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Abstract
Discussion Forum (0)
Abstract number: 4965

Session Type: ePosters

Session Title: ePosters

Authors(s): I. Boussen (1), M. Salmona (2), F. Sicre De Fontbrune (3), A. Xhaard (3), N. De Castro (1), M.L. Chaix (2), C. Delaugerre (2), J.M. Molina (1)

Authors Affiliations(s): (1) Department of Infectious Disease, Saint Louis Hospital, France, (2) Laboratory of Virology, Saint Louis Hospital, France, (3) Hematology Transplantation, Saint Louis Hospital, France

Background:

Bamlanivimab monotherapy has shown reduction in hospitalization rates when administered within 3 days of diagnosis among SARS-CoV-2 infected patients with mild or moderate disease. However, there is a potential risk of emergence of mutations in the spike protein receptor binding domain especially among immunocompromised patients.

Methods: Results:

A 62 year-old man with a history of relapsing acute myeloid leukemia was admitted in February 2021 for transient headache and confusion two months after allogeneic stem cell transplantation. His treatment included low dose steroids, mycophenolate mofetil and cyclosporine-A. Symptoms were attributed to cyclosporine-A toxicity. During hospitalization, the patient was briefly in contact with another patient later diagnosed with SARS-CoV-2 infection. Nasopharyngeal swabs for detection of SARS-CoV-2 by PCR at the time of admission and 5 days after exposure were negative. Eleven days after exposure, while the patient was asymptomatic, the nasopharyngeal test for SARS-CoV-2 returned positive (31 cycle threshold – ct, Wuhan strain). Bamlanivimab (700 mg intravenous infusion) was administered 48 hours later. At that time, RT–qPCR was positive in nasopharyngeal swab (13 ct) and plasma (35 ct) but the patient was asymptomatic and returned home. He was re-admitted 7 days later (day 20 after exposure) for dyspnea without fever. Chest CT-scan showed widespread bilateral infiltrates and peripheral oxygen saturation was 89%. Treatment included high dose steroids, high flow oxygen, a five-day course of remdesivir followed by tocilizumab. Nasopharyngeal swab and plasma were still positive for SARS-CoV-2 (24 and 34 ct respectively). A E484K mutation emerged on day 24. Because of clinical deterioration, four units of hyperimmune convalescent plasma were administered on day 28 and 29. Unfortunately, the patient developed acute respiratory distress and was admitted to the intensive care unit where he developed pancytopenia attributed to hematologic relapse and he died of septic shock 44 days after exposure.

Conclusions:

Single agent Bamlanivimab is unlikely to be beneficial in immunocompromised patients diagnosed with SARS-CoV-2 infection and may select for E484K mutation with a risk of dissemination.

Keyword(s): COVID-19, Bamlavinimab, mutation

Abstract number: 4965

Session Type: ePosters

Session Title: ePosters

Authors(s): I. Boussen (1), M. Salmona (2), F. Sicre De Fontbrune (3), A. Xhaard (3), N. De Castro (1), M.L. Chaix (2), C. Delaugerre (2), J.M. Molina (1)

Authors Affiliations(s): (1) Department of Infectious Disease, Saint Louis Hospital, France, (2) Laboratory of Virology, Saint Louis Hospital, France, (3) Hematology Transplantation, Saint Louis Hospital, France

Background:

Bamlanivimab monotherapy has shown reduction in hospitalization rates when administered within 3 days of diagnosis among SARS-CoV-2 infected patients with mild or moderate disease. However, there is a potential risk of emergence of mutations in the spike protein receptor binding domain especially among immunocompromised patients.

Methods: Results:

A 62 year-old man with a history of relapsing acute myeloid leukemia was admitted in February 2021 for transient headache and confusion two months after allogeneic stem cell transplantation. His treatment included low dose steroids, mycophenolate mofetil and cyclosporine-A. Symptoms were attributed to cyclosporine-A toxicity. During hospitalization, the patient was briefly in contact with another patient later diagnosed with SARS-CoV-2 infection. Nasopharyngeal swabs for detection of SARS-CoV-2 by PCR at the time of admission and 5 days after exposure were negative. Eleven days after exposure, while the patient was asymptomatic, the nasopharyngeal test for SARS-CoV-2 returned positive (31 cycle threshold – ct, Wuhan strain). Bamlanivimab (700 mg intravenous infusion) was administered 48 hours later. At that time, RT–qPCR was positive in nasopharyngeal swab (13 ct) and plasma (35 ct) but the patient was asymptomatic and returned home. He was re-admitted 7 days later (day 20 after exposure) for dyspnea without fever. Chest CT-scan showed widespread bilateral infiltrates and peripheral oxygen saturation was 89%. Treatment included high dose steroids, high flow oxygen, a five-day course of remdesivir followed by tocilizumab. Nasopharyngeal swab and plasma were still positive for SARS-CoV-2 (24 and 34 ct respectively). A E484K mutation emerged on day 24. Because of clinical deterioration, four units of hyperimmune convalescent plasma were administered on day 28 and 29. Unfortunately, the patient developed acute respiratory distress and was admitted to the intensive care unit where he developed pancytopenia attributed to hematologic relapse and he died of septic shock 44 days after exposure.

Conclusions:

Single agent Bamlanivimab is unlikely to be beneficial in immunocompromised patients diagnosed with SARS-CoV-2 infection and may select for E484K mutation with a risk of dissemination.

