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Sousa GF, Carpes RM, Silva CAO, Pereira MEP, Silva ACVF, Coelho VAGS, Costa EP, Mury FB, Gestinari RS, Souza-Menezes J, Leal-da-Silva M, Nepomuceno-Silva JL, Tanuri A, Ferreira-Júnior OC, Monteiro-de-Barros C. Immunoglobulin A as a Key Immunological Molecular Signature of Post-COVID-19 Conditions. Viruses 2023; 15:1545. [PMID: 37515231 PMCID: PMC10385093 DOI: 10.3390/v15071545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/04/2023] [Accepted: 07/08/2023] [Indexed: 07/30/2023] Open
Abstract
COVID-19 has infected humans worldwide, causing millions of deaths or prolonged symptoms in survivors. The transient or persistent symptoms after SARS-CoV-2 infection have been defined as post-COVID-19 conditions (PCC). We conducted a study of 151 Brazilian PCC patients to analyze symptoms and immunoglobulin profiles, taking into account sex, vaccination, hospitalization, and age. Fatigue and myalgia were the most common symptoms, and lack of vaccination, hospitalization, and neuropsychiatric and metabolic comorbidities were relevant to the development of PCC. Analysis of serological immunoglobulins showed that IgA was higher in PCC patients, especially in the adult and elderly groups. Also, non-hospitalized and hospitalized PCC patients produced high and similar levels of IgA. Our results indicated that the detection of IgA antibodies against SARS-CoV-2 during the course of the disease could be associated with the development of PCC and may be an immunological signature to predict prolonged symptoms in COVID-19 patients.
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Affiliation(s)
- Graziele F. Sousa
- Laboratório de Campanha para Testagem e Pesquisa do COVID-19 (LCC), Instituto de Biodiversidade e Sustentabilidade (NUPEM), Universidade Federal do Rio de Janeiro (UFRJ), Macaé 27965-045, RJ, Brazil
| | - Raphael M. Carpes
- Laboratório de Campanha para Testagem e Pesquisa do COVID-19 (LCC), Instituto de Biodiversidade e Sustentabilidade (NUPEM), Universidade Federal do Rio de Janeiro (UFRJ), Macaé 27965-045, RJ, Brazil
| | - Carina A. O. Silva
- Laboratório de Campanha para Testagem e Pesquisa do COVID-19 (LCC), Instituto de Biodiversidade e Sustentabilidade (NUPEM), Universidade Federal do Rio de Janeiro (UFRJ), Macaé 27965-045, RJ, Brazil
| | - Marcela E. P. Pereira
- Laboratório de Campanha para Testagem e Pesquisa do COVID-19 (LCC), Instituto de Biodiversidade e Sustentabilidade (NUPEM), Universidade Federal do Rio de Janeiro (UFRJ), Macaé 27965-045, RJ, Brazil
| | - Amanda C. V. F. Silva
- Laboratório de Campanha para Testagem e Pesquisa do COVID-19 (LCC), Instituto de Biodiversidade e Sustentabilidade (NUPEM), Universidade Federal do Rio de Janeiro (UFRJ), Macaé 27965-045, RJ, Brazil
| | - Viktoria A. G. S. Coelho
- Laboratório de Campanha para Testagem e Pesquisa do COVID-19 (LCC), Instituto de Biodiversidade e Sustentabilidade (NUPEM), Universidade Federal do Rio de Janeiro (UFRJ), Macaé 27965-045, RJ, Brazil
| | - Evenilton P. Costa
- Laboratório de Campanha para Testagem e Pesquisa do COVID-19 (LCC), Instituto de Biodiversidade e Sustentabilidade (NUPEM), Universidade Federal do Rio de Janeiro (UFRJ), Macaé 27965-045, RJ, Brazil
| | - Flávia B. Mury
- Laboratório de Campanha para Testagem e Pesquisa do COVID-19 (LCC), Instituto de Biodiversidade e Sustentabilidade (NUPEM), Universidade Federal do Rio de Janeiro (UFRJ), Macaé 27965-045, RJ, Brazil
| | - Raquel S. Gestinari
