomatology, 6-minute walking test (6MWT), pulmonary function test with spirometry and diffusing capacity of carbon monoxide (DLCO) were analyzed. RESULT(S): Eighty-six (82.7%) patients referred at least one symptom at 3 months, 46 (44.2%) at 6 months and 24 (23.1%) at 12 months. At the 3-months visit, patients with moderate COVID showed a slight decrease of distance at the 6MWT, with an improvement at 12 months (P=0.04). Patients with severe COVID-19 showed a recovery of SpO2 at rest (P<0.001), DLCO (P=0.001), DLCO/VA (P=0.002), forced vital capacity (P=0.01) and 6MWT distance (P=0.002) at 6 and 12 months. Patients with critical COVID-19 showed a remarkable reduction of DLCO at 3 months (65+/-21%). Then a subsequent gradual improvement of DLCO was recorded (78+/-18% at 6 months, 85+/-16% at 12 months, P=0.01). Patients with DLCO<80% of predicted at 12 months were older (P=0.02), with higher prevalence of cardio-vascular disease (P=0.006), diabetes (P=0.01) and critical COVID-19 (P=0.003). The improvement of 6MWT distance and DLCO during the three visits did not correlate with physical activity. CONCLUSION(S): Patients with COVID-19 lung involvement showed a progressive improvement in respiratory function and physical performance at 6 and 12 months after acute disease.Copyright © 2022 EDIZIONI MINERVA MEDICA.

Review of Benchmark Analysis during COVID-19: Case Study Analysis in Three Industries Particularly Affected by the Pandemic

This article discusses the potential adjustments adopted in the benchmark analysis for selected industries for the year 2020. The chosen sectors – apparel and non-apparel retail, oil and gas, and air transportation and tourism – are examined in detail in specific case studies. © IBFD.

Covid-19: The Effect on Hospitalization Patient of Ophthalmology Department in "Antonio Cardarelli” Hospital

A pneumonia outbreak of unknown origin was reported in Wuhan, China in late December. This virus, called coronavirus-2, has an impact on the respiratory tract, leading to acute respiratory syndromes. In 2020, this virus was declared a pandemic by the World Health Organization since it caused a high number of deaths worldwide. In addition, this pandemic has had a negative impact on the world economy, focusing the attention of the practitioners on the resource management in health structures. This work was carried out to evaluate the effects of the pandemic on the ordinary hospitalization activities of the Department of Ophthalmology at "A. Cardarelli” based in Naples (Italy). The dataset was evaluated using statistical analysis techniques and logistic regression. The results, for this department, did not show significant differences when comparing the health variables of the pre-pandemic year (2019) with the pandemic year (2020). © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Analysis of Hospital Admissions of Neurological Patients in the COVID-19 Era: Comparison Between Hospitals

In the last few years, the COVID-19 pandemic has strongly affected different hospital departments, revealing their major weaknesses. For this reason, this emergency has been a driver for healthcare transformation in a very short interval of time in order to optimize the resources, minimize costs and simultaneously increase the caring services, also limiting over-occupancy in wards, especially emergency ones. One of the main factors for assessing the efficiency of a department is associated with how long a patient stays in the facility (LOS). This bicentric study investigated how COVID-19 has modified the activity of the Complex Operative Unit (C.O.U.) of Neurology and Stroke of the University Hospital "San Giovanni di Dio e Ruggi d'Aragona” of Salerno (Italy) and the hospital A.O.R.N. "Antonio Cardarelli” of Naples (Italy). In the work data for the year 2019 (in the absence of Covid-19) and in the year of Covid-19 pandemic 2020 were considered. This work used the logistic regression technique to study the following variables: age, gender, length of stay (LOS), relative weight of DRG and mode of discharge. The analysis shows that in 2020 there was a greater adequacy of admissions, with an increase in the relative weight of DRG. And the statistical analysis obtained the following significant variables: gender, age, relative weight of DRG and discharge mode. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Impact of COVID-19 in a Surgery Department: Comparison Between Two Italian Hospitals

