Patients with hematological malignancies have an increased susceptibility to COVID-19 and higher mortality. They can also have prolonged symptoms and shedding of the virus. Clinical studies have not specifically addressed the treatment of this patient population. We present a lymphoma patient with COVID-19 treated with remdesivir and a literature review of similar cases.
SARS-CoV-2 RT-PCR, virus culture and whole genome sequencing were performed from nasopharyngeal swabs and serum antibody tests. In addition, SARS-CoV-2 nucleocapsid antigen from serum was tested. Medline was searched for reported cases of lymphoma and COVID-19 treated with remdesivir.
The patient was undergoing lymphoma treatment including chemotherapy, rituximab and prednisolone. After diagnosis of COVID-19, broad-spectrum antibiotics were administered due to neutropenia and fever. After 20 days of fever with no evidence of co-infection, remdesivir was initiated with a rapid response. Treatment was continued for 4 d. Serum SARS-CoV-2 antibody tests were negative at 20, 30 and 66 days after symptom onset. Before starting remdesivir, the SARS-CoV-2 PCR and virus culture from the nasopharynx and serum antigen test were positive. From previous reports, we have identified a total of eleven cases of lymphoma and COVID-19 treated with remdesivir in combination with other antiviral and anti-inflammatory agents.
As this and previous reports on lymphoma patients show, the clinical course of COVID-19 can be protracted and a humoral immune response can be absent. In addition, optimal management remains undecided. The patient presented responded well to a short course of remdesivir.
COVID-19; lymphoma; remdesivir.