- Laboratório de Campanha para Testagem e Pesquisa do COVID-19 (LCC), Instituto de Biodiversidade e Sustentabilidade (NUPEM), Universidade Federal do Rio de Janeiro (UFRJ), Macaé 27965-045, RJ, Brazil
| | - Jackson Souza-Menezes
- Laboratório de Campanha para Testagem e Pesquisa do COVID-19 (LCC), Instituto de Biodiversidade e Sustentabilidade (NUPEM), Universidade Federal do Rio de Janeiro (UFRJ), Macaé 27965-045, RJ, Brazil
| | - Manuela Leal-da-Silva
- Laboratório de Campanha para Testagem e Pesquisa do COVID-19 (LCC), Instituto de Biodiversidade e Sustentabilidade (NUPEM), Universidade Federal do Rio de Janeiro (UFRJ), Macaé 27965-045, RJ, Brazil
| | - José L. Nepomuceno-Silva
- Laboratório de Campanha para Testagem e Pesquisa do COVID-19 (LCC), Instituto de Biodiversidade e Sustentabilidade (NUPEM), Universidade Federal do Rio de Janeiro (UFRJ), Macaé 27965-045, RJ, Brazil
| | - Amilcar Tanuri
- Laboratório de Virologia Molecular, Departamento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941-902, RJ, Brazil
| | - Orlando C. Ferreira-Júnior
- Laboratório de Virologia Molecular, Departamento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941-902, RJ, Brazil
| | - Cintia Monteiro-de-Barros
- Laboratório de Campanha para Testagem e Pesquisa do COVID-19 (LCC), Instituto de Biodiversidade e Sustentabilidade (NUPEM), Universidade Federal do Rio de Janeiro (UFRJ), Macaé 27965-045, RJ, Brazil
- Cintia Monteiro de Barros, Instituto de Biodiversidade e Sustentabilidade (NUPEM), Universidade Federal do Rio de Janeiro (UFRJ), Av. São José do Barreto 764, Macaé 27965-045, RJ, Brazil
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2
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Jolles S, Giralt S, Kerre T, Lazarus HM, Mustafa SS, Ria R, Vinh DC. Agents contributing to secondary immunodeficiency development in patients with multiple myeloma, chronic lymphocytic leukemia and non-Hodgkin lymphoma: A systematic literature review. Front Oncol 2023; 13:1098326. [PMID: 36824125 PMCID: PMC9941665 DOI: 10.3389/fonc.2023.1098326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/04/2023] [Indexed: 02/09/2023] Open
Abstract
Introduction Patients with hematological malignancies (HMs), like chronic lymphocytic leukemia (CLL), multiple myeloma (MM), and non-Hodgkin lymphoma (NHL), have a high risk of secondary immunodeficiency (SID), SID-related infections, and mortality. Here, we report the results of a systematic literature review on the potential association of various cancer regimens with infection rates, neutropenia, lymphocytopenia, or hypogammaglobulinemia, indicative of SID. Methods A systematic literature search was performed in 03/2022 using PubMed to search for clinical trials that mentioned in the title and/or abstract selected cancer (CLL, MM, or NHL) treatments covering 12 classes of drugs, including B-lineage monoclonal antibodies, CAR T therapies, proteasome inhibitors, kinase inhibitors, immunomodulators, antimetabolites, anti-tumor antibiotics, alkylating agents, Bcl-2 antagonists, histone deacetylase inhibitors, vinca alkaloids, and selective inhibitors of nuclear export. To be included, a publication had to report at least one of the following: percentages of patients with any grade and/or grade ≥3 infections, any grade and/or grade ≥3 neutropenia, or hypogammaglobulinemia. From the relevant publications, the percentages of patients with lymphocytopenia and specific types of infection (fungal, viral, bacterial, respiratory [upper or lower respiratory tract], bronchitis, pneumonia, urinary tract infection, skin, gastrointestinal, and sepsis) were collected. Results Of 89 relevant studies, 17, 38, and 34 included patients with CLL, MM, and NHL, respectively. In CLL, MM, and NHL, any grade infections were seen in 51.3%, 35.9% and 31.1% of patients, and any grade neutropenia in 36.3%, 36.4%, and 35.4% of patients, respectively. The highest proportion of patients with grade ≥3 infections across classes of drugs were: 41.0% in patients with MM treated with a B-lineage monoclonal antibody combination; and 29.9% and 38.0% of patients with CLL and NHL treated with a kinase inhibitor combination, respectively. In the limited studies, the mean percentage of patients with lymphocytopenia was 1.9%, 11.9%, and 38.6% in CLL, MM, and NHL, respectively. Two studies reported the proportion of patients with hypogammaglobulinemia: 0-15.3% in CLL and 5.9% in NHL (no studies reported hypogammaglobulinemia in MM). Conclusion This review highlights cancer treatments contributing to infections and neutropenia, potentially related to SID, and shows underreporting of hypogammaglobulinemia and lymphocytopenia before and during HM therapies.
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Affiliation(s)
- Stephen Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, United Kingdom
| | - Sergio Giralt
- Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Tessa Kerre
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - Hillard M. Lazarus
- Department of Medicine, Hematology-Oncology, Case Western Reserve University, Cleveland, OH, United States
| | - S. Shahzad Mustafa
- Rochester Regional Health, Rochester, NY, United States
- Department of Medicine, Allergy/Immunology and Rheumatology, University of Rochester, Rochester, NY, United States
| | - Roberto Ria
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro Medical School, Bari, Italy
| | - Donald C. Vinh
- Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
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3
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Fernandez CA. Pharmacological strategies for mitigating anti-TNF biologic immunogenicity in rheumatoid arthritis patients. Curr Opin Pharmacol 2023; 68:102320. [PMID: 36580770 PMCID: PMC10540078 DOI: 10.1016/j.coph.2022.102320] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/19/2022] [Indexed: 12/28/2022]
Abstract
Tumor necrosis factor alpha (TNFα) inhibitors are a mainstay of treatment for rheumatoid arthritis (RA) patients after failed responses to conventional disease-modifying antirheumatic drugs (DMARDs). Despite the clinical efficacy of TNFα inhibitors (TNFi), many RA patients experience TNFi treatment failure due to the development of anti-drug antibodies (ADAs) that can neutralize drug levels and lead to RA disease relapse. Methotrexate (MTX) therapy with concomitant TNFα inhibitors decreases the risk of TNFi immunogenicity, but additional and/or alternative strategies are needed to reduce MTX-associated toxicities and to further increase its potency for preventing TNFα inhibitor immunogenicity. In this review, we highlight the limitations of MTX for mitigating TNFα inhibitor immunogenicity, and we discuss potential alternative pharmacological targets for decreasing the risk of immunogenicity during TNFα inhibitor therapy based on the key kinases, second messengers, and shared signaling mechanisms of lymphocyte receptor signaling.
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Affiliation(s)
- Christian A Fernandez
- Center for Pharmacogenetics and Department of Pharmaceutical Sciences, University of Pittsburgh, Pittsburgh, PA 15261, USA.