The main phenomenon that impacted people's lives was the COVID-19 pandemic, having strong consequences on national health systems. Since the beginning of the Covid-19 pandemic, hospital admissions dropped precipitously in 2020. Our aim concerns the analysis about how the COVID-19 affects the activity of the Department of General Surgery, Day Surgery and Breast Unit in the University Hospital "San Giovanni di Dio and Ruggi d'Aragona” of Salerno and the hospital "A.O.R.N. Antonio Cardarelli” of Naples (Italy). In the work data for the year 2019 (in the absence of pandemic) and in the year of pandemic 2020 were considered. This work used the logistic regression technique to study the following variables: age, gender, length of stay (LOS), relative weight of DRG, admission procedure, mode of discharge and the results about both hospitals were used to make a comparison. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Use of Statistical Analysis to Evaluate How Covid-19 Has Changed the Management of the Neurosurgery Department of the AORN "A. Cardarelli” in Naples

The pandemic related to the Covid-19 virus that began in 2019 in China and then extended to the rest of the world has led to changes in the management of almost all clinical specializations. The main adaptations are due not only to changes in managerial management to better address organizational difficulties but there have also been variations from a treatment and care management point of view with respect to different clinical sectors including that relating to the Neurosurgery sector. In our analysis, the activity of the Department of Neurosurgery in AORN "A. Cardarelli” in Naples (Italy) was analysed. In particular, our analysis aims to investigate variables pre and post pandemic, comparing information gathered in 2019 and 2020. In the specific case, the hospitalizations of 2177 patients were considered in order to understand the influences that the Department has suffered due to the difficulties linked to the pandemic. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

The role of Zn ions in the interaction between SARS-CoV-2 orf7a protein and BST2/tetherin.

In this paper, we provide evidence that Zn 2 + ions play a role in the SARS-CoV-2 virus strategy to escape the immune response mediated by the BST2-tetherin host protein. This conclusion is based on sequence analysis and molecular dynamics simulations as well as X-ray absorption experiments [1].

Maladie de Kawasaki de l'adulte satellite d'une infection à SARS-CoV-2

Introduction: L'infection par le SARS-CoV-2 est responsable de nombreuses atteintes cutanées. Des syndromes proches de la maladie de Kawasaki ont été décrits dans la littérature, notamment chez les enfants, avec des tableaux abdominaux et systémiques parfois mortels.Nous présentons un cas de maladie de Kawasaki satellite d'une infection à SARS-CoV-2 avec retard diagnostique. Observations: Un homme de 24 ans sans antécédent notable consultait pour des douleurs abdominales fébriles associées à des diarrhées. Une échographie trouvait un épaississement des parois vésiculaires. Un traitement symptomatique était prescrit par son médecin traitant qui signalait la présence initiale d'adénopathies cervicales bilatérales.Il consultait aux urgences après 5 jours d'évolution devant l'absence d'amélioration clinique. Il était fébrile avec un syndrome inflammatoire important (CRP 125 mg/L, hyperleucocytose à 10 000/mm3) associé à une cytolyse hépatique et un ictère cholestatique. Une PCR COVID systématique aux urgences était positive. La prise en charge initiale aux urgences était celle d'une angiocholite, avec début d'une antibiothérapie probabiliste par ceftriaxone et métronidazole. Les explorations radiologiques ne montraient pas de dilatation des voies biliaires ni de calcul. Au troisième jour d'hospitalisation, il présentait une desquamation des mains et des pieds en doigts de gants et du scrotum, une fièvre persistante, une conjonctivite, une chéilite avec langue framboisée. Biologiquement on notait une hypoalbuminémie et une leucocyturie aseptique.Le diagnostic retenu était alors celui d'une maladie de Kawasaki satellite d'une infection COVID. La prise en charge thérapeutique adaptée au diagnostic associait une corticothérapie générale à 1 mg/kg et une cure d'immunoglobuline intraveineuse (IgIV) à 1 g/kg/j sur 2 jours. Un traitement par aspirine 100 mg par jour était également débuté. Au lendemain des IgIV, la fièvre cessait, et le patient se rétablissait. Le bilan cardiologique (ECG, ETT et IRM cardiaque) était normal et le patient n'avait pas eu de défaillance hémodynamique.Un coroscanner est programmé pour s'assurer de l'absence d'atteinte coronarienne au décours. Discussion: Il s'agit d'un cas de maladie de Kawasaki au décours d'une infection par la COVID-19 avec retard de diagnostic. En effet, la prise en charge initiale avait été celle d'une angiocholite. La maladie de Kawasaki associée à une infection par le SARS-CoV-2 de l'adulte est moins fréquente que chez l'enfant. Néanmoins, les complications peuvent être sévères et le diagnostic sémiologique précoce est nécessaire pour adapter rapidement la prise en charge.

