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3.
Front Cell Infect Microbiol ; 12: 928344, 2022.
Article in English | MEDLINE | ID: covidwho-1892619
4.
Clin Lymphoma Myeloma Leuk ; 22(8): e691-e707, 2022 08.
Article in English | MEDLINE | ID: covidwho-1763646

ABSTRACT

BACKGROUND: The humoral response to vaccination in individuals with lymphoid malignancies or those undergoing anti-CD20 antibody therapy is impaired, but details of the response to mRNA vaccines to protect against COVID-19 remain unclear. This systematic review and meta-analysis aimed to characterize the response to COVID-19 mRNA vaccines in patients with lymphoid malignancies or those undergoing anti-CD20 antibody therapy. MATERIALS AND METHODS: A literature search retrieved 52 relevant articles, and random-effect models were used to analyze humoral and cellular responses. RESULTS: Lymphoid malignancies and anti-CD20 antibody therapy for non-malignancies were significantly associated with lower seropositivity rates (risk ratio 0.60 [95% CI 0.53-0.69]; risk ratio 0.45 [95% CI 0.39-0.52], respectively). Some subtypes (chronic lymphocytic leukemia, treatment-naïve chronic lymphocytic leukemia, myeloma, and non-Hodgkin's lymphoma) exhibited impaired humoral response. Anti-CD20 antibody therapy within 6 months of vaccination decreased humoral response; moreover, therapy > 12 months before vaccination still impaired the humoral response. However, anti-CD20 antibody therapy in non-malignant patients did not attenuate T cell responses. CONCLUSION: These data suggest that patients with lymphoid malignancies or those undergoing anti-CD20 antibody therapy experience an impaired humoral response, but cellular response can be detected independent of anti-CD20 antibody therapy. Studies with long-term follow-up of vaccine effectiveness are warranted (PROSPERO registration number: CRD42021265780).


Subject(s)
COVID-19 , Leukemia, Lymphocytic, Chronic, B-Cell , Lymphoma, Non-Hodgkin , COVID-19/prevention & control , COVID-19 Vaccines/therapeutic use , Humans , Leukemia, Lymphocytic, Chronic, B-Cell/therapy , Vaccines, Synthetic , mRNA Vaccines
5.
Haematologica ; 107(2): 353-354, 2022 02 01.
Article in English | MEDLINE | ID: covidwho-1725345
6.
Br J Haematol ; 196(6): 1329-1333, 2022 03.
Article in English | MEDLINE | ID: covidwho-1648446

ABSTRACT

This prospective study evaluated seroconversion rates in response to BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine booster in 44 B-cell non-Hodgkin lymphoma (B-NHL) patients who failed to respond to two prior doses [42 previously exposed to anti-CD20 monoclonal antibodies (moAbs) including 13 under maintenance treatment]. Seroconversion was obtained in 29.5% of the patients. Longer time from last anti-CD20 moAb (>6 months) and diagnosis of aggressive lymphoma compared to other, incurable B-NHLs were associated with increased seroconversion rates (47.8% vs.10.5%, p = 0.019 and 50% vs. 17.9%, p = 0.025 respectively). Thus, seronegative patients with B-NHL that completed anti-CD20 therapy more than 6 months prior to the booster have greater chances to achieve seroconversion.


Subject(s)
COVID-19 , Lymphoma, Non-Hodgkin , Vaccines , COVID-19/prevention & control , COVID-19 Vaccines , Humans , Immunization, Secondary , Lymphoma, Non-Hodgkin/therapy , Prospective Studies , RNA, Messenger , SARS-CoV-2 , Seroconversion
7.
Exp Hematol ; 107: 20-23, 2022 03.
Article in English | MEDLINE | ID: covidwho-1587768

ABSTRACT

The Covid-19 pandemic has caused millions of deaths worldwide. Although vaccines have been developed, patients on immunosuppressive therapy are less likely to respond. This study was aimed at investigating the efficacy of a Covid-19 vaccine (Pfizer-BioNTech) in patients with non-Hodgkin lymphoma treated with anti-CD20 monoclonal antibodies. Only 1 of 28 lymphoma patients (3.6%) developed a seropositive response, compared with 100% (28/28) of the healthy volunteers. The low levels of CD19+ lymphocytes among the lymphoma patients suggest that anti-CD20 treatment prevents the seropositive response to the vaccine. An additional vaccination might be indicated in these patients once B cells are repopulated.


