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Relapsed Mantle Cell Lymphoma, Allogenic Stem Cell Transplantation and COVID-19

Received: 11 January 2021     Accepted: 25 January 2021     Published: 30 January 2021
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Abstract

The standard of care for fit patients with Mantle Cell Lymphoma (MCL) includes cytarabine containing induction treatment and consolidation with BEAM (Carmustine, Etoposide, Cytarabine and Melphalan). Chemo-refractory cases have a poorer prognosis and are candidates for allogenic stem cell transplantation (allo-SCT). Targeted therapy, such as BTK-inhibitors or BCL-mimetics can be used to bridge patients to SCT. COVID-19, a novel coronavirus has the potential to cause life threatening immune dysregulation and cytokine release syndrome (CRS) resulting in respiratory failure. Haematology patients, particularly post allogenic stem cell transplant, are high risk for developing CRS due to T-lymphopenia. PD, a 55-year-old male, with chemo-refractory MCL tested positive for COVID-19 day + 45 post allo-SCT after presenting with mild gastrointestinal symptoms and remained positive for 70 days. At day + 92 relapse was confirmed by CT and axillary node biopsy. Ibrutinib, a BTK inhibitor, was commenced with resolution of symptoms and a negative test within 20 days. With minimal reduction in adenopathy, Ibrutinib was stopped at day +110, while Cytarabine and Venetoclax (BCL-mimetic) were commenced with Donor lymphocyte infusion at day +145 resulting in complete remission. Ibrutinib’s therapeutic role against COVID-19 is now being investigated in clinical trials.

Published in American Journal of Internal Medicine (Volume 9, Issue 1)
DOI 10.11648/j.ajim.20210901.17
Page(s) 49-51
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Mantle Cell Lymphoma, Allogenic Stem-Cell Transplantation, COVID-19, Ibrutinib, BTK-inhibitor, Venetoclax, BCL2 Mimetic, Graft Versus Host Disease

References
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[2] El-Sharkawi, D., & Iyengar, S. (2020). Haematological cancers and the risk of severe COVID-19: Exploration and critical evaluation of the evidence to date. British Journal Of Haematology, 190 (3), 336-345. doi: 10.1111/bjh.16956.
[3] Eskelund, C., Kolstad, A., Jerkeman, M., Räty, R., Laurell, A., & Eloranta, S. et al. (2016). 15-year follow-up of the Second Nordic Mantle Cell Lymphoma trial (MCL2): prolonged remissions without survival plateau. British Journal Of Haematology, 175 (3), 410-418. doi: 10.1111/bjh.14241.
[4] Eyre, T., Walter, H., Iyengar, S., Follows, G., Cross, M., & Fox, C. et al. (2018). Efficacy of venetoclax monotherapy in patients with relapsed, refractory mantle cell lymphoma after Bruton tyrosine kinase inhibitor therapy. Haematologica, 104 (2), e68-e71. doi: 10.3324/haematol.2018.198812.
[5] Fogarty, H., Townsend, L., Ni Cheallaigh, C., Bergin, C., Martin-Loeches, I., & Browne, P. et al. (2020). COVID19 coagulopathy in Caucasian patients. British Journal Of Haematology, 189 (6), 1044-1049. doi: 10.1111/bjh.16749.
[6] Hermine, O., Hoster, E., Walewski, J., Bosly, A., Stilgenbauer, S., & Thieblemont, C. et al. (2016). Addition of high-dose cytarabine to immunochemotherapy before autologous stem-cell transplantation in patients aged 65 years or younger with mantle cell lymphoma (MCL Younger): a randomised, open-label, phase 3 trial of the European Mantle Cell Lymphoma Network. The Lancet, 388 (10044), 565-575. doi: 10.1016/s0140-6736(16)00739-x.
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[10] McGee, M., August, A., & Huang, W. (2020). BTK/ITK dual inhibitors: Modulating immunopathology and lymphopenia for COVID-19 therapy. Journal Of Leukocyte Biology. doi: 10.1002/jlb.5covr0620-306r.
[11] Ogimi, C., Greninger, A., Waghmare, A., Kuypers, J., Shean, R., & Xie, H. et al. (2017). Prolonged Shedding of Human Coronavirus in Hematopoietic Cell Transplant Recipients: Risk Factors and Viral Genome Evolution. The Journal Of Infectious Diseases, 216 (2), 203-209. doi: 10.1093/infdis/jix264.
[12] Roué, G., & Sola, B. (2020). Management of Drug Resistance in Mantle Cell Lymphoma. Cancers, 12 (6), 1565. doi: 10.3390/cancers12061565.
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Cite This Article
  • APA Style

    James Dillon, Elizabeth Higgins, Carmel-Ann Galligan, Majella Moran, Brendan Crowley, et al. (2021). Relapsed Mantle Cell Lymphoma, Allogenic Stem Cell Transplantation and COVID-19. American Journal of Internal Medicine, 9(1), 49-51. https://doi.org/10.11648/j.ajim.20210901.17

