Frontiers in Oncology (Sep 2022)

Case report: Long-lasting SARS-CoV-2 infection with post-COVID-19 condition in two patients with chronic lymphocytic leukemia: The emerging therapeutic role of casirivimab/imdevimab

  • Laura Ballotta,
  • Laura Ballotta,
  • Omar Simonetti,
  • Pierlanfranco D’Agaro,
  • Pierlanfranco D’Agaro,
  • Ludovica Segat,
  • Raffaella Koncan,
  • Raffaella Koncan,
  • Pamela Martinez-Orellana,
  • Federica Dattola,
  • Federica Dattola,
  • Emanuele Orsini,
  • Alessandro Marcello,
  • Simeone Dal Monego,
  • Danilo Licastro,
  • Andrea Misin,
  • Sara Mohamed,
  • Eugenio Sbisà,
  • Elisa Lucchini,
  • Giovanni Maria De Sabbata,
  • Francesco Zaja,
  • Francesco Zaja,
  • Roberto Luzzati,
  • Roberto Luzzati

DOI
https://doi.org/10.3389/fonc.2022.945060
Journal volume & issue
Vol. 12

Abstract

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Post-coronavirus disease 2019 (post-COVID-19) condition, previously referred to as long COVID, includes a post-acute syndrome defined by the presence of non-specific symptoms occurring usually 3 months from the onset of the acute phase and lasting at least 2 months. Patients with chronic lymphocytic leukemia (CLL) represent a high-risk population for COVID-19. Moreover, the response to SARS-CoV-2 vaccination is often absent or inadequate. The introduction of monoclonal antibodies (mAbs) in the treatment landscape of COVID-19 allowed to reduce hospitalization and mortality in mild–moderate SARS-CoV-2 infection, but limited data are available in hematological patients. We here report the effective use of casirivimab/imdevimab (CI) in the treatment of two CLL patients with persistent infection and post-COVID-19 condition. Full genome sequencing of viral RNA from nasopharyngeal swabs was performed at the time of COVID-19 diagnosis and before the administration of CI. Both patients experienced persistent SARS-CoV-2 infection with no seroconversion for 8 and 7 months, respectively, associated with COVID symptoms. In both cases after the infusion of CI, we observed a rapid negativization of the nasal swabs, the resolution of post-COVID-19 condition, and the development of both the IgG against the trimeric spike protein and the receptor-binding domain (RBD) of the spike protein. The analysis of the viral genome in the period elapsed from the time of COVID-19 diagnosis and the administration of mAbs showed the development of new mutations, especially in the S gene. The genome variations observed during the time suggest a role of persistent SARS-CoV-2 infection as a possible source for the development of viral variants. The effects observed in these two patients appeared strongly related to passive immunity conferred by CI treatment permitting SARS-CoV-2 clearance and resolution of post-COVID-19 condition. On these grounds, passive anti-SARS-CoV-2 antibody treatment may represent as a possible therapeutic option in some patients with persistent SARS-CoV-2 infection.

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