Logistic regression to study the change in length of stay in a department of ophthalmology in CoViD-19 era

The CoViD-19 pandemic since December 2019 has rapidly spread around the world and to date does not seem to stop its run. The world has paid a very high price in terms of human lives lost and economic repercussions. Health systems have generally been severely tested. The strong demand for CoViD-19 patients has resulted in the blocking of deferred elective procedures and a reconversion of beds and human and technological resources towards the management of the pandemic. In this work, the activity of the Department of Ophthalmology in "San Giovanni di Dio and Ruggi d'Aragona"University Hospital of Salerno (Italy) was analyzed. Specifically, the value obtained from a set of data in the year 2019 (pre-pandemic) was compared with that obtained in the following year, in the height of the pandemic. The results show that patients admitted in 2020 have a shorter length of stay. © 2021 ACM.

Analysis of the adequacy of admissions in a complex operative unit of general surgery and day surgery and breast unit

Hospital admissions and surgical activities have undergone substantial changes due to the spread of the coronavirus 19 (CoViD-19) pandemic. To date, however, there are in increasingly number studies that have quantified the effect of the pandemic and its protocols on hospital activity. Unlike other studies, which identify protocols for the containment of infections, in this study, logistic regression and statistical analysis were used to evaluate the type of patients admitted to the Complex Operative Unit (COU) of General Surgery and Day Surgery and Breast Unit in "San Giovanni di Dio and Ruggi d'Aragona"University Hospital of Salerno (Italy) in CoViD-19 era. Specifically, the aim is to study how hospitalized patients has changed by investigating the relative parameters extracts from hospital discharge forms, comparing year 2019 and year 2020. The result shows that in year 2020, the weight of Diagnostic Related Group (DRG) was significantly higher and it highlighted an increased use of the emergency hospitalization. © 2021 ACM.

Appropriate admission in Covid-19 era: The case study of the C.O.U. neurology and stroke unit

Hospital services absorb almost half of the costs of the health sector;therefore, it is necessary to promote the effectiveness, efficiency and appropriateness of the services provided. These concepts become even more important in the era of the CoViD-19 pandemic, where the efforts made to manage it have absorbed all hospital resources. Inappropriate hospitalization and length of stay (LOS) are the factors that impose higher costs on hospitals. This study analyzed how CoViD-19 changed the activity of the Department of Neurology and Stroke Unit of the "San Giovanni di Dio e Ruggi d'Aragona"University Hospital of Salerno (Italy). Logistic regression showed a significant increase in relative Diagnosis Related Group (DRG) weight which translates into greater appropriateness of admission diagnoses. © 2021 ACM.

Using statistical analysis and logistic regression to study the effect of CoViD-19 on hospital activities of the C.O.U. general surgery and kidney transplants

Due to the Sars-Cov-2 pandemic, the entire health sector in all countries around the world had to reorganize. It was not only a question of increasing the number of intensive care places, but all other medical specialties also had to rewrite their protocols. In this context, it is interesting to investigate whether these new measures have changed the volume of activity and the way hospital departments work. The aim of this study is precisely to verify what has happened to the Transplantation and Related Surgery Centre of the "San Giovanni di Dio e Ruggi d'Aragona"University Hospital of Salerno. For this reason, data were collected on patients who were admitted in 2019 (pre-pendemic) and 2020. The statistical analysis carried out showed that nothing had changed in this department in 2020. © 2021 ACM.

