SARS-CoV-2感染的早期治疗结果在血液系统疾病患者中的应用。
Outcome of early treatment of SARS-CoV-2 infection in patients with haematological disorders.
发表日期：2023 Feb 20
作者：
Malgorzata Mikulska, Diletta Testi, Chiara Russo, Elisa Balletto, Chiara Sepulcri, Linda Bussini, Chiara Dentone, Federica Magne, Sílvia Policarpo, Caterina Campoli, Filippo Miselli, Alessandro Cilli, Chiara Ghiggi, Sara Aquino, Carmen Di Grazia, Maddalena Giannella, Daniele Roberto Giacobbe, Antonio Vena, Anna Maria Raiola, Francesca Bonifazi, Pierluigi Zinzani, Michele Cavo, Roberto Lemoli, Emanuele Angelucci, Pierluigi Viale, Matteo Bassetti, Michele Bartoletti
来源：
BRITISH JOURNAL OF HAEMATOLOGY
摘要：
对于有血液恶性肿瘤（HM）患者的COVID-19早期使用抗病毒药物或抗Spike单克隆抗体（MABs）的治疗结果尚不确定。我们针对2021年3月至2022年7月间受治疗的轻度/中度 COVID-19 的HM患者进行了回顾性研究。主要终点是治疗失败（严重的 COVID-19 或 COVID-19 相关死亡）。我们纳入了328名连续接受 MABs（n = 120，37％；其中sotrovimab为73）或抗病毒药物（n = 208，63％；其中nirmatrelvir / ritonavir为116）治疗的患者，均在开始出现症状的中位数两天内接受治疗；111人（33.8％）为非何杰金淋巴瘤患者（NHL）；89人（27％）接受过移植/ CAR-T（嵌合抗原受体T细胞疗法）。绝大部分感染病例（n = 309，94％）发生在Omicron期间。有31名患者（9.5％）治疗失败。其独立的预测因素为年龄较大、接种疫苗次数较少和接受MABs治疗。失败率在Omicron期间与Omicron期前相比更低（7.8％与36.8％，p <0.001）。在Omicron期间，失败的预测因素为年龄、接种疫苗次数较少和急性髓系白血病 / 骨髓增生异常综合征（AML / MDS）的诊断。年龄、合并症、入院治疗、NHL / CLL和接受MABs治疗是病毒排泄持续时间较长的独立预测因子。COVID-19相关死亡率为3.4％（n = 11）。在早期治疗后发展为严重COVID-19的患者中，Omicron期间的死亡率为26％。即使在Omicron期间，HM患者早期治疗失败的风险仍然显著，死亡率很高。
© 2023 The Authors. British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd.
Outcome of early treatment of COVID-19 with antivirals or anti-spike monoclonal antibodies (MABs) in patients with haematological malignancies (HM) is unknown. A retrospective study of HM patients treated for mild/moderate COVID-19 between March 2021 and July 2022 was performed. The main composite end-point was treatment failure (severe COVID-19 or COVID-19-related death). We included 328 consecutive patients who received MABs (n = 120, 37%; sotrovimab, n = 73) or antivirals (n = 208, 63%; nirmatrelvir/ritonavir, n = 116) over a median of two days after symptoms started; 111 (33.8%) had non-Hodgkin lymphoma (NHL); 89 (27%) were transplant/CAR-T (chimaeric antigen receptor T-cell therapy) recipients. Most infections (n = 309, 94%) occurred during the Omicron period. Failure developed in 31 patients (9.5%). Its independent predictors were older age, fewer vaccine doses, and treatment with MABs. Rate of failure was lower in the Omicron versus the pre-Omicron period (7.8% versus 36.8%, p < 0.001). During the Omicron period, predictors of failure were age, fewer vaccine doses and diagnosis of acute myeloid leukaemia/myelodysplastic syndrome (AML/MDS). Independent predictors of longer viral shedding were age, comorbidities, hospital admission at diagnosis, NHL/CLL, treatment with MABs. COVID-19-associated mortality was 3.4% (n = 11). The mortality in those who developed severe COVID-19 after early treatment was 26% in the Omicron period. Patients with HM had a significant risk of failure of early treatment, even during the Omicron period, with high mortality rate.© 2023 The Authors. British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd.