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Author Spotlight: Unveiling the Polyfunctionality and Heterogeneity in Immune Responses
Published on: March 8, 2024
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B-cell malignancies and COVID-19: a narrative review
David Luque-Paz1, Pierre Sesques2, Florent Wallet3
1Université Rennes-I, Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Rennes, France.
Summary
Patients with B-cell malignancies are at high risk for severe COVID-19 due to immunosuppression. Vaccination and antiviral therapies are crucial for managing COVID-19 in these vulnerable populations.
Area of Science:
- Immunology
- Oncology
- Infectious Diseases
Background:
- Patients treated for B-cell malignancies experience immunosuppression, increasing susceptibility to respiratory infections like COVID-19.
- This immunosuppression, stemming from B-cell lymphodepletion/aplasia, leads to a poor response to vaccination and a higher likelihood of severe or critical COVID-19.
- Chimeric antigen receptor T (CAR-T) immunotherapy recipients with relapsed or refractory disease also represent an immunocompromised group at risk.
Purpose of the Study:
- To evaluate the comprehensive impact of COVID-19 on patients undergoing treatment for B-cell malignancies.
- To assess the effects of COVID-19 in individuals who have received chimeric antigen receptor T (CAR-T) immunotherapy for relapsed or refractory conditions.
Main Methods:
- A systematic literature search was conducted in the MEDLINE database.
- Studies, trials, reviews, and meta-analyses focusing on SARS-CoV-2 vaccination and COVID-19 management in B-cell malignancy patients and CAR-T cell recipients were identified.
- The search included data up to July 8, 2022, to capture recent findings.
Main Results:
- The epidemiology and outcomes of COVID-19 in patients with B-cell malignancy and CAR-T cell recipients were summarized.
- Vaccine efficacy in these specific patient subgroups was compiled and analyzed.
- A critical appraisal of treatment strategies, including monoclonal antibodies, convalescent plasma, antivirals, corticosteroids, and immunomodulators, was performed in the context of emerging variants.
Conclusions:
- Preventive SARS-CoV-2 vaccination is essential for patients with B-cell malignancies.
- Management of COVID-19 in these patients necessitates controlling viral replication due to prolonged viral shedding.
- Current best treatments include passive immunotherapy (monoclonal antibodies, convalescent plasma) and direct-acting antivirals (remdesivir, nirmatrelvir/ritonavir); further real-world data are needed.
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