Keyword(s): COVID-19, Bamlavinimab, mutation

Failure of bamlanivimab with selection of E484K mutation in an allogeneic stem cell transplant recipient with nosocomial SARS-CoV-2 infection
Dr. Inès Boussen
Dr. Inès Boussen
Affiliations:
Infectious diseases department, Saint Louis Hospital, Paris.
ESCMID eAcademy. Boussen I. 07/09/2021; 332428; 4965;
user
Dr. Inès Boussen
Affiliations:
Infectious diseases department, Saint Louis Hospital, Paris.
Abstract
Discussion Forum (0)
Abstract number: 4965

Session Type: ePosters

Session Title: ePosters

Authors(s): I. Boussen (1), M. Salmona (2), F. Sicre De Fontbrune (3), A. Xhaard (3), N. De Castro (1), M.L. Chaix (2), C. Delaugerre (2), J.M. Molina (1)

Authors Affiliations(s): (1) Department of Infectious Disease, Saint Louis Hospital, France, (2) Laboratory of Virology, Saint Louis Hospital, France, (3) Hematology Transplantation, Saint Louis Hospital, France

Background:

Bamlanivimab monotherapy has shown reduction in hospitalization rates when administered within 3 days of diagnosis among SARS-CoV-2 infected patients with mild or moderate disease. However, there is a potential risk of emergence of mutations in the spike protein receptor binding domain especially among immunocompromised patients.

Methods: Results:

A 62 year-old man with a history of relapsing acute myeloid leukemia was admitted in February 2021 for transient headache and confusion two months after allogeneic stem cell transplantation. His treatment included low dose steroids, mycophenolate mofetil and cyclosporine-A. Symptoms were attributed to cyclosporine-A toxicity. During hospitalization, the patient was briefly in contact with another patient later diagnosed with SARS-CoV-2 infection. Nasopharyngeal swabs for detection of SARS-CoV-2 by PCR at the time of admission and 5 days after exposure were negative. Eleven days after exposure, while the patient was asymptomatic, the nasopharyngeal test for SARS-CoV-2 returned positive (31 cycle threshold – ct, Wuhan strain). Bamlanivimab (700 mg intravenous infusion) was administered 48 hours later. At that time, RT–qPCR was positive in nasopharyngeal swab (13 ct) and plasma (35 ct) but the patient was asymptomatic and returned home. He was re-admitted 7 days later (day 20 after exposure) for dyspnea without fever. Chest CT-scan showed widespread bilateral infiltrates and peripheral oxygen saturation was 89%. Treatment included high dose steroids, high flow oxygen, a five-day course of remdesivir followed by tocilizumab. Nasopharyngeal swab and plasma were still positive for SARS-CoV-2 (24 and 34 ct respectively). A E484K mutation emerged on day 24. Because of clinical deterioration, four units of hyperimmune convalescent plasma were administered on day 28 and 29. Unfortunately, the patient developed acute respiratory distress and was admitted to the intensive care unit where he developed pancytopenia attributed to hematologic relapse and he died of septic shock 44 days after exposure.

Conclusions:

Single agent Bamlanivimab is unlikely to be beneficial in immunocompromised patients diagnosed with SARS-CoV-2 infection and may select for E484K mutation with a risk of dissemination.

Keyword(s): COVID-19, Bamlavinimab, mutation

Abstract number: 4965

Session Type: ePosters

Session Title: ePosters

Authors(s): I. Boussen (1), M. Salmona (2), F. Sicre De Fontbrune (3), A. Xhaard (3), N. De Castro (1), M.L. Chaix (2), C. Delaugerre (2), J.M. Molina (1)

Authors Affiliations(s): (1) Department of Infectious Disease, Saint Louis Hospital, France, (2) Laboratory of Virology, Saint Louis Hospital, France, (3) Hematology Transplantation, Saint Louis Hospital, France

Background:

Bamlanivimab monotherapy has shown reduction in hospitalization rates when administered within 3 days of diagnosis among SARS-CoV-2 infected patients with mild or moderate disease. However, there is a potential risk of emergence of mutations in the spike protein receptor binding domain especially among immunocompromised patients.

Methods: Results:

A 62 year-old man with a history of relapsing acute myeloid leukemia was admitted in February 2021 for transient headache and confusion two months after allogeneic stem cell transplantation. His treatment included low dose steroids, mycophenolate mofetil and cyclosporine-A. Symptoms were attributed to cyclosporine-A toxicity. During hospitalization, the patient was briefly in contact with another patient later diagnosed with SARS-CoV-2 infection. Nasopharyngeal swabs for detection of SARS-CoV-2 by PCR at the time of admission and 5 days after exposure were negative. Eleven days after exposure, while the patient was asymptomatic, the nasopharyngeal test for SARS-CoV-2 returned positive (31 cycle threshold – ct, Wuhan strain). Bamlanivimab (700 mg intravenous infusion) was administered 48 hours later. At that time, RT–qPCR was positive in nasopharyngeal swab (13 ct) and plasma (35 ct) but the patient was asymptomatic and returned home. He was re-admitted 7 days later (day 20 after exposure) for dyspnea without fever. Chest CT-scan showed widespread bilateral infiltrates and peripheral oxygen saturation was 89%. Treatment included high dose steroids, high flow oxygen, a five-day course of remdesivir followed by tocilizumab. Nasopharyngeal swab and plasma were still positive for SARS-CoV-2 (24 and 34 ct respectively). A E484K mutation emerged on day 24. Because of clinical deterioration, four units of hyperimmune convalescent plasma were administered on day 28 and 29. Unfortunately, the patient developed acute respiratory distress and was admitted to the intensive care unit where he developed pancytopenia attributed to hematologic relapse and he died of septic shock 44 days after exposure.

Conclusions:

Single agent Bamlanivimab is unlikely to be beneficial in immunocompromised patients diagnosed with SARS-CoV-2 infection and may select for E484K mutation with a risk of dissemination.

Keyword(s): COVID-19, Bamlavinimab, mutation

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