SARS-CoV-2 infection in liver transplantation is associated with favorable outcomes: an Italian transplant registry study

Background and aims: Solid organ transplant recipients (SOTRs) have been considered as an extremely vulnerable population in respect to SARS-CoV-2 infection. We aimed to assess the incidence and lethality rate of SARS-CoV-2 infection in different organ transplant settings using the liver as a comparator. Methods: In this nationwide population-based study we compared the crude incidence and lethality rates of SARS-CoV-2 infection [95% Bonferroni adjusted CI (Ba-CI)] among Italian LTRs as compared to non-liver SOTRs and to general population. The following independent groups had been compared: Italian general population, all SOTRs, liver transplant recipients (LTRs) and non-Liver SOTRs in area with different incidence of infection. Incidence rate ratio (IRR) and lethality rate ratio (LRR) was assessed. Community risk exposures in transplant settings were assessed. Results: From February 21 to June 22, 2020, there were 450 cases of SARS-CoV-2 infections over 14168 LTRs (n=89) and 29815 non-liver SOTRs (n= 361). A significantly lower risk of infection [IRR 0.56 (Ba-CI 0.34-0.92), 0.45 (Ba-CI 0.26-0.79), 0.52 (Ba-CI 0.36-0.75)] and a lower lethality rate ratio [(LRR 0.61 (Ba-CI 0.23-1.57), 0.37 (0.08-1.76), 0.52 (0.23-1.18] was found among LTRs as compared to non-liver SOTRs in the three areas. Excluding Lombardy, the risk of infection and lethality in LTRs was lower compared to general population. Non-Liver SOTRs showed an increased risk of infection and lethality at all geographic levels compared to general population. No significant difference in the adherence to mitigation policies was found. Conclusions: Liver transplantation was associated with a significantly lower risk of SARS-CoV-2 infection and lethality in respect to non-liver solid organ transplants. A separate evaluation of organ-specific risk stratification analysis and vaccination responses in transplant population is needed.

A Phase 1b Study of Blinatumomab Including Subcutaneous Administration in Relapsed / Refractory (R/R) Indolent Non Hodgkin's Lymphoma (NHL)

Background: Blinatumomab, a bispecific T-cell engager (BiTE ®) molecule that directs cytotoxic T-cells to lyse CD19-expressing B lineage cells, has been investigated in NHL (Goebeler JCO 2016, Viardot Blood 2016, Katz ASH 2019). Here, we evaluated subcutaneous (SC) blinatumomab, which may simplify administration, improve convenience, and potentially reduce adverse events (AEs). Methods: Patients (pts;≥18 y) had indolent NHL (follicular, marginal zone, lymphoplasmacytic, mantle cell, or small lymphocytic) that was primary refractory (1+ prior line), relapsed (within 1 y of first response), or that had responded to initial therapy for ≥1 y and relapsed after 2+ lines, including an anti-CD20 monoclonal antibody. Disease must not have been irradiated and was measurable (≥1.5 cm) on PET-CT or CT. Pts had a 3-wk continuous intravenous (cIV) run-in period followed by SC dosing in 5 cohorts, a further 2 wks of cIV dosing, and the option for a second cycle of cIV dosing (Figure). The primary objective was safety and tolerability of SC blinatumomab;secondary objectives included pharmacokinetics (PK), estimating the maximum tolerated dose (MTD), ie, the highest dose at which ≤1/6 pts had a dose-limiting toxicity (DLT), and efficacy (NCT 02961881). Results: Pts (n=29) had a median (range) age of 64 (42-75) y, 55% were male, 90% Caucasian, with follicular I-IIIA (76%), marginal zone (10%), mantle cell (10%) and lymphoplasmacytic lymphoma (3%) subtypes;no pts had prior allo-hematopoietic stem cell transplant (HSCT), 38% had prior auto-HSCT. Of the 29 pts, 5 discontinued (D/C) blinatumomab due to AEs (n=3;2 cIV, 1 SC), pt request (1), and disease progression (1);no pts D/C due to COVID-19 control measures;26 pts completed the study;pts received a median (range) of 5 (3-10) doses. AEs leading to D/C in SC treatment included neurologic events of aphasia and seizure. During SC dosing, 2 DLTs occurred (aphasia, n=1;seizure, n=1 ). MTD was not reached. Five pts had grade 3 (G3) AEs (thrombocytopenia, erosive esophagitis, asthenia, device-related infection, hyperglycemia, aphasia, seizure;pts may have had >1 G3 AE);there were no G4 AEs or fatal AEs. AEs of interest included neurologic events (all, n=15;G3, n=2), infection (2;1), and cytokine release syndrome (4;0). One pt had grade 1 injection site erythema. Anti-blinatumomab antibodies have not been detected to date. Preliminary PK results were consistent across the 5 SC cohorts and 3 different dosing regimens. Following the first dose, maximum concentrations (C max) were reached after ~5-12 hours and exposures (C max and area under concentration-time curve [AUC] from 0-12 hours) increased in a dose-related manner. At steady state, exposures (AUC over the dosing interval) increased in a dose-related manner for dosing intervals of once every 12, 24, and 48 hours across cohorts. Blinatumomab bioavailability and apparent terminal elimination half-life were favorable for extending the dosing interval to once every other day and potentially longer intervals. The steady-state concentrations during both cIV infusion periods were consistent with those previously reported in NHL pts. In all pts, the overall response rate (ORR, representative of cIV, 5 wks and SC, 1wk) per Cheson criteria was 69% (evaluable, n=23: complete response [CR], 21%;partial response [PR], 48%;cycle 1 [C1], n=22: ORR, 62%;CR, 14%;PR,48%;cycle 2 [C2], n=17: 45%;17%;28%;respectively);per Lugano criteria, the ORR was 52% (n=21: CR, 24%;PR, 28%;C1, n=18: 45%;17%;28%;C2, n=12: 31%;21%;10%);for follicular lymphoma, ORR was 77% per Cheson (n=19: CR, 23%;PR, 55%) and 55% per Lugano (n=15: CR, 23%;PR, 32%). Conclusions: In pts with R/R indolent NHL, SC blinatumomab had a favorable safety profile, with the caveat that pts who could not tolerate cIV blinatumomab did not advance to SC dosing. Efficacy was comparable with that seen for cIV dosing in prior blinatumomab NHL studies. In contrast to prior blinatumomab trials, no dose dependency in efficacy or toxicity was observed because SC dosi g was administered for only 1 wk, after 3 wks of cIV;pts not tolerating cIV did not receive SC dosing. Safety/tolerability of blinatumomab SC administration over the whole cycle is currently being evaluated in a phase 1 trial of pts with R/R acute lymphoblastic leukemia (NCT 04521231). SC blinatumomab PK, including bioavailability and half-life, showed promising features, warranting further investigation. [Formula presented] Disclosures: Rossi: Astellas: Membership on an entity's Board of Directors or advisory committees;Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees;Abbvie: Membership on an entity's Board of Directors or advisory committees;Alexion: Membership on an entity's Board of Directors or advisory committees;Sanofi: Honoraria;Takeda: Membership on an entity's Board of Directors or advisory committees;Celgene: Membership on an entity's Board of Directors or advisory committees;Daiichi Sankyo: Consultancy, Honoraria;Janssen: Membership on an entity's Board of Directors or advisory committees;Jazz: Membership on an entity's Board of Directors or advisory committees;Novartis: Membership on an entity's Board of Directors or advisory committees;Pfizer: Membership on an entity's Board of Directors or advisory committees. Prince: Takeda: Consultancy, Honoraria;Amgen: Honoraria, Research Funding;Novartis: Honoraria. Tam: Janssen: Consultancy, Honoraria, Research Funding;BeiGene: Consultancy, Honoraria;AbbVie: Consultancy, Honoraria, Research Funding;Loxo: Consultancy;Roche: Consultancy, Honoraria;Novartis: Honoraria;Pharmacyclics: Honoraria. Ku: Roche: Consultancy;Genor Biopharma: Consultancy;Antegene: Consultancy. Thieblemont: Gilead Sciences: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses;Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding;Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees;Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees;Kyte: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses;Bristol Myers Squibb/Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses;Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses;Incyte: Honoraria, Membership on an entity's Board of Directors or advisory committees;Abbvie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses;Cellectis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses;Hospira: Research Funding;Bayer: Honoraria;Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses. Popplewell: Pfizer: Other: Travel;Hoffman La Roche: Other: Food;Novartis: Other: Travel. Wermke: Novartis, Roche, Pfizer, BMS: Consultancy, Honoraria, Research Funding. Haioun: Roche: Consultancy, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company);Janssen-Cilag: Consultancy;Celgene: Consultancy, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company);Novartis: Honoraria;Amgen: Honoraria, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company);Servier/Pfizer: Honoraria;Gilead Sciences: Consultancy, Honoraria;Takeda: Consultancy;Miltenyi Biotec: Consultancy. Viardot: Bristol-Myers Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees;Amgen: Membership on an entity's Board of Directors or advisory committees;Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees;Kite/Gilead: Honoraria, Membership on an entity's Board of Directors or advisory committees;F. Hoffmann-La Roche Ltd: Honoraria, Membership on an entity's Board of Directors or advisory committees;University Hospital of Ulm: Current Employment. Ferreri: Pfizer: Research Funding;x Incyte: Membership on an entity's Board of Directors or advisory committees;Amgen: Research Funding;Genmab: Research Funding;BMS: Research Funding;Hutchison Medipharma: Research Funding;PletixaPharm: Membership on an entity's Board of Directors or advisory committees;Adienne: Membership on an entity's Board of Directors or advisory committees;ADC Therapeutics: Research Funding;Gilead: Membership on an entity's Board of Directors or advisory committees, Research Funding;Roche: Membership on an entity's Board of Directors or advisory committees, Research Funding;Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding;Ospedale San Raffaele srl: Patents & Royalties;Beigene: Research Funding. Wong: Amgen: Current Employment;Amgen: Current equity holder in publicly-traded company. Kadu: IQVIA: Current Employment. Zugmaier: Amgen: Current Employment;Micromet/Amgen: Patents & Royalties: Patents 20190300609 and 20130323247 licensed;receives royalties of family members of international applications published as WO2010/052014;WO2010/052013;WO2011/051307;WO2012/055961;WO 2012/062596;WO2014/122251;and WO2015/181683;Amgen: Current equity holder in publicly-traded company. Zeng: Amgen: Current Employment, Current equity holder in publicly-traded company. Rambaldi: Celgene: Other: Travel, Accommodations, Expenses;Jazz Pharmaceuticals: Consultancy;Astellas Pharma: Consultancy;Novartis: Consultancy;Omeros: Consultancy, Honoraria;Amgen: Consultancy, Honoraria. OffLabelDisclosure: Blinatumomab is approved in the United States for administration as a continuous intravenous infusion. It has not been approved for subcutaneous administration.

