Severe COVID-19 virus reactivation following treatment for B cell acute lymphoblastic leukemia
Abstract SARS-CoV-2 has infected millions of people worldwide, but little is known at this time about second infections or reactivation. Here, we report a case of a 55-year-old female undergoing treatment for CD20+ B cell acute lymphoblastic leukemia who experienced a viral reactivation after receiv...
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doaj-585b9b03a01f4365b3bcdce3c039342d2020-11-25T03:55:47ZengBMCJournal of Hematology & Oncology1756-87222020-10-011311310.1186/s13045-020-00968-1Severe COVID-19 virus reactivation following treatment for B cell acute lymphoblastic leukemiaGuido Lancman0John Mascarenhas1Michal Bar-Natan2Tisch Cancer Institute, Icahn School of Medicine At Mount SinaiTisch Cancer Institute, Icahn School of Medicine At Mount SinaiTisch Cancer Institute, Icahn School of Medicine At Mount SinaiAbstract SARS-CoV-2 has infected millions of people worldwide, but little is known at this time about second infections or reactivation. Here, we report a case of a 55-year-old female undergoing treatment for CD20+ B cell acute lymphoblastic leukemia who experienced a viral reactivation after receiving rituximab, cytarabine, and dasatinib. She was initially hospitalized with COVID-19 in April and developed a high antibody titer with two negative nasal polymerase chain reaction (PCR) swabs for SARS-CoV-2 on discharge. After recovery, she resumed treatment in June for her leukemia, which included rituximab, cytarabine, and dasatinib. She promptly lost her COVID-19 antibodies, and her nasal PCR turned positive in June. She developed a severe COVID-19 pneumonia with lymphopenia, high inflammatory markers, and characteristic bilateral ground-glass opacities on chest CT, requiring high-flow nasal cannula and transfer to the intensive care unit. She received steroids, anticoagulation, and convalescent plasma, and within 48 h she was off oxygen. She was discharged home in stable condition several days later. Given the short time frame from leukemia treatment to PCR positivity and the low case rate in mid-June in New York City, reinfection appears to have been unlikely and SARS-CoV-2 reactivation is a possible explanation. This case illustrates the risks of treating recently recovered COVID-19 patients with immunosuppressive therapy, particularly lymphocyte- and antibody-depleting therapy, and raises new questions about the potential of SARS-CoV-2 reactivation.http://link.springer.com/article/10.1186/s13045-020-00968-1COVID-19SARS-CoV-2ReactivationRituximabCytarabine |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Guido Lancman John Mascarenhas Michal Bar-Natan |
spellingShingle |
Guido Lancman John Mascarenhas Michal Bar-Natan Severe COVID-19 virus reactivation following treatment for B cell acute lymphoblastic leukemia Journal of Hematology & Oncology COVID-19 SARS-CoV-2 Reactivation Rituximab Cytarabine |
author_facet |
Guido Lancman John Mascarenhas Michal Bar-Natan |
author_sort |
Guido Lancman |
title |
Severe COVID-19 virus reactivation following treatment for B cell acute lymphoblastic leukemia |
title_short |
Severe COVID-19 virus reactivation following treatment for B cell acute lymphoblastic leukemia |
title_full |
Severe COVID-19 virus reactivation following treatment for B cell acute lymphoblastic leukemia |
title_fullStr |
Severe COVID-19 virus reactivation following treatment for B cell acute lymphoblastic leukemia |
title_full_unstemmed |
Severe COVID-19 virus reactivation following treatment for B cell acute lymphoblastic leukemia |
title_sort |
severe covid-19 virus reactivation following treatment for b cell acute lymphoblastic leukemia |
publisher |
BMC |
series |
Journal of Hematology & Oncology |
issn |
1756-8722 |
publishDate |
2020-10-01 |
description |
Abstract SARS-CoV-2 has infected millions of people worldwide, but little is known at this time about second infections or reactivation. Here, we report a case of a 55-year-old female undergoing treatment for CD20+ B cell acute lymphoblastic leukemia who experienced a viral reactivation after receiving rituximab, cytarabine, and dasatinib. She was initially hospitalized with COVID-19 in April and developed a high antibody titer with two negative nasal polymerase chain reaction (PCR) swabs for SARS-CoV-2 on discharge. After recovery, she resumed treatment in June for her leukemia, which included rituximab, cytarabine, and dasatinib. She promptly lost her COVID-19 antibodies, and her nasal PCR turned positive in June. She developed a severe COVID-19 pneumonia with lymphopenia, high inflammatory markers, and characteristic bilateral ground-glass opacities on chest CT, requiring high-flow nasal cannula and transfer to the intensive care unit. She received steroids, anticoagulation, and convalescent plasma, and within 48 h she was off oxygen. She was discharged home in stable condition several days later. Given the short time frame from leukemia treatment to PCR positivity and the low case rate in mid-June in New York City, reinfection appears to have been unlikely and SARS-CoV-2 reactivation is a possible explanation. This case illustrates the risks of treating recently recovered COVID-19 patients with immunosuppressive therapy, particularly lymphocyte- and antibody-depleting therapy, and raises new questions about the potential of SARS-CoV-2 reactivation. |
topic |
COVID-19 SARS-CoV-2 Reactivation Rituximab Cytarabine |
url |
http://link.springer.com/article/10.1186/s13045-020-00968-1 |
work_keys_str_mv |
AT guidolancman severecovid19virusreactivationfollowingtreatmentforbcellacutelymphoblasticleukemia AT johnmascarenhas severecovid19virusreactivationfollowingtreatmentforbcellacutelymphoblasticleukemia AT michalbarnatan severecovid19virusreactivationfollowingtreatmentforbcellacutelymphoblasticleukemia |
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1724468102015483904 |