Subject(s)
COVID-19 , Lymphoma, Non-Hodgkin , Antibodies, Monoclonal/therapeutic use , COVID-19/prevention & control , COVID-19 Vaccines , Humans , Lymphoma, Non-Hodgkin/drug therapy , Pandemics , SARS-CoV-2 , Vaccination
10.
Br J Nurs ; 30(17): S16-S22, 2021 Sep 23.
Article in English | MEDLINE | ID: covidwho-1450994

ABSTRACT

In the extraordinary times the COVID-19 pandemic has created for cancer patients and the health professionals caring for them, the need for strong knowledge and understanding of disease processes and treatments has never been more important. This article presents a review of Hodgkin lymphoma and non-Hodgkin lymphoma. These two common haematology diagnoses are frequently suspected by GPs and non-cancer professionals, and subsequently treated by haematologists and chemotherapy outpatient departments across the country. It is therefore important for all health professionals, including nurses in all settings, to be aware of the main characteristics of both of these lymphomas. There are strong similarities and striking differences between the disease processes, the presenting symptoms, prognostics and treatment pathways. The age of presentation in each is markedly different. There is a significant contrast in the number of subtypes between the two diagnoses, but the presenting symptoms are similar as are investigations required for diagnoses.


Subject(s)
COVID-19 , Lymphoma, Non-Hodgkin , Health Personnel , Humans , Lymphoma, Non-Hodgkin/diagnosis , Lymphoma, Non-Hodgkin/drug therapy , Pandemics , SARS-CoV-2
11.
BMC Infect Dis ; 21(1): 809, 2021 Aug 12.
Article in English | MEDLINE | ID: covidwho-1440906

ABSTRACT

BACKGROUND: The current literature is scarce as to the outcomes of COVID-19 infection in non-Hodgkin's lymphoma patients and whether immunosuppressive or chemotherapeutic agents can cause worsening of the patients' condition during COVID-19 infection. CASE PRESENTATION: Our case is a 59-year-old gentleman who presented to the Emergency Department of the Cancer Institute of Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil on 10th May 2020 with a worsening dyspnea and chest pain which had started 3 days prior to presentation to the Emergency Department. He had a past history of non-Hodgkin's lymphoma for which he was receiving chemotherapy. Subsequent PCR testing demonstrated that our patient was SARS-CoV-2 positive. CONCLUSION: In this report, we show a patient with non-Hodgkin lymphoma in the middle of chemotherapy, presented a mild clinical course of COVID-19 infection.


Subject(s)
COVID-19 , Lymphoma, Non-Hodgkin , Brazil , Humans , Immunosuppressive Agents , Lymphoma, Non-Hodgkin/complications , Lymphoma, Non-Hodgkin/drug therapy , Male , Middle Aged , SARS-CoV-2
15.
Blood Adv ; 5(16): 3053-3061, 2021 08 24.
Article in English | MEDLINE | ID: covidwho-1357010

ABSTRACT

Patients diagnosed with B-cell non-Hodgkin lymphoma (B-NHL), particularly if recently treated with anti-CD20 antibodies, are at risk of severe COVID-19 disease. Because studies evaluating humoral response to COVID-19 vaccine in these patients are lacking, recommendations regarding vaccination strategy remain unclear. The humoral immune response to BNT162b2 messenger RNA (mRNA) COVID-19 vaccine was evaluated in patients with B-NHL who received 2 vaccine doses 21 days apart and compared with the response in healthy controls. Antibody titer, measured by the Elecsys Anti-SARS-CoV-2S assay, was evaluated 2 to 3 weeks after the second vaccine dose. Patients with B-NHL (n = 149), aggressive B-NHL (a-B-NHL; 47%), or indolent B-NHL (i-B-NHL; 53%) were evaluated. Twenty-eight (19%) were treatment naïve, 37% were actively treated with a rituximab/obinutuzumab (R/Obi)-based induction regimen or R/Obi maintenance, and 44% had last been treated with R/Obi >6 months before vaccination. A seropositive response was achieved in 89%, 7.3%, and 66.7%, respectively, with response rates of 49% in patients with B-NHL vs 98.5% in 65 healthy controls (P < .001). Multivariate analysis revealed that longer time since exposure to R/Obi and absolute lymphocyte count ≥0.9 × 103/µL predicted a positive serological response. Median time to achieve positive serology among anti-CD20 antibody-treated patients was longer in i-B-NHL vs a-B-NHL. The humoral response to BNT162b2 mRNA COVID-19 vaccine is impaired in patients with B-NHL who are undergoing R/Obi treatment. Longer time since exposure to R/Obi is associated with improved response rates to the COVID-19 vaccine. This study is registered at www.clinicaltrials.gov as #NCT04746092.


Subject(s)
COVID-19 , Lymphoma, Non-Hodgkin , B-Lymphocytes , COVID-19 Vaccines , Humans , Lymphoma, Non-Hodgkin/therapy , RNA, Messenger , SARS-CoV-2
16.
mSphere ; 6(4): e0024421, 2021 08 25.
Article in English | MEDLINE | ID: covidwho-1329039

ABSTRACT

Recent studies have shown that persistent SARS-CoV-2 infections in immunocompromised patients can trigger the accumulation of an unusual high number of mutations with potential relevance at both biological and epidemiological levels. Here, we report a case of an immunocompromised patient (non-Hodgkin lymphoma patient under immunosuppressive therapy) with a persistent SARS-CoV-2 infection (marked by intermittent positivity) over at least 6 months. Viral genome sequencing was performed at days 1, 164, and 171 to evaluate SARS-CoV-2 evolution. Among the 15 single-nucleotide polymorphisms (SNPs) (11 leading to amino acid alterations) and 3 deletions accumulated during this long-term infection, four amino acid changes (V3G, S50L, N87S, and A222V) and two deletions (18-30del and 141-144del) occurred in the virus Spike protein. Although no convalescent plasma therapy was administered, some of the detected mutations have been independently reported in other chronically infected individuals, which supports a scenario of convergent adaptive evolution. This study shows that it is of the utmost relevance to monitor the SARS-CoV-2 evolution in immunocompromised individuals, not only to identify novel potentially adaptive mutations, but also to mitigate the risk of introducing "hyper-evolved" variants in the community. IMPORTANCE Tracking the within-patient evolution of SARS-CoV-2 is key to understanding how this pandemic virus shapes its genome toward immune evasion and survival. In the present study, by monitoring a long-term COVID-19 immunocompromised patient, we observed the concurrent emergence of mutations potentially associated with immune evasion and/or enhanced transmission, mostly targeting the SARS-CoV-2 key host-interacting protein and antigen. These findings show that the frequent oscillation in the immune status in immunocompromised individuals can trigger an accelerated virus evolution, thus consolidating this study model as an accelerated pathway to better understand SARS-CoV-2 adaptive traits and anticipate the emergence of variants of concern.


Subject(s)
COVID-19/immunology , Immune Evasion/immunology , Immunocompromised Host/immunology , Lymphoma, Non-Hodgkin/immunology , SARS-CoV-2/immunology , Amino Acids/genetics , Amino Acids/immunology , Animals , COVID-19/virology , Cell Line , Chlorocebus aethiops , Female , Genome, Viral/genetics , Genome, Viral/immunology , Humans , Immune Evasion/genetics , Immunization, Passive/methods , Lymphoma, Non-Hodgkin/virology , Middle Aged , Mutation/genetics , Mutation/immunology , Pandemics/prevention & control , SARS-CoV-2/genetics , Vero Cells , Virus Replication/genetics , Virus Replication/immunology
17.
BMJ ; 374: n1647, 2021 07 21.
Article in English | MEDLINE | ID: covidwho-1320441

ABSTRACT

OBJECTIVE: To evaluate effects of remote monitoring of adjuvant chemotherapy related side effects via the Advanced Symptom Management System (ASyMS) on symptom burden, quality of life, supportive care needs, anxiety, self-efficacy, and work limitations. DESIGN: Multicentre, repeated measures, parallel group, evaluator masked, stratified randomised controlled trial. SETTING: Twelve cancer centres in Austria, Greece, Norway, Republic of Ireland, and UK. PARTICIPANTS: 829 patients with non-metastatic breast cancer, colorectal cancer, Hodgkin's disease, or non-Hodgkin's lymphoma receiving first line adjuvant chemotherapy or chemotherapy for the first time in five years. INTERVENTION: Patients were randomised to ASyMS (intervention; n=415) or standard care (control; n=414) over six cycles of chemotherapy. MAIN OUTCOME MEASURES: The primary outcome was symptom burden (Memorial Symptom Assessment Scale; MSAS). Secondary outcomes were health related quality of life (Functional Assessment of Cancer Therapy-General; FACT-G), Supportive Care Needs Survey Short-Form (SCNS-SF34), State-Trait Anxiety Inventory-Revised (STAI-R), Communication and Attitudinal Self-Efficacy scale for cancer (CASE-Cancer), and work limitations questionnaire (WLQ). RESULTS: For the intervention group, symptom burden remained at pre-chemotherapy treatment levels, whereas controls reported an increase from cycle 1 onwards (least squares absolute mean difference -0.15, 95% confidence interval -0.19 to -0.12; P<0.001; Cohen's D effect size=0.5). Analysis of MSAS sub-domains indicated significant reductions in favour of ASyMS for global distress index (-0.21, -0.27 to -0.16; P<0.001), psychological symptoms (-0.16, -0.23 to -0.10; P<0.001), and physical symptoms (-0.21, -0.26 to -0.17; P<0.001). FACT-G scores were higher in the intervention group across all cycles (mean difference 4.06, 95% confidence interval 2.65 to 5.46; P<0.001), whereas mean scores for STAI-R trait (-1.15, -1.90 to -0.41; P=0.003) and STAI-R state anxiety (-1.13, -2.06 to -0.20; P=0.02) were lower. CASE-Cancer scores were higher in the intervention group (mean difference 0.81, 0.19 to 1.43; P=0.01), and most SCNS-SF34 domains were lower, including sexuality needs (-1.56, -3.11 to -0.01; P<0.05), patient care and support needs (-1.74, -3.31 to -0.16; P=0.03), and physical and daily living needs (-2.8, -5.0 to -0.6; P=0.01). Other SCNS-SF34 domains and WLQ were not significantly different. Safety of ASyMS was satisfactory. Neutropenic events were higher in the intervention group. CONCLUSIONS: Significant reduction in symptom burden supports the use of ASyMS for remote symptom monitoring in cancer care. A "medium" Cohen's effect size of 0.5 showed a sizable, positive clinical effect of ASyMS on patients' symptom experiences. Remote monitoring systems will be vital for future services, particularly with blended models of care delivery arising from the covid-19 pandemic. TRIAL REGISTRATION: Clinicaltrials.gov NCT02356081.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Cell Phone , Drug-Related Side Effects and Adverse Reactions/diagnosis , Quality of Life , Telemedicine/methods , Adult , Aged , Austria , Breast Neoplasms/psychology , Breast Neoplasms/therapy , Chemotherapy, Adjuvant/adverse effects , Colorectal Neoplasms/psychology , Colorectal Neoplasms/therapy , Drug-Related Side Effects and Adverse Reactions/etiology , Drug-Related Side Effects and Adverse Reactions/psychology , Female , Greece , Hodgkin Disease/psychology , Hodgkin Disease/therapy , Humans , Ireland , Lymphoma, Non-Hodgkin/psychology , Lymphoma, Non-Hodgkin/therapy , Male , Middle Aged , Norway , Telemedicine/instrumentation , Treatment Outcome , United Kingdom
18.
Clin Exp Med ; 22(2): 319-323, 2022 May.
Article in English | MEDLINE | ID: covidwho-1317568

