Prolonged COVID RT-PCR and Higher Mortality in COVID-19 Patients with Rituximab Treated Non-Hodgkin-Lymphoma: A Case Series

ABSTRACT

Introduction: Patients with pre-existing comorbidities and immunosuppression due to lymphoma and its treatments, are at greater risk for SARS-CoV-2 infection and severe manifestation of COVID-19. Patients treated with anti CD 20 monoclonal antibody such as rituximab for non-Hodgkin-lymphoma, which induces rapid B cell depletion and possibly impacting the clinical course of COVID- 19 in terms of prolonged hospital stay and higher mortality. Case report Here, we describe a case series of three male patients already COVID RTPCR positive admitted at our institute aged >60 years, all treated with rituximab for non-Hodgkin-lymphoma. All patients had increased inflammatory markers, bilateral ground-glass opacities on chest CT and required intensive care in view of progressive hypoxemia and respiratory distress, treated with broad-spectrum antibiotics, antifungals, corticosteroids, anticoagulants, injection remdesivir, Tab barcitinib, and other supportive treatment. One patient also received IVIG. Initially, all patients required high oxygen support followed by non-invasive ventilation and finally invasive mechanical ventilatory support in view of increased ventilatory need with Fio2 100%. Despite best intensive care, all patients showed progressive deterioration with refractory hypoxemia and refractory hypotension and succumbed. Discussion: All three patients had prolonged COVID RT PCR positive varies from one month to maximum 5 months and showed mortality. High in-hospital mortality related to severe COVID-19 among patients with lymphoma has been reported in several countries. The risk of early death for patients with severe COVID-19 and lymphoma increases with age and relapsed lymphoma disease. Lack of an efficient antibody production caused by B cell depletion might explain the protracted course, moderate symptoms as lack of antibody producing B cell may have prevented activation of the complement system. Conclusion: The incidence, risk factors, and outcome of prolonged forms of COVID-19 for patients with lymphoma are still poorly assessed. Relapsed/refractory lymphoma and recent administration of anti CD20 therapy are risk factors for prolonged in-hospital stay and death for lymphoma patients hospitalized for COVID-19. These findings may contribute to guide the management of lymphoma during the pandemic.