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    ACS Style

    James Dillon; Elizabeth Higgins; Carmel-Ann Galligan; Majella Moran; Brendan Crowley, et al. Relapsed Mantle Cell Lymphoma, Allogenic Stem Cell Transplantation and COVID-19. Am. J. Intern. Med. 2021, 9(1), 49-51. doi: 10.11648/j.ajim.20210901.17

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    AMA Style

    James Dillon, Elizabeth Higgins, Carmel-Ann Galligan, Majella Moran, Brendan Crowley, et al. Relapsed Mantle Cell Lymphoma, Allogenic Stem Cell Transplantation and COVID-19. Am J Intern Med. 2021;9(1):49-51. doi: 10.11648/j.ajim.20210901.17

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  • @article{10.11648/j.ajim.20210901.17,
      author = {James Dillon and Elizabeth Higgins and Carmel-Ann Galligan and Majella Moran and Brendan Crowley and Ciaran Bannan and Carmel Waldron and Christopher Larry Bacon and Elisabeth Vandenberghe},
      title = {Relapsed Mantle Cell Lymphoma, Allogenic Stem Cell Transplantation and COVID-19},
      journal = {American Journal of Internal Medicine},
      volume = {9},
      number = {1},
      pages = {49-51},
      doi = {10.11648/j.ajim.20210901.17},
      url = {https://doi.org/10.11648/j.ajim.20210901.17},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20210901.17},
      abstract = {The standard of care for fit patients with Mantle Cell Lymphoma (MCL) includes cytarabine containing induction treatment and consolidation with BEAM (Carmustine, Etoposide, Cytarabine and Melphalan). Chemo-refractory cases have a poorer prognosis and are candidates for allogenic stem cell transplantation (allo-SCT). Targeted therapy, such as BTK-inhibitors or BCL-mimetics can be used to bridge patients to SCT. COVID-19, a novel coronavirus has the potential to cause life threatening immune dysregulation and cytokine release syndrome (CRS) resulting in respiratory failure. Haematology patients, particularly post allogenic stem cell transplant, are high risk for developing CRS due to T-lymphopenia. PD, a 55-year-old male, with chemo-refractory MCL tested positive for COVID-19 day + 45 post allo-SCT after presenting with mild gastrointestinal symptoms and remained positive for 70 days. At day + 92 relapse was confirmed by CT and axillary node biopsy. Ibrutinib, a BTK inhibitor, was commenced with resolution of symptoms and a negative test within 20 days. With minimal reduction in adenopathy, Ibrutinib was stopped at day +110, while Cytarabine and Venetoclax (BCL-mimetic) were commenced with Donor lymphocyte infusion at day +145 resulting in complete remission. Ibrutinib’s therapeutic role against COVID-19 is now being investigated in clinical trials.},
     year = {2021}
    }
    

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    T1  - Relapsed Mantle Cell Lymphoma, Allogenic Stem Cell Transplantation and COVID-19
    AU  - James Dillon
    AU  - Elizabeth Higgins
    AU  - Carmel-Ann Galligan
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    AB  - The standard of care for fit patients with Mantle Cell Lymphoma (MCL) includes cytarabine containing induction treatment and consolidation with BEAM (Carmustine, Etoposide, Cytarabine and Melphalan). Chemo-refractory cases have a poorer prognosis and are candidates for allogenic stem cell transplantation (allo-SCT). Targeted therapy, such as BTK-inhibitors or BCL-mimetics can be used to bridge patients to SCT. COVID-19, a novel coronavirus has the potential to cause life threatening immune dysregulation and cytokine release syndrome (CRS) resulting in respiratory failure. Haematology patients, particularly post allogenic stem cell transplant, are high risk for developing CRS due to T-lymphopenia. PD, a 55-year-old male, with chemo-refractory MCL tested positive for COVID-19 day + 45 post allo-SCT after presenting with mild gastrointestinal symptoms and remained positive for 70 days. At day + 92 relapse was confirmed by CT and axillary node biopsy. Ibrutinib, a BTK inhibitor, was commenced with resolution of symptoms and a negative test within 20 days. With minimal reduction in adenopathy, Ibrutinib was stopped at day +110, while Cytarabine and Venetoclax (BCL-mimetic) were commenced with Donor lymphocyte infusion at day +145 resulting in complete remission. Ibrutinib’s therapeutic role against COVID-19 is now being investigated in clinical trials.
    VL  - 9
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Author Information
  • Department of Haematology, St James’s Hospital, Dublin, Ireland

  • Department of Haematology, St James’s Hospital, Dublin, Ireland

  • Department of Haematology, St James’s Hospital, Dublin, Ireland

  • Department of Haematology, St James’s Hospital, Dublin, Ireland

  • Department of Virology, St James’s Hospital, Dublin, Ireland

  • Department of Infectious Diseases, St James’s Hospital, Dublin, Ireland

  • Department of Haematology, St James’s Hospital, Dublin, Ireland

  • Department of Haematology, St James’s Hospital, Dublin, Ireland

  • Department of Haematology, St James’s Hospital, Dublin, Ireland

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