Successful clearance of 300 day sars-cov-2 infection in a subject with b-cell depletion associated prolonged (B-deap) covid by regen-cov anti-spike monoclonal antibody cocktail

Arnaud C. Drouin, Marc W. Theberge, Sharon Y. Liu, Allison R. Smither, Shelby M. Flaherty, Mark Zeller, Gregory P. Geba, Peter Reynaud, W. Benjamin Rothwell, Alfred P. Luk, Di Tian, Matthew L. Boisen, Luis M. Branco, Kristian G. Andersen, James E. Robinson, Robert F. Garry, Dahlene N. Fusco

Research output: Contribution to journalArticlepeer-review

21 Scopus citations

Abstract

A 59-year-old male with follicular lymphoma treated by anti-CD20-mediated B-cell depletion and ablative chemotherapy was hospitalized with a COVID-19 infection. Although the patient did not develop specific humoral immunity, he had a mild clinical course overall. The failure of all therapeutic options allowed infection to persist nearly 300 days with active accumulation of SARS-CoV-2 virus mutations. As a rescue therapy, an infusion of REGEN-COV (10933 and 10987) anti-spike monoclonal antibodies was performed 270 days from initial diagnosis. Due to partial clearance after the first dose (2.4 g), a consolidation dose (8 g) was infused six weeks later. Complete virus clearance could then be observed over the following month, after he was vaccinated with the Pfizer-BioNTech anti-COVID-19 vaccination. The successful management of this patient required prolonged enhanced quarantine, monitoring of virus mutations, pioneering clinical decisions based upon close consultation, and the coordination of multidisciplinary experts in virology, immunology, pharmacology, input from REGN, the FDA, the IRB, the health care team, the patient, and the pa-tient’s family. Current decisions to take revolve around patient’s follicular lymphoma management, and monitoring for virus clearance persistence beyond disappearance of REGEN-COV monoclonal antibodies after anti-SARS-CoV-2 vaccination. Overall, specific guidelines for similar cases should be established.

Original languageEnglish (US)
Article number1202
JournalViruses
Volume13
Issue number7
DOIs
StatePublished - Jul 2021

Keywords

  • Anti-CD20-mediated B-cell depletion
  • Anti-COVID-19 vaccine
  • B-DEAP COVID-19
  • B-cell depletion associated prolonged COVID-19
  • COVID-19
  • Obinutuzumab
  • REGEN-COV
  • REGN10933 and REGN10987
  • SARS-CoV-2 persistence
  • Spike mutation
  • Virus mutations

ASJC Scopus subject areas

  • Infectious Diseases
  • Virology

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