Plitidepsin as a successful rescue treatment for prolonged viral SARS-CoV-2 replication in a patient with previous anti-CD20 monoclonal antibody-mediated B cell depletion and chronic lymphocytic leukemia

J Hematol Oncol. 2022 Jan 10;15(1):4. doi: 10.1186/s13045-021-01220-0.

Abstract

Background: There is an urgent need for highly efficacious antiviral therapies in immunosuppressed hosts who develop coronavirus disease (COVID-19), with special concern for those affected by hematological malignancies.

Case presentation: Here, we report the case of a 75-year-old male with chronic lymphocytic leukemia who was deficient in CD19+CD20+ B-lymphocyte populations due to previous treatment with anti-CD20 monoclonal antibodies. The patient presented with severe COVID-19 pneumonia due to prolonged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and was treated with two courses of the antiviral plitidepsin on a compassionate use basis. The patient subsequently achieved an undetectable viral load, and his pneumonia resolved.

Conclusions: Treatment with plitidepsin was well-tolerated without any further hematological or cardiovascular toxicities. This case further supports plitidepsin as a potential antiviral drug in SARS-CoV-2 patients affected by immune deficiencies and hematological malignancies.

Keywords: Anti-CD20 monoclonal antibody; Chronic lymphocytic leukemia; Covid-19; Plitidepsin; Prolonged viral replication; SARS-CoV-2.

Publication types

  • Case Reports
  • Letter
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Antibodies, Monoclonal / therapeutic use*
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Antigens, CD20 / immunology
  • B-Lymphocytes / drug effects*
  • B-Lymphocytes / metabolism
  • COVID-19 / complications
  • COVID-19 / prevention & control*
  • COVID-19 / virology
  • Depsipeptides / therapeutic use*
  • Humans
  • Leukemia, Lymphocytic, Chronic, B-Cell / complications*
  • Leukemia, Lymphocytic, Chronic, B-Cell / drug therapy
  • Lymphocyte Depletion / methods
  • Male
  • Peptides, Cyclic / therapeutic use*
  • SARS-CoV-2 / drug effects*
  • SARS-CoV-2 / genetics
  • SARS-CoV-2 / physiology
  • Treatment Outcome
  • Virus Replication / drug effects*

Substances

  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Antigens, CD20
  • Depsipeptides
  • Peptides, Cyclic
  • obinutuzumab
  • plitidepsin