Production and persistence of specific antibodies in COVID-19 patients with hematologic malignancies: role of rituximab.

The ability of patients with hematologic malignancies (HM) to develop an effective humoral immune response after COVID-19 is unknown. A prospective study was performed to monitor the immune response to SARS-CoV-2 of patients with follicular lymphoma (FL), diffuse large B-cell lymphoma (DLBCL), chronic lymphoproliferative disorders (CLD), multiple myeloma (MM), or myelodysplastic/myeloproliferative syndromes (MDS/MPN). Antibody (Ab) levels to the SARS-CoV-2 nucleocapsid (N) and spike (S) protein were measured at +1, +3, +6 months after nasal swabs became PCR-negative. Forty-five patients (9 FL, 8 DLBCL, 8 CLD, 10 MM, 10 MDS/MPS) and 18 controls were studied. Mean anti-N and anti-S-Ab levels were similar between HM patients and controls, and shared the same behavior, with anti-N Ab levels declining at +6 months and anti-S-Ab remaining stable. Seroconversion rates were lower in HM patients than in controls. In lymphoma patients mean Ab levels and seroconversion rates were lower than in other HM patients, primarily because all nine patients who had received rituximab within 6 months before COVID-19 failed to produce anti-N and anti-S-Ab. Only one patient requiring hematological treatment after COVID-19 lost seropositivity after 6 months. No reinfections were observed. These results may inform vaccination policies and clinical management of HM patients.

