Patients with cancer and SARS-CoV-2 infection may be candidates for anti-inflammatory treatments to avoid long-term neurocognitive sequelae. These findings were published in Cancer Cell.
In this study, 18 patients with cancer and coronavirus disease 2019 (COVID-19) admitted to Memorial Sloan Kettering Cancer Center between May and August 2020 with severe neurologic symptoms had their blood and cerebrospinal fluid (CSF) assessed via proteomics analysis.
Most patients (72.2%) had received tumor-directed treatment within 30 days of infection with SARS-CoV-2 and a third (38.9%) had a median lymphocyte count of 0.9 (range, 0.2 to 4.3).
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A median 19 days (range, 0 to 77) after the onset of respiratory symptoms, patients presented with prolonged hypoactive or hyperactive critical care delirium (10 patients), limbic encephalitis (4), refractory headache (2), large territory infarctions (1), and rhombencephalitis (1).
A median 37 days (range, 1 to 117) after neurological symptom onset, analysis of CSF indicated 83% of patients had oligoclonal bands, indicating systemic gamma globulin production. Only 1 patient had evidence of SARS-CoV-2 invasion of the blood-brain barrier.
Despite little evidence of CSF invasion, the patients with SARS-CoV-2 infection had elevated levels of 12 inflammatory mediators, similar to patients with severe immune effector cell-associated neurotoxicity. They also had enrichment of 10 neuronal biomarkers associated with autoimmunity- and virus-induced neurodegeneration.
This study was limited by its low sample size and lack of a control group, therefore it remains unclear whether the protein elevations observed in CSF had a causative link with neurodegeneration.
These findings suggested patients with cancer and severe or prolonged COVID-19 may benefit from anti-inflammatory therapies such that neurodegeneration may be avoided.
Disclosure: Some authors declared affiliations with or received funding from the pharmaceutical industry. Please refer to the original article for a full list of disclosures.
Reference
Remsik J, Wilcox J A, Babady N E, et al. Inflammatory leptomeningeal cytokines mediate COVID-19 neurologic symptoms in cancer patients. Cancer Cell. 2021;39(2):276-283.e3. doi:10.1016/j.ccell.2021.01.007