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4
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A Case of a Malignant Lymphoma Patient Persistently Infected with SARS-CoV-2 for More than 6 Months. Medicina (B Aires) 2023; 59:medicina59010108. [PMID: 36676732 PMCID: PMC9864643 DOI: 10.3390/medicina59010108] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 12/25/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is an emerging infectious disease caused by severe acute respiratory syndrome 2 (SARS-CoV-2). There are many unknowns regarding the handling of long-term SARS-CoV-2 infections in immunocompromised patients. Here, we describe the lethal disease course in a SARS-CoV-2-infected patient during Bruton's tyrosine kinase inhibitor therapy. We performed whole-genome analysis using samples obtained during the course of the disease in a 63-year-old woman who was diagnosed with intraocular malignant lymphoma of the right eye in 2012. She had received treatment since the diagnosis. An autologous transplant was performed in 2020, but she experienced a worsening of the primary disease 26 days before she was diagnosed with a positive SARS-CoV-2 RT-PCR. Tirabrutinib was administered for the primary disease. A cluster of COVID-19 infections occurred in the hematological ward while the patient was hospitalized, and she became infected on day 0. During the course of the disease, she experienced repeated remission exacerbations of COVID-19 pneumonia and eventually died on day 204. SARS-CoV-2 whole-viral sequencing revealed that the patient shed the virus long-term. Viral infectivity studies confirmed infectious virus on day 189, suggesting that the patient might be still infectious. This case report describes the duration and viral genetic evaluation of a patient with malignant lymphoma who developed SARS-CoV-2 infection during Bruton's tyrosine kinase inhibitor therapy and in whom the infection persisted for over 6 months.
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Heterogeneity of Patient-Derived Acute Myeloid Leukemia Cells Subjected to SYK In Vitro Inhibition. Int J Mol Sci 2022; 23:ijms232314706. [PMID: 36499034 PMCID: PMC9737311 DOI: 10.3390/ijms232314706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/15/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022] Open
Abstract
Acute myeloid leukemia (AML) is an aggressive hematological malignancy with a dismal prognosis. The cytoplasmic spleen tyrosine kinase (SYK) is highly expressed by hematopoietic cells and has emerged as a potential therapeutic target. In this study, we evaluated the in vitro antileukemic effects of five SYK inhibitors, fostamatinib, entospletinib, cerdulatinib, TAK-659, and RO9021, in a consecutive AML patient cohort. All inhibitors demonstrated a concentration-dependent antiproliferative effect, although there was considerable heterogeneity among patients. For fostamatinib and TAK-659, the antiproliferative effects were significantly higher in FLT3 mutated patients compared to nonmutated patients. Fostamatinib, entospletinib, TAK-659, and RO9021 induced significant apoptosis in primary AML cells, although the proapoptotic effects of the SYK inhibitors were less pronounced than the antiproliferative effects. Finally, most of the SYK inhibitors caused a significant decrease in the release of cytokines and chemokines from primary AML cells, indicating a potent inhibitory effect on the release of these leukemic signaling molecules. We concluded that the SYK inhibitors had antileukemic effects in AML, although larger studies are strongly needed to identify which patient subsets will benefit most from such a treatment.
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Hasan S, Awasthi P, Malik S, Dwivedi M. Immunotherapeutic strategies to induce inflection in the immune response: therapy for cancer and COVID-19. Biotechnol Genet Eng Rev 2022:1-40. [PMID: 36411974 DOI: 10.1080/02648725.2022.2147661] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 10/11/2022] [Indexed: 11/23/2022]
Abstract
Cancer has agonized the human race for millions of years. The present decade witnesses biological therapeutics to combat cancer effectively. Cancer Immunotherapy involves the use of therapeutics for manipulation of the immune system by immune agents like cytokines, vaccines, and transfection agents. Recently, this therapeutic approach has got vast attention due to the current pandemic COVID-19 and has been very effective. Concerning cancer, immunotherapy is based on the activation of the host's antitumor response by enhancing effector cell number and the production of soluble mediators, thereby reducing the host's suppressor mechanisms by induction of a tumour killing environment and by modulating immune checkpoints. In the present era, immunotherapies have gained traction and momentum as a pedestal of cancer treatment, improving the prognosis of many patients with a wide variety of haematological and solid malignancies. Food supplements, natural immunomodulatory drugs, and phytochemicals, with recent developments, have shown positive trends in cancer treatment by improving the immune system. The current review presents the systematic studies on major immunotherapeutics and their development for the effective treatment of cancers as well as in COVID-19. The focus of the review is to highlight comparative analytics of existing and novel immunotherapies in cancers, concerning immunomodulatory drugs and natural immunosuppressants, including immunotherapy in COVID-19 patients.
