tetano
Editor, Senior Moderator
Curr Probl Cancer
. 2021 Mar 24;100739.
doi: 10.1016/j.currproblcancer.2021.100739. Online ahead of print.
Prolonged persistence of SARS-CoV-2 infection during A+AVD therapy for classical Hodgkin's lymphoma: A case report
Hiroyuki Fujii[SUP] 1 [/SUP], Taisuke Tsuji[SUP] 2 [/SUP], Mio Sugitani[SUP] 3 [/SUP], Yosuke Matsumoto[SUP] 3 [/SUP], Tatsuya Yuba[SUP] 4 [/SUP], Shunya Tanaka[SUP] 2 [/SUP], Yoshifumi Suga[SUP] 2 [/SUP], Aosa Matsuyama[SUP] 2 [/SUP], Shiho Goda[SUP] 2 [/SUP], Ayaka Omura[SUP] 2 [/SUP], Shinsuke Shiotsu[SUP] 5 [/SUP], Chieko Takumi[SUP] 5 [/SUP], Seiko Ono[SUP] 4 [/SUP], Noriya Hiraoka[SUP] 2 [/SUP]
Affiliations
Abstract
We describe a case of coronavirus disease 2019 (COVID-19) in a patient with mixed cellularity classical Hodgkin lymphoma (cHL) undergoing brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine (A+AVD) therapy. A 43-year-old man presented to our hospital with a complaint of fever, for which he was diagnosed with COVID-19 after a positive polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and antiviral therapy with favipiravir and ciclesonide was started subsequently. The fever persisted for the first few days of treatment, but his respiratory status was stable, and he became asymptomatic and afebrile on day 9. Although the PCR tests remained positive, he met the updated discharge criteria of the World Health Organization (WHO) on day 12. However, his fever recurred, and his condition worsened on day 16. A chest X-ray showed a new opacity. It is likely that favipiravir and ciclesonide treatment probably did not completely eliminate the virus in the patient, and therefore the infection persisted. We added remdesivir from day 21, and the improvement was remarkable. He was discharged on day 29 after two consecutive PCR test results were negative. PCR tests are not mandatory for the updated WHO discharge criteria. However, even after antiviral therapy, COVID-19 patients with hematologic malignancies may have prolonged active infection with impaired viral excretion. Depending on the background disease and comorbidities, there may be some patient populations for whom it is not appropriate to simply comply with the current discharge criteria. Therefore, more emphasis may be needed on PCR examinations.
Keywords: A+AVD therapy (brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine); COVID-19; Classical Hodgkin lymphoma; Remdesivir, RT-PCR; SARS-CoV-2.
. 2021 Mar 24;100739.
doi: 10.1016/j.currproblcancer.2021.100739. Online ahead of print.
Prolonged persistence of SARS-CoV-2 infection during A+AVD therapy for classical Hodgkin's lymphoma: A case report
Hiroyuki Fujii[SUP] 1 [/SUP], Taisuke Tsuji[SUP] 2 [/SUP], Mio Sugitani[SUP] 3 [/SUP], Yosuke Matsumoto[SUP] 3 [/SUP], Tatsuya Yuba[SUP] 4 [/SUP], Shunya Tanaka[SUP] 2 [/SUP], Yoshifumi Suga[SUP] 2 [/SUP], Aosa Matsuyama[SUP] 2 [/SUP], Shiho Goda[SUP] 2 [/SUP], Ayaka Omura[SUP] 2 [/SUP], Shinsuke Shiotsu[SUP] 5 [/SUP], Chieko Takumi[SUP] 5 [/SUP], Seiko Ono[SUP] 4 [/SUP], Noriya Hiraoka[SUP] 2 [/SUP]
Affiliations
- PMID: 33810911
- DOI: 10.1016/j.currproblcancer.2021.100739
Abstract
We describe a case of coronavirus disease 2019 (COVID-19) in a patient with mixed cellularity classical Hodgkin lymphoma (cHL) undergoing brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine (A+AVD) therapy. A 43-year-old man presented to our hospital with a complaint of fever, for which he was diagnosed with COVID-19 after a positive polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and antiviral therapy with favipiravir and ciclesonide was started subsequently. The fever persisted for the first few days of treatment, but his respiratory status was stable, and he became asymptomatic and afebrile on day 9. Although the PCR tests remained positive, he met the updated discharge criteria of the World Health Organization (WHO) on day 12. However, his fever recurred, and his condition worsened on day 16. A chest X-ray showed a new opacity. It is likely that favipiravir and ciclesonide treatment probably did not completely eliminate the virus in the patient, and therefore the infection persisted. We added remdesivir from day 21, and the improvement was remarkable. He was discharged on day 29 after two consecutive PCR test results were negative. PCR tests are not mandatory for the updated WHO discharge criteria. However, even after antiviral therapy, COVID-19 patients with hematologic malignancies may have prolonged active infection with impaired viral excretion. Depending on the background disease and comorbidities, there may be some patient populations for whom it is not appropriate to simply comply with the current discharge criteria. Therefore, more emphasis may be needed on PCR examinations.
Keywords: A+AVD therapy (brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine); COVID-19; Classical Hodgkin lymphoma; Remdesivir, RT-PCR; SARS-CoV-2.