Reactions Weekly | 2021
Multiple drugs
Abstract
Coronavirus disease-2019, lack of efficacy and off-label treatment: 21 case reports In a retrospective multicentric study of 111 patients, admitted for coronavirus disease-2019 (COVID-19) at various different hospitals in France between March 2020 and April 2020, 21 patients [12 men and 9 women] aged 43–80 years were described, who developed COVID-19 during treatment with rituximab, bendamustine, cyclophosphamide, doxorubicin, vincristine, prednisone, obinutuzumab, venetoclax, methotrexate, dexamethasone, cytarabine, cisplatin, ifosfamide, carboplatin or etoposide for various types of lymphomas. Out of these 21 patients, two patients exhibited lack of efficacy with remdesivir or exhibited lack of efficacy following an off-label treatment with anakinra and convalescent-anti-SARS-CoV-2-plasma for COVID-19 [dosages not stated; not all routes and outcomes stated]. The patients, who had various types of lymphomas including follicular lymphoma (9 patients), mantle cell lymphoma (2 patients), nodular lymphocyte-predominant hodgkin lymphoma (1 patient), diffuse large B-cell lymphoma (6 patients), marginal zone lymphoma (1 patient), lymphoplasmacytic lymphoma (1 patient) and Richter syndrome (1 patient), received maintenance therapy with rituximab (6 patients), R-CHOP therapy comprising rituximab, cyclophosphamide, doxorubicin [hydroxydoxorubicine], vincristine [Oncovin] and prednisone (5 patients), maintenance therapy with obinutuzumab (3 patients), rituximab (1 patient), venetoclax [ventoclax] and obinutuzumab (1 patient), R-CHOP therapy comprising rituximab, cyclophosphamide, doxorubicin [hydroxydoxorubicine], vincristine [Oncovin] and prednisone along with methotrexate (1 patient), R-DHAP therapy comprising rituximab, dexamethasone, high-dose cytarabine and cisplatin (1 patient), rituximab and bendamustine (2 patients) and R-ICE therapy comprising rituximab, ifosfamide, carboplatin and etoposide (1 patient). The patients additionally had various concomitant comorbidities. After 3 months–24 years from the diagnosis of lymphoma, all the patients were admitted to the hospital and underwent chest CT. The chest CT findings revealed bilateral ground-glass opacities, which were consistent with the diagnosis of COVID-19. Therefore, the patients received an off-label treatment with convalescent-anti-SARS-CoV-2-plasma infusion (2 patients), hydroxychloroquine, azithromycin [azithromycine] and tocilizumab (1 patient), convalescent-anti-SARS-CoV-2-plasma infusion and unspecified corticosteroids (1 patient), tocilizumab and convalescent-anti-SARS-CoV-2-plasma infusion (1 patient), anakinra and unspecified corticosteroids (1 patient), lopinavir/ritonavir, convalescent-anti-SARS-CoV-2-plasma infusion and unspecified corticosteroids (1 patient) and unspecified corticosteroids (1 patient). Out of these 21 patients, one patient was treated with remdesivir and an off-label treatment with unspecified corticosteroids, and one patient was treated with remdesivir and an off-label treatment with eculizumab and unspecified corticosteroids. Out of the 21 patients, 14 patients recovered after experiencing COVID-19 for a duration of 41–237 days; however, COVID-19 symptoms persisted in 2 patients. Of these 21 patients, 16 patients were found to be alive after more than 30 days of hospitalisation. Out of these 21 patients, one patient recovered with an off-label treatment with unspecified corticosteroids after experiencing COVID-19 for a duration of 163 days. However, the patient had a recurrence of COVID-19 four months after the initial diagnosis of COVID-19. Out of these 21 patients, one patient received an offlabel treatment with half of the scheduled dose of convalescent-anti-SARS-CoV-2-plasma infusion and anakinra, and one patient was treated with remdesivir. One of these 2 patients developed multiple organ failure 6 days after receiving convalescent-anti-SARSCoV-2-plasma therapy. Despite treatment, these two patients died due to COVID-19 (after more than 30 days of hospitalisation), indicating lack of efficacy with remdesivir (1 patient) and following an off-label treatment with convalescent-anti-SARSCoV-2-plasma and anakinra (1 patient). Of these 21 patients, one patient experienced COVID-19 for a duration of 32 days. However, the patient did not receive any specific treatment and died subsequently due to COVID-19 after more than 30 days of hospitalisation. Out of these 21 patients, the remaining one patient recovered with an off-label treatment convalescent-anti-SARSCoV-2-plasma after experiencing COVID-19 for a duration of 43 days. However, the patient subsequently died due to progression of Richter syndrome.