Long-term follow-up of recovered mpn patients with covid-19

To our knowledge, there is no information on long-term follow-up of recovered patients with chronic myeloproliferative neoplasms (MPN) with COVID-19. It can be hypothesized that cytokine storm of the acute phase and the post-COVID persistence of a residual inflammatory state may contribute to elicit hematopoietic stem cell insults and continuous vascular endothelial damage, leading to MPN disease progression and persistent high risk of thrombosis. Aims: To describe sequelae of COVID-19 in surviving patients with MPN following COVID-19. Methods: MPN-COVID study involved 38 European blood centers, and accrued 180 patients with MPN diagnosed with COVID-19 from Feb to Jun 2020, assessing mortality and incidence of thrombosis and bleeding during the acute phase of the pandemic [Barbui T et al. Leukemia. 2021;35(2):485-493. Barbui T et al. Blood Cancer J. 2021;11(2):21]. One-hundred-twenty-five (69%) of these patients survived and were followed up for at least 6 months. Centers were asked to update symptoms, treatments, hematological changes, major outcomes (i.e., thrombosis, disease evolution and death). Results: Among the 125 surviving patients, all eligible for the follow-up update, with a median age 70 years (IQR: 58-79), the following phenotypes were registered: PV (n=38, 30%), ET (n=37, 30%), early PMF (n=14, 11%) and MF (n=36, 29%). During the acute phase of infection, 38 (30%) were managed at home, 80 (64%) in a regular ward and 7 (6%) in ICU. Symptoms (i)The 3 prevalent symptoms during the acute phase of the disease were fever (79%), cough (56%) and dyspnea (53%), while gastrointestinal, neurological, musculoskeletal symptoms, as well as fatigue and anosmia/ dysgeusia, were present in a minor proportion, ranging from 1.6% to 17%. (ii) In the post-acute COVID-19 phase, 36 of 125 patients (32%) declared the persistence of some of these symptoms, fatigue being the most frequent (19%), while none presented persistence of fever and only 10% of dyspnea. Major outcomes (i) Major thrombosis was documented in 5 patients and involved 3 patients with MF (one fatal intestinal ischemia, two non-fatal events: splenic infarction and peripheral artery thrombosis), one case in PV (acute myocardial infarction) and one with ET (DVT of the legs with pulmonary embolism). Age varied from 61 to 80 years. The first event occurred five months after COVID-19 recovery and the Kaplan Meier thrombosis-free survival probability after 9 months was 82%. (ii) Acute myelogenous leukemia (AML) was ascertained in 3 patients (1 in MF, 1 in early-PMF, 1 in ET);one was fatal and occurred in a 49-yearold patient, the other 2 in 78- and 82-year-old patients, respectively. One non-Hodgkin′s lymphoma (in ET) and one progression of a previous parotid carcinoma (in MF) were seen in two patients aged 60 and 77 years, respectively. (iii) Deaths were reported in 8 patients (6.4%), due to AML (n=1), thrombosis (n=1), progression to prior carcinoma (n=2, 1 suspected), multi organ failure (n=1) and heart failure (n=2);the cause was unknown in a single patient. Five deaths (63%) occurred in MF patients. (iv) Overall, the event-free survival pooling together thrombosis, disease evolution and death reached 66% after 9 months from COVID- 19 recovery, indicating that, during this time of observation, 1 out of 3 patients died or have experienced at least one of the other two severe events. Summary/Conclusion: These results indicate that MPN patients who have survived SARS-CoV-2 infection continue to experience severe events suggesting an increased vigilance in the post-COVID period.