Individual patient characteristics
| . | Persistent or recurrent SARS-CoV-2 infection . | Serologically defined COVID-19 vaccine failure . | ||||
|---|---|---|---|---|---|---|
| . | Patient A . | Patient B . | Patient C . | Patient D . | Patient E . | Patient F . |
| Age, y | 48 | 56 | 63 | 78 | 63 | 39 |
| Sex | Male | Male | Male | Female | Male | Female |
| Type of B-NHL | Follicular | Follicular | Follicular | Unspecified | CLL | DLBCL |
| Basal characteristics | ||||||
| B-cell depleting therapy (active and past) | O-CHOP + obinutuzumab maintenance (ongoing treatment) | R-CHOP Rituximab mono DHAP+rituximab High dose BEAM (5 m before admission) | Obinutuzumab + bendamustine (ongoing treatment) | Rituximab mono (last treatment 4 y ago) | (Venetoclax, ongoing treatment) | R-CHOP R-GemOx R-EPOCH (ongoing treatment) |
| Gammaglobulinemia, g/L (normal range, 7-16) | 2.4(IVIG)* | 3.8 | 8.3(IVIG)* | 5.4(SCIG)* | 5.4(IVIG)* | 5.7 |
| COVID-19 vaccination status (months since last dose) | Not vaccinated | Not vaccinated | One dose BNT162b2 (3) | Two doses BNT162b2 (2) | Two doses AZD1222 (4) | Two doses BNT162b2 (3) |
| SARS-CoV-2 IgG serostatus | Negative† | Negative† | 434 BAU/mL‡ | Negative† | Negative† | 8.2 BAU/mL† |
| Clinical course | ||||||
| Time from first positive PCR to nmAb treatment, d | 86 | 63 | 56 | 5 | 12 | 2 |
| Time from symptom onset to nmAb treatment, d | ∼56 | ∼63 | 13 | 11 | 13 | 2 |
| COVID-19 symptoms | Fever, dyspnea | Fever, cough | Fever, fatigue, cough | Fever, fatigue, dry cough | Fever, fatigue, dyspnea | Fever |
| WHO progression score (highest) | 6 | 5 | 5 | 5 | 4 | 4 |
| SARS-CoV-2 viremia,copies per mL | 1567 | 1336 | 1176 | 36 | 159 | 735 |
| Length of hospital stay after nmAb treatment, d | 8 | 11 | 7 | 12 | 10 | Ongoing hospitalization for treatment of lymphoma |
| . | Persistent or recurrent SARS-CoV-2 infection . | Serologically defined COVID-19 vaccine failure . | ||||
|---|---|---|---|---|---|---|
| . | Patient A . | Patient B . | Patient C . | Patient D . | Patient E . | Patient F . |
| Age, y | 48 | 56 | 63 | 78 | 63 | 39 |
| Sex | Male | Male | Male | Female | Male | Female |
| Type of B-NHL | Follicular | Follicular | Follicular | Unspecified | CLL | DLBCL |
| Basal characteristics | ||||||
| B-cell depleting therapy (active and past) | O-CHOP + obinutuzumab maintenance (ongoing treatment) | R-CHOP Rituximab mono DHAP+rituximab High dose BEAM (5 m before admission) | Obinutuzumab + bendamustine (ongoing treatment) | Rituximab mono (last treatment 4 y ago) | (Venetoclax, ongoing treatment) | R-CHOP R-GemOx R-EPOCH (ongoing treatment) |
| Gammaglobulinemia, g/L (normal range, 7-16) | 2.4(IVIG)* | 3.8 | 8.3(IVIG)* | 5.4(SCIG)* | 5.4(IVIG)* | 5.7 |
| COVID-19 vaccination status (months since last dose) | Not vaccinated | Not vaccinated | One dose BNT162b2 (3) | Two doses BNT162b2 (2) | Two doses AZD1222 (4) | Two doses BNT162b2 (3) |
| SARS-CoV-2 IgG serostatus | Negative† | Negative† | 434 BAU/mL‡ | Negative† | Negative† | 8.2 BAU/mL† |
| Clinical course | ||||||
| Time from first positive PCR to nmAb treatment, d | 86 | 63 | 56 | 5 | 12 | 2 |
| Time from symptom onset to nmAb treatment, d | ∼56 | ∼63 | 13 | 11 | 13 | 2 |
| COVID-19 symptoms | Fever, dyspnea | Fever, cough | Fever, fatigue, cough | Fever, fatigue, dry cough | Fever, fatigue, dyspnea | Fever |
| WHO progression score (highest) | 6 | 5 | 5 | 5 | 4 | 4 |
| SARS-CoV-2 viremia,copies per mL | 1567 | 1336 | 1176 | 36 | 159 | 735 |
| Length of hospital stay after nmAb treatment, d | 8 | 11 | 7 | 12 | 10 | Ongoing hospitalization for treatment of lymphoma |
N = 6.
BAU, binding antibody units; BEAM, carmustine (BCNU), etoposide, cytarabine, melphalan; CHOP, cyclophosphamide, hydroxydaunorubicin, vincristine, prednisone; CLL, chronic lymphocytic leukemia; DHAP, dexamethasone; high-dose cytarabine, cisplatin; DLBCL, diffuse large B-cell lymphoma; EPOCH etoposide, prednisone, vincristine, cyclophosphamide, hydroxydaunorubicin; GemOx, gemcitabine, oxaliplatin; O, obinutuzumab; and R, rituximab.
IVIG, intravenous immunoglobulin substitution; SCIG, subcutaneous immunoglobulin substitution.
Reference value: negative antibodies, <7.1 BAU/mL.
A live virus neutralization test (VNT) demonstrated poor neutralizing activity (100% inhibitory dilution [ID100] of 10).