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Journal Articles Clinical Microbiology and Infection Year : 2023

B-cell malignancies and COVID-19: a narrative review

Abstract

Background. COVID-19 has been extensively characterized in immunocompetent hosts and to a lesser extent in immunocompromised populations. Among the latter, patients treated for Bcell malignancies have immunosuppression generated by B-cell lymphodepletion/aplasia resulting in a higher susceptibility to respiratory virus infections and poor response to vaccination. The consequence is that these patients are likely to develop severe or critical COVID-19. Objectives. To examine the overall impact of COVID-19 in patients treated for a B-cell malignancy or receiving chimeric antigen receptor T (CAR-T) immunotherapy administered in case of relapsed or refractory disease. Sources. We searched in the Medline database to identify relevant studies, trials, reviews, or meta-analyses focusing on SARS-CoV-2 vaccination or COVID-19 management in patients treated for a B-cell malignancy or recipients of CART cell therapy up to July 8 th , 2022. Content. The epidemiology and the outcomes of COVID-19 in B-cell malignancy patients and CART cell recipients are summarized. Vaccine efficacy in these subgroups is compiled. Considering the successive surges of variants of concern, we propose a critical appraisal of treatment strategies by discussing the use of neutralizing monoclonal antibodies, convalescent plasma therapy, direct-acting antiviral drugs, corticosteroids and immunomodulators. Implications. For B-cell malignancy patients, preventive vaccination against SARS-CoV-2 remain essential and management of COVID-19 includes the control of viral replication due to protracted SARS-CoV-2 shedding. Passive immunotherapy (monoclonal neutralizing antibody therapy, convalescent plasma therapy) and direct-active antivirals such as remdesivir and nirmatrelvir/ritonavir are the best currently available treatments. Real-world data and subgroup analyses in larger trials are warranted to assess COVID-19 therapeutics in B-cell depleted populations.
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hal-03955801 , version 1 (25-01-2023)

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David Luque-Paz, Pierre Sesques, Florent Wallet, Emmanuel Bachy, Florence Ader. B-cell malignancies and COVID-19: a narrative review. Clinical Microbiology and Infection, 2023, ⟨10.1016/j.cmi.2022.10.030⟩. ⟨hal-03955801⟩
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