PMC10242072_01
Next Generation Sequencing performed at SARS-CoV-2 infection diagnosis and repeated with the same results 3-week after nirmatrelvir/ritonavir therapy and 1-week after tixagevimab/cilgavimab and remdesivir therapy.
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After achieving second complete morphological remission with detectable MRD after two cycles of Inotuzumab ozogamicin (IO), an allo-HSCT was scheduled.  Figure 1  displays the Next-Generation Sequencing (NGS) analysis of the virus.
Comprehensive schematic case summary of SARS-CoV-2 nasopharyngeal viral load trends by PCR cycles, C-reactive protein and D-dimer values, COVID-19 treatments in pre and post-transplant phases, veno-occlusive disease, and acute graft-versus host disease treatments.
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Antibody and T-cell responses to SARS-CoV-2 antigens. Line plots show: the IgG binding to the spike RBD and NP proteins (A); the Nab ID50 titer (B) expressed as the reciprocal of the serum dilution giving 50% RLU reduction compared to control wells; the absolute counts of total CD3+ T-cells, and the CD4+ and CD8+ subsets expressed as Cells/ml (C); and the magnitude of T-cell responses either polyclonal or specific for Spike and Nucleocapsid proteins expressed as specific Spot Forming Cells (SFC)\400'000 Peripheral Blood Mononuclear Cells (PBMC) (D). Dashed lines: Blue coincides with the date of tixagevimab-cilgavimab administration, Red with graft-versus host disease. Black is the threshold for the positivity of the assay.
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Post tixagevimab-cilgavimab administration, anti-RBD IgG levels against Wuhan and delta increased and followed a similar kinetic over time, while an omicron IgG rise lagged until day +30, which is consistent with the reduced binding by tixagevimab-cilgavimab to this VOC ( Figure 3A ). Neutralizing Ab (NAb) against delta and omicron VOC were at low titers (1/82 and 1/66 respectively) twenty-one days after the positive swab, a time point which was, however, two days after chemotherapy ( Figure 3B ). Both polyclonal ( Figure 3C ) and SARS-CoV-2 specific T-cell reconstitution ( Figure 3D ) were longitudinally evaluated before (-4 days) and at day +30, +60 and +90 after HSCT.