Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Antígenos CD20/inmunología , Vacuna BNT162/administración & dosificación , Tratamiento Farmacológico de COVID-19 , Linfoma de Células B/inmunología , Linfoma no Hodgkin/inmunología , SARS-CoV-2/inmunología , Anciano , Anciano de 80 o más Años , COVID-19/inmunología , COVID-19/virología , Femenino , Estudios de Seguimiento , Humanos , Linfoma de Células B/sangre , Linfoma de Células B/tratamiento farmacológico , Linfoma de Células B/virología , Linfoma no Hodgkin/sangre , Linfoma no Hodgkin/tratamiento farmacológico , Linfoma no Hodgkin/virología , Masculino , PronósticoRESUMEN
We investigated the efficacy of BNT162b2 mRNA COVID-19 vaccine in patients with B-cell malignancies treated with anti-CD20 antibody. Although T-cell-mediated immune responses were detected even in patients receiving R-CHOP treatment, the S1 antibody titer following BNT162b2 vaccination remained only marginally increased for more than 3 years after the final dose of anti-CD20 antibody. We found no relationship between the percent of B-cells and S1 antibody titer. The duration of this suppression was much longer than we anticipated. Further protection and treatment strategies against COVID-19 for these patients are warranted.
Asunto(s)
Anticuerpos Monoclonales Humanizados/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Vacuna BNT162/uso terapéutico , COVID-19/prevención & control , Linfoma de Células B/complicaciones , Linfoma de Células B/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Formación de Anticuerpos , Antígenos CD20/inmunología , COVID-19/inmunología , Ciclofosfamida/uso terapéutico , Doxorrubicina/uso terapéutico , Femenino , Humanos , Linfoma de Células B/inmunología , Masculino , Persona de Mediana Edad , Prednisona/uso terapéutico , Rituximab/uso terapéutico , Vincristina/uso terapéuticoAsunto(s)
Anticuerpos Antivirales/inmunología , Antígenos Virales/inmunología , Linfocitos B/inmunología , Vacunas contra la COVID-19/inmunología , COVID-19/prevención & control , Linfoma de Células B/inmunología , SARS-CoV-2/inmunología , Glicoproteína de la Espiga del Coronavirus/inmunología , Vacunación , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Antivirales/biosíntesis , Anticuerpos Antivirales/sangre , Antineoplásicos/efectos adversos , Antineoplásicos/farmacología , Antineoplásicos/uso terapéutico , Linfocitos B/efectos de los fármacos , Instituciones Oncológicas , Estudios de Cohortes , Femenino , Personal de Salud , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Humanos , Inmunoglobulina G/biosíntesis , Inmunoglobulina G/sangre , Inmunoglobulina G/inmunología , Inmunoglobulina M/biosíntesis , Inmunoglobulina M/sangre , Inmunoglobulina M/inmunología , Inmunoterapia Adoptiva/efectos adversos , Institucionalización , Linfoma de Células B/terapia , Linfoma de Células T/inmunología , Linfoma de Células T/terapia , Masculino , Persona de Mediana Edad , Mieloma Múltiple/inmunología , Mieloma Múltiple/terapia , Casas de Salud , Pacientes , Estudios ProspectivosRESUMEN
Chimeric antigen receptor (CAR) T-cell therapies that specifically target the CD19 antigen have emerged as a highly effective treatment option in patients with refractory B-cell hematological malignancies. Safety and efficacy outcomes from the pivotal prospective clinical trials of axicabtagene ciloleucel, tisagenlecleucel and lisocabtagene maraleucel and the retrospective, postmarketing, real-world analyses have confirmed high response rates and durable remissions in patients who had failed multiple lines of therapy and had no meaningful treatment options. Although initially administered in the inpatient setting, there has been a growing interest in delivering CAR-T cell therapy in the outpatient setting; however, this has not been adopted as standard clinical practice for multiple reasons, including logistic and reimbursement issues. CAR-T cell therapy requires a multidisciplinary approach and coordination, particularly if given in an outpatient setting. The ability to monitor patients closely is necessary and proper protocols must be established to respond to clinical changes to ensure efficient, effective and rapid evaluation either in the clinic or emergency department for management decisions regarding fever, sepsis, cytokine release syndrome and neurological events, specifically immune effector cell-associated neurotoxicity syndrome. This review presents the authors' institutional experience with the preparation and delivery of outpatient CD19-directed CAR-T cell therapy.
Asunto(s)
Atención Ambulatoria , Antígenos CD19/inmunología , Inmunoterapia Adoptiva , Linfoma de Células B/terapia , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Receptores Quiméricos de Antígenos/genética , Linfocitos T/trasplante , Atención Ambulatoria/economía , Análisis Costo-Beneficio , Costos de Hospital , Humanos , Inmunoterapia Adoptiva/efectos adversos , Inmunoterapia Adoptiva/economía , Inmunoterapia Adoptiva/mortalidad , Linfoma de Células B/economía , Linfoma de Células B/inmunología , Linfoma de Células B/mortalidad , Seguridad del Paciente , Leucemia-Linfoma Linfoblástico de Células Precursoras/economía , Leucemia-Linfoma Linfoblástico de Células Precursoras/inmunología , Leucemia-Linfoma Linfoblástico de Células Precursoras/mortalidad , Medición de Riesgo , Factores de Riesgo , Linfocitos T/inmunología , Resultado del TratamientoRESUMEN
Since the coronavirus disease (COVID-19) pandemic was first identified in early 2020, rare cases of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in pet cats have been reported worldwide. Some reports of cats with SARS-CoV-2 showed self-limiting respiratory or gastrointestinal disease after suspected human-to-feline transmission via close contact with humans with SARS-CoV-2. In the present study, we investigated a cat with SARS-CoV-2 that was presented to a private animal clinic in Northern Italy in May 2020 in a weak clinical condition due to an underlying intestinal B-cell lymphoma. The cat developed signs of respiratory tract disease, including a sneeze, a cough and ocular discharge, three days after an oropharyngeal swab tested positive for SARS-CoV-2 viral RNA using two real-time reverse transcriptase polymerase chain reaction (RT-qPCR) assays for the envelope (E) and RNA-dependent RNA polymerase (RdRp) gene. Thus, SARS-CoV-2 viral RNA was detectable prior to the onset of clinical signs. Five and six months after positive molecular results, the serological testing substantiated the presence of a SARS-CoV-2 infection in the cat with the detection of anti-SARS-CoV-2 receptor binding domain (RBD) immunoglobulin (IgG) antibodies and neutralizing activity in a surrogate virus neutralization assay (sVNT). To the best of our knowledge, this extends the known duration of seropositivity of SARS-CoV-2 in a cat. Our study provides further evidence that cats are susceptible to SARS-CoV-2 under natural conditions and strengthens the assumption that comorbidities may play a role in the development of clinical disease.
Asunto(s)
Anticuerpos Neutralizantes/inmunología , Anticuerpos Antivirales/inmunología , COVID-19/veterinaria , Enfermedades de los Gatos/inmunología , Linfoma de Células B/veterinaria , Animales , Formación de Anticuerpos , COVID-19/inmunología , COVID-19/virología , Enfermedades de los Gatos/virología , Gatos , Inmunoglobulina G/inmunología , Italia , Linfoma de Células B/inmunología , Linfoma de Células B/virología , SARS-CoV-2 , Glicoproteína de la Espiga del CoronavirusAsunto(s)
COVID-19/complicaciones , Hipoxia/etiología , Terapia de Inmunosupresión , Leucemia de Células Pilosas/complicaciones , Leucemia Mieloide Aguda/complicaciones , Linfoma de Células B/complicaciones , Linfoma Folicular/complicaciones , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , COVID-19/inmunología , Neoplasias del Colon , Comorbilidad , Síndrome de Liberación de Citoquinas/etiología , Síndrome de Liberación de Citoquinas/prevención & control , Humanos , Hipoxia/terapia , Huésped Inmunocomprometido , Leucemia de Células Pilosas/tratamiento farmacológico , Leucemia de Células Pilosas/inmunología , Leucemia Mieloide Aguda/tratamiento farmacológico , Leucemia Mieloide Aguda/inmunología , Linfoma de Células B/tratamiento farmacológico , Linfoma de Células B/inmunología , Linfoma Folicular/tratamiento farmacológico , Linfoma Folicular/inmunología , Masculino , Neoplasias Primarias Secundarias/complicaciones , Terapia por Inhalación de Oxígeno , Pandemias , Recurrencia , Respiración Artificial , SARS-CoV-2RESUMEN
The SARS-CoV-2 coronavirus (COVID-19) pandemic has significantly impacted the delivery of cellular therapeutics, including chimeric antigen receptor (CAR) T cells. This impact has extended beyond patient care to include logistics, administration, and distribution of increasingly limited health care resources. Based on the collective experience of the CAR T-cell Consortium investigators, we review and address several questions and concerns regarding cellular therapy administration in the setting of COVID-19 and make general recommendations to address these issues. Specifically, we address (1) necessary resources for safe administration of cell therapies; (2) determinants of cell therapy utilization; (3) selection among patients with B cell non-Hodgkin lymphomas and B cell acute lymphoblastic leukemia; (4) supportive measures during cell therapy administration; (5) use and prioritization of tocilizumab; and (6) collaborative care with referring physicians. These recommendations were carefully formulated with the understanding that resource allocation is of the utmost importance, and that the decision to proceed with CAR T cell therapy will require extensive discussion of potential risks and benefits. Although these recommendations are fluid, at this time it is our opinion that the COVID-19 pandemic should not serve as reason to defer CAR T cell therapy for patients truly in need of a potentially curative therapy.