ABSTRACT

Vaccination against SARS-CoV-2 is considered as the most important preventive strategy against COVID-19, but its efficacy in patients with hematological malignancies is largely unknown. We investigated the development of neutralizing antibodies (NAbs) against SARS-CoV-2 in patients with Waldenstrom Macroglobulinemia (WM), Chronic Lymphocytic Leukemia (CLL) and Non-Hodgkin Lymphoma (NHL). After the first dose of the vaccine, on D22, WM/CLL/NHL patients had lower NAb titers compared to controls: the median NAb inhibition titer was 17% (range 0-91%, IQR 8-27%) for WM/CLL/NHL patients versus 32% (range 2-98%, IQR 19-48%) for controls (P < 0.001). Only 8 (14%) patients versus 114 (54%) controls developed NAb titers ≥ 30% on D22 (p < 0.001). Our data indicate that the first dose of both BNT162b2 and AZD1222 leads to lower production of NAbs against SARS-CoV-2 in patients with WM/CLL/NHL compared to controls of similar age and gender and without malignant disease. Even though the response rates were not optimal, vaccination is still considered essential and if possible should be performed before treatment initiation. These patients with suboptimal responses should be considered to be prioritized for booster doses.


Subject(s)
COVID-19 , Leukemia, Lymphocytic, Chronic, B-Cell , Lymphoma, Non-Hodgkin , Waldenstrom Macroglobulinemia , Antibodies, Neutralizing , Antibodies, Viral , BNT162 Vaccine , COVID-19/prevention & control , COVID-19 Vaccines , ChAdOx1 nCoV-19 , Humans , SARS-CoV-2
19.
Transfus Apher Sci ; 60(5): 103200, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1284583

ABSTRACT

Psoriasis is a chronic inflammatory skin disease that is characterized by well-demarcated erythematous plaques with a silver scale. Although many new and emerging therapeutic agents are often sufficient to control the disease, there is still a need for alternative treatment options in challenging cases. Extracorporeal photopheresis (ECP) has been applied to many T-cell-mediated diseases to restore immune homeostasis and treat psoriasis effectively. In this paper, we present a psoriasis patient who did not respond to methotrexate, narrowband ultraviolet B, or acitretin. Because of a diagnosis of non-Hodgkin lymphoma, the patient had contraindications for cyclosporine, fumaric acid esters, and biologics but achieved remission with a total of 12 sessions of ECP in two and a half months. Although exacerbation was recorded after polymerase chain reaction (PCR) confirmed coronavirus 2019 (COVID-19) disease infection at the end of the first month, scores from the psoriasis area severity index (PASI) and dermatological life quality index (DLQI) were regressed significantly within two and a half months. ECP seems to provide an effective and rapid response for psoriasis and should be considered for psoriasis patients who fail to respond or have contraindications to existing treatments.


Subject(s)
COVID-19/complications , Lymphoma, Non-Hodgkin/complications , Pandemics , Photopheresis , Psoriasis/drug therapy , SARS-CoV-2 , Acitretin/therapeutic use , Chemical and Drug Induced Liver Injury/etiology , Combined Modality Therapy , Contraindications, Drug , Cyclosporine/adverse effects , Humans , Male , Methotrexate/adverse effects , Methotrexate/therapeutic use , Middle Aged , Nails/pathology , Psoriasis/complications , Psoriasis/pathology , Psoriasis/radiotherapy , Quality of Life , Severity of Illness Index , Ultraviolet Therapy
20.
Blood Cancer J ; 11(6): 115, 2021 06 16.
Article in English | MEDLINE | ID: covidwho-1275905
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