Abstract
AB013. Occurrence and severity of COVID-19 in patients affected by thymic epithelial tumors with or without Good’s syndrome: a single centre experience
Erica Pietroluongo1#, Pietro De Placido1#, Marianna Tortora2, Mariarosaria Saponaro1, Rocco Morra1, Giuseppe Neola1, Angela Grieco1, Anna Piscopo1, Annarita Peddio1, Antonella Lucia Marretta1, Roberto Buonaiuto1, Aldo Caltavituro1, Giacomo Mirello1, Rossana Di Rienzo1, Margherita Tafuro1, Monica Gelzo3,4, Gustavo Cernera3,4, Margaret Ottaviano5, Giuseppe Castaldo3,4, Pietro Formisano6, Sabino De Placido1,2, Giovannella Palmieri2, Mario Giuliano1,2
1Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy;
2Rare Tumors Coordinating Center of Campania Region (CRCTR), Naples, Italy;
3CEINGE, Biotecnologie Avanzate, Naples, Italy,
4Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy;
5Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Italian National Cancer Institute-IRCCS Pascale Foundation, Naples, Italy;
6Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
#These authors contributed equally to this work as co-first authors.
Correspondence to: Mario Giuliano, MD, PhD. Professor of Medical Oncology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via S. Pansini, 5, Napoli 80131, Italy. Email: mario.giuliano@unina.it.
Background: Good’s syndrome (GS) is a rare immunodeficiency (6–11%) associated with thymic epithelial tumors (TETs), defined by the presence of recurrent infections due to encapsulated bacteria, fungi and viruses, hypogammaglobulinemia, low or absent B cells, abnormal CD4/CD8 T cell ratio, CD4 T cell lymphopenia and impaired T cell mitogenic responses. Currently, there are no data on occurrence and severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in particularly frail patients, such as those with TET and GS.
Methods: We retrospectively collected data on SARS-CoV-2 infection occurrence and severity of TET patients during corona virus disease 2019 (COVID-19) pandemic (from March 2020 to April 2023), who were referred to the Regional Coordination Center for Rare Tumors (CRCTR) of Campania Region (