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Sufferers with most cancers are thought of in danger for COVID-19, however in some instances, may the an infection be a great factor? A case report of a affected person with Hodgkin lymphoma whose situation went into remission led to a headline suggesting that COVID -19 had “cured” the affected person.
The case report was published within the British Journal of Haematology.
The affected person subsequently skilled relapsed, however the SARS-CoV-2 an infection had induced remission for a while.
Within the case report, Sarah Challenor, MD, and David Tucker, MD, each of the Division of Haematology, Royal Cornwall NHS Hospital Belief, Truro, Cornwall, United Kingdom, describe how a 61-year-old man was referred to their division with progressive lymphadenopathy and weight reduction. He had been receiving hemodialysis for end-stage renal failure secondary to IgA nephropathy and had not been taking immunosuppressive remedy for Three years after a failed renal transplant.
The affected person was recognized with Epstein-Barr virus (EBV)–optimistic classical Hodgkin lymphoma. Fluorodeoxyglucose positron-emission tomography/CT (FDG-PET/CT) revealed that he had stage IIIs illness.
Quickly after his prognosis of Hodgkin lymphoma, he developed respiratory signs and was recognized with polymerase chain response (PCR)–optimistic SARS-CoV-2 pneumonia.
“This affected person’s lymphoma was recognized about this time final yr (February 2020),” Tucker informed Medscape Medical Information. He has “PET avid and clinically palpable Hodgkin lymphoma.”
In March–April 2020, he was admitted to the hospital with COVID-19. The affected person remained within the hospital for 11 days. He acquired supportive care on a daily medical unit however was not handled with corticosteroids or immunotherapy. He was then discharged dwelling.
4 months later (Could 2020), scans and exams revealed that his a number of tumors had largely vanished. The palpable lymphadenopathy had shrunk, and an interim PET/CT scan confirmed that lymphadenopathy had largely resolved. The EBV viral load on PCR had declined from 4800 copies/mL (log10, 3.68) to 413 copies/mL (log10, 2.62).
The affected person’s situation had gone into remission.
Coincidence or COVID-19 Induced?
The authors hypothesize that the SARS-CoV-2 an infection triggered an antitumor immune response. “The putative mechanisms of motion embody cross-reactivity of pathogen-specific T cells with tumor antigens and pure killer cell activation by inflammatory cytokines produced in response to an infection,” they write.
They level to a 2012 case report during which a affected person with diffuse giant B-cell lymphoma (DLBCL) skilled spontaneous regression of illness within the maxillary sinus after an infection with concurrent pneumonia and Clostridium difficile colitis. The authors of that case report word that spontaneous DLBCL remission has been reported, and in some instances, it occurred the setting of concurrent an infection.
Tucker defined that the mechanism of motion stays unclear. “I’ve not seen spontaneous remission of classical Hodgkin lymphoma earlier than, though it does not often happen, so I believe coincidence is much less possible,” he mentioned. “The coincidence appeared worthy of word, so we wrote it up.”
He speculates that there might have been some form of immune response, “probably T-cell mediated or maybe associated to interferon-induced cell destruction, as we all know that interferon can management lymphoma ― it was used as upkeep remedy till it was changed by rituximab,” he mentioned. “What I do know is that he acquired no medicines corresponding to steroids or different cytotoxics which may clarify the response.”
Nevertheless, the remission was solely short-term. “His illness returned in August 2020, and he has subsequently been efficiently handled,” mentioned Tucker. “So it was solely a transient response, however relapse was not current on the time of writing [the case report].”
Two consultants weighed in on the report.
“I might have wished to examine the prognosis of lymphoma ― however with that spectacular PET, it actually appears an affordable prognosis,” commented Girish Venkataraman, MBBS, affiliate professor of pathology on the College of Chicago, Chicago, Illinois.
An infection with a virus “does activate the immune microenvironment fairly a bit, and relying on the host baseline immune competence, it does appear tenable that the cytokine profile/signature of the microenvironment was altered sufficient by the SARS-CoV-2 an infection that rendered the microenvironment to be not conducive for the expansion of the lymphoma cells,” he mentioned.
“Hodgkin illness may be very depending on an immunosuppressive anergic microevironment to thrive and subvert any immune response,” he famous.
This phenomena has been described earlier than, and the speculation is believable, commented Leo I. Gordon, MD, FACP, professor of medication and codirector of the Hematologic Malignancies Program, Division of Hematology/Oncology, Northwestern College Feinberg College of Medication, Chicago, Illinois.
“Given the very encouraging information with checkpoint inhibitors, which activate T cells, in classical Hodgkin lymphoma, the concept that activated T cells would possibly result in remission isn’t far-fetched and is in line with what we predict is a mechanism of lung harm in SARs-CoV-2 ― particularly, overenthusiastic T cells,” he mentioned. “A caveat is that we’ve got seen spontaneous remissions on this illness, particularly in these sufferers who’ve EBV-associated basic Hodgkin lymphoma, so the function that [infection] performs on this case stays unclear.
“Whereas nobody is advocating a SARS-CoV-2 an infection as a remedy for lymphoma, this highlights the significance of understanding the frequent immunologic mechanisms at play,” he mentioned.
The authors, Venkataraman, and Gordon have disclosed no related monetary relationships.
Br J Haematol. Printed on-line January 2, 2021. Full text