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Affiliation(s)
- Saba Hasan
- Amity Institute of Biotechnology, Amity University Uttar Pradesh, Lucknow, India
| | - Prankur Awasthi
- Amity Institute of Biotechnology, Amity University Uttar Pradesh, Lucknow, India
| | - Sumira Malik
- Amity Institute of Biotechnology, Amity University, Ranchi, Jharkhand, India
| | - Manish Dwivedi
- Amity Institute of Biotechnology, Amity University Uttar Pradesh, Lucknow, India
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Infante MS, Salmanton-García J, Fernández-Cruz A, Marchesi F, Jaksic O, Weinbergerová B, Besson C, Duarte RF, Itri F, Valković T, Szotkovski T, Busca A, Guidetti A, Glenthøj A, Collins GP, Bonuomo V, Sili U, Seval GC, Machado M, Cordoba R, Blennow O, Abu-Zeinah G, Lamure S, Kulasekararaj A, Falces-Romero I, Cattaneo C, Van Doesum J, Piukovics K, Omrani AS, Magliano G, Ledoux MP, de Ramon C, Cabirta A, Verga L, López-García A, Da Silva MG, Stojanoski Z, Meers S, Lahmer T, Martín-Pérez S, Dávila-Vals J, Van Praet J, Samarkos M, Bilgin YM, Karlsson LK, Batinić J, Nordlander A, Schönlein M, Hoenigl M, Ráčil Z, Mladenović M, Hanakova M, Zambrotta GPM, De Jonge N, Adžić-Vukičević T, Nunes-Rodrigues R, Prezioso L, Navrátil M, Marchetti M, Cuccaro A, Calbacho M, Giordano A, Cornely OA, Hernández-Rivas JÁ, Pagano L. B-cell malignancies treated with targeted drugs and SARS-CoV-2 infection: A European Hematology Association Survey (EPICOVIDEHA). Front Oncol 2022; 12:992137. [PMID: 36276116 PMCID: PMC9583921 DOI: 10.3389/fonc.2022.992137] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/31/2022] [Indexed: 01/26/2023] Open
Abstract
Patients with lymphoproliferative diseases (LPD) are vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Here, we describe and analyze the outcome of 366 adult patients with chronic lymphocytic leukemia (CLL) or non-Hodgkin Lymphoma (NHL) treated with targeted drugs and laboratory-confirmed COVID-19 diagnosed between February 2020 and January 2022. Median follow-up was 70.5 days (IQR 0-609). Most used targeted drugs were Bruton-kinase inhibitors (BKIs) (N= 201, 55%), anti-CD20 other than rituximab (N=61, 16%), BCL2 inhibitors (N=33, 9%) and lenalidomide (N=28, 8%).Only 16.2% of the patients were vaccinated with 2 or more doses of vaccine at the onset of COVID-19. Mortality was 24% (89/366) on day 30 and 36%(134/366) on the last day of follow-up. Age >75 years (p<0.001, HR 1.036), active malignancy (p<0.001, HR 2.215), severe COVID-19 (p=0.017, HR 2.270) and admission to ICU (p<0.001, HR 5.751) were risk factors for mortality at last day of follow up. There was no difference in OS rates in NHL vs CLL patients (p=0.306), nor in patients treated with or without BKIs (p=0.151). Mortality in ICU was 66% (CLL 61%, NHL 76%). Overall mortality rate decreased according to vaccination status, being 39% in unvaccinated patients, 32% and 26% in those having received one or two doses, respectively, and 20% in patients with a booster dose (p=0.245). Overall mortality rate dropped from 41% during the first semester of 2020 to 25% at the last semester of 2021. These results show increased severity and mortality from COVID-19 in LPDs patients treated with targeted drugs.
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Affiliation(s)
| | - Jon Salmanton-García
- 2Faculty of Medicine and University Hospital Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany,3Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany,*Correspondence: Jon Salmanton-García,
| | | | - Francesco Marchesi
- 5Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Ozren Jaksic
- 6Department of Hematology, University Hospital Dubrava, Zagreb, Croatia
| | - Barbora Weinbergerová
- 7Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czechia
| | | | | | - Federico Itri
- 9San Luigi Gonzaga Hospital - Orbassano, Orbassano, Italy
| | - Toni Valković
- 10University Hospital Centre Rijeka, Rijeka, Croatia,11Croatian Cooperative Group for Hematological Diseases (CROHEM), Zagreb, Croatia,12Faculty of Medicine and Faculty of Health Studies University of Rijeka, Rijeka, Croatia
| | | | - Alessandro Busca
- 14Stem Cell Transplant Center, AOU Citta’ della Salute e della Scienza, Turin, Italy
| | - Anna Guidetti
- 15Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andreas Glenthøj
- 16Department of Hematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Graham P. Collins
- 17NIHR Oxford Biomedical Research Centre, Churchill Hospital, Oxford, United Kingdom
| | - Valentina Bonuomo
- 18Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Uluhan Sili
- 19Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | | | - Marina Machado
- 21Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Raul Cordoba
- 22Health Research Institute IIS-FJD, Fundación Jimenez Diaz University Hospital, Madrid, Spain
| | - Ola Blennow
- 19Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Ghaith Abu-Zeinah
- 23Division of Hematology and Oncology, Weill Cornell Medicine, New York, NY, United States
| | - Sylvain Lamure
- 24Departement d’Hematologie Clinique, CHU de Montpellier, UMR-CNRS 5535, Universite de Montpellier, Montpellier, France
| | - Austin Kulasekararaj
- 25King’s College Hospital, London, United Kingdom,26King’s College London, London, United Kingdom
| | | | | | - Jaap Van Doesum
- 29University Medical Center Groningen, Groningen, Netherlands
| | - Klára Piukovics
- 30Department of Internal Medicine, Albert Szent-Györgyi Health Center, Faculty of Medicine University of Szeged, Szeged, Hungary
| | - Ali S. Omrani
- 31Communicable Disease Center, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Cristina de Ramon
- 34Hematology Department, Hospital Universitario de Salamanca, Salamanca, Spain,35IBSAL, Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Alba Cabirta
- 36Department of Hematology, Vall d’Hebron Hospital Universitari, Experimental Hematology, Vall d’Hebron Institute of Oncology (VHIO), Vall d’Hebron Barcelona, Spain,37Hospital Campus, Barcelona, Spain,38Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Luisa Verga
- 39Azienda Ospedaliera San Gerardo - Monza, Monza, Italy,40Università Milano-Bicocca, Milan, Italy
| | - Alberto López-García
- 41Health Research Institute IIS-FJD, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
| | | | | | | | - Tobias Lahmer
- 45Medizinische Klinik II, Klinikum rechts der Isar, TU München, Munich, Germany
| | | | | | - Jens Van Praet
- 47Department of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
| | | | | | - Linda Katharina Karlsson
- 16Department of Hematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | | | - Anna Nordlander
- 19Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Schönlein
- 51Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Hoenigl
- 52Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, San Diego, CA, United States,53Clinical and Translational Fungal-Working Group, University of California San Diego, La Jolla, CA, United States,54Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Zdeněk Ráčil
- 55Institute of Hematology and Blood Transfusion, Prague, Czechia
| | | | | | | | - Nick De Jonge
- 57Amsterdam UMC, location VUmc, Amsterdam, Netherlands
| | | | | | - Lucia Prezioso
- 58U.O. Ematologia e Centro Trapianti Midollo Osseo, Ospedale Maggiore, Parma, Italy
| | | | - Monia Marchetti
- 60Hematology and BMT Unit, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Annarosa Cuccaro
- 61Hematology Unit, Center for Translational Medicine, Azienda USL Toscana NordOvest, Livorno, Italy
| | - Maria Calbacho
- 62Hematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Antonio Giordano
- 63Hematology Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy,64Hematology Unit, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Oliver A. Cornely
- 2Faculty of Medicine and University Hospital Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany,3Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany,65University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), Cologne, Germany,66University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Molecular Medicine Cologne (CMMC), Cologne, Germany,67German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | | | - Livio Pagano
- 64Hematology Unit, Università Cattolica del Sacro Cuore, Rome, Italy
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Gur I, Giladi A, Isenberg YN, Neuberger A, Stern A. COVID-19 in Patients with Hematologic Malignancies: Clinical Manifestations, Persistence, and Immune Response. Acta Haematol 2022; 145:297-309. [PMID: 35235928 DOI: 10.1159/000523872] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/24/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND The clinical presentation of coronavirus disease 19 (COVID-19) is the result of intricate interactions between the novel coronavirus and the immune system. In patients with hematologic malignancies (HM), these interactions dramatically change the clinical course and outcomes of COVID-19. SUMMARY Patients with HM and COVID-19 are at an increased risk for prolonged viral shedding, more protracted and severe presentation, and death, even when compared to other immunocompromised hosts. HM (e.g., multiple myeloma, chronic lymphocytic leukemia) and anticancer treatments (e.g., anti-CD20 agents) that impair humoral immunity markedly increase the risk of severe COVID-19 as well as protracted viral shedding and possibly longer infectivity. Cytokine release syndrome (CRS) is an important player in the pathophysiology of severe and fatal COVID-19. Treatments targeting specific cytokines involved in CRS such as interleukin-6 and Janus kinase have proven beneficial in COVID-19 patients but were not assessed specifically in HM patients. Although neutropenia (as well as neutrophilia) was associated with increased COVID-19 mortality, granulocyte colony-stimulating factors were not beneficial in patients with COVID-19 and may have been associated with worse outcomes. Decreased levels of T lymphocytes and especially decreased CD4+ counts, and depletion of CD8+ lymphocytes, are a hallmark of severe COVID-19, and even more so among patients with HM, underlying the important role of T-helper dysfunction in severe COVID-19. In HM patients with intact cellular immunity, robust T-cell responses may compensate for an impaired humoral immune system. Further prospective studies are needed to evaluate the mechanisms of severe COVID-19 among patients with HM and assess the efficacy of new immunomodulating COVID-19 treatments in this population. KEY MESSAGES Understanding the immunopathology of COVID-19 has greatly benefited from the previous research in patients with HM. So far, no COVID-19 treatments were properly evaluated in patients with HM. Patients with HM should be included in future RCTs assessing treatments for COVID-19.
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Affiliation(s)
- Ivan Gur
- Internal Medicine C, Rambam Health Care Campus, Haifa, Israel
| | - Amir Giladi
- Oncode Institute, Hubrecht Institute, Utrecht, The Netherlands
| | | | - Ami Neuberger
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
- Department of COVID-19-19 "Keter", Rambam Health Care Campus, Haifa, Israel
| | - Anat Stern
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
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9
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van de Veerdonk FL, Giamarellos-Bourboulis E, Pickkers P, Derde L, Leavis H, van Crevel R, Engel JJ, Wiersinga WJ, Vlaar APJ, Shankar-Hari M, van der Poll T, Bonten M, Angus DC, van der Meer JWM, Netea MG. A guide to immunotherapy for COVID-19. Nat Med 2022; 28:39-50. [PMID: 35064248 DOI: 10.1038/s41591-021-01643-9] [Citation(s) in RCA: 205] [Impact Index Per Article: 102.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/24/2021] [Indexed: 12/15/2022]
Abstract
Immune dysregulation is an important component of the pathophysiology of COVID-19. A large body of literature has reported the effect of immune-based therapies in patients with COVID-19, with some remarkable successes such as the use of steroids or anti-cytokine therapies. However, challenges in clinical decision-making arise from the complexity of the disease phenotypes and patient heterogeneity, as well as the variable quality of evidence from immunotherapy studies. This Review aims to support clinical decision-making by providing an overview of the evidence generated by major clinical trials of host-directed therapy. We discuss patient stratification and propose an algorithm to guide the use of immunotherapy strategies in the clinic. This will not only help guide treatment decisions, but may also help to design future trials that investigate immunotherapy in other severe infections.
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Affiliation(s)
- Frank L van de Veerdonk
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands.
| | | | - Peter Pickkers
- Department of Intensive Care Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lennie Derde
- Department of Intensive Care, University Medical Center Utrecht, Utrecht, the Netherlands.,Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands
| | - Helen Leavis
- Department of Internal Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Job J Engel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - W Joost Wiersinga
- Division of Infectious Diseases, Center for Experimental Molecular Medicine (CEMM), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Alexander P J Vlaar
- Department of Intensive Care Medicine and Laboratory of Experimental Intensive Care Medicine and Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Manu Shankar-Hari
- School of Immunobiology and Microbial Sciences, King's College London, London, UK
| | - Tom van der Poll
- Division of Infectious Diseases, Center for Experimental Molecular Medicine (CEMM), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marc Bonten
- Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands
| | - Derek C Angus
- UPMC and University of Pittsburgh, Pittsburgh, PA, United States
| | - Jos W M van der Meer
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands. .,Department of Immunology and Metabolism, Life & Medical Sciences Institute, University of Bonn, Bonn, Germany.
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10
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Barcellini W, Fattizzo B. Immune Phenomena in Myeloid Neoplasms: An " Egg or Chicken" Question. Front Immunol 2021; 12:751630. [PMID: 34659257 PMCID: PMC8511478 DOI: 10.3389/fimmu.2021.751630] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/13/2021] [Indexed: 11/13/2022] Open
Abstract
Immune phenomena are increasingly reported in myeloid neoplasms, and include autoimmune cytopenias/diseases and immunodeficiency, either preceding or complicating acute myeloid leukemia, myelodysplastic syndromes (MDS), chronic myeloproliferative neoplasms, and bone marrow failure (BMF) syndromes. Autoimmunity and immunodeficiency are the two faces of a dysregulated immune tolerance and surveillance and may result, along with contributing environmental and genetic factors, in an increased incidence of both tumors and infections. The latter may fuel both autoimmunity and immune activation, triggering a vicious circle among infections, tumors and autoimmune phenomena. Additionally, alterations of the microbiota and of mesenchymal stem cells (MSCs) pinpoint to the importance of a permissive or hostile microenvironment for tumor growth. Finally, several therapies of myeloid neoplasms are aimed at increasing host immunity against the tumor, but at the price of increased autoimmune phenomena. In this review we will examine the epidemiological association of myeloid neoplasms with autoimmune diseases and immunodeficiencies, and the pivotal role of autoimmunity in the pathogenesis of MDS and BMF syndromes, including the paroxysmal nocturnal hemoglobinuria conundrum. Furthermore, we will briefly examine autoimmune complications following therapy of myeloid neoplasms, as well as the role of MSCs and microbiota in these settings.
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Affiliation(s)
- Wilma Barcellini
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Bruno Fattizzo
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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11
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Morales-Ortega A, Farfán-Sedano AI, Izquierdo-Martínez A, Llarena-Barroso C, Jaenes-Barrios B, Mesa-Plaza N, Toledano-Macías M, Soria Fernández-Llamazares G, Molina-Esteban L, García de Tena J, Prieto-Menchero S, Gonzalo-Pascua S, San Martín-López JV, Bernal-Bello D. Antibody formation against SARS-CoV-2 in imatinib-treated COVID-19 patients. J Infect 2021; 84:248-288. [PMID: 34437930 PMCID: PMC8381632 DOI: 10.1016/j.jinf.2021.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 08/21/2021] [Indexed: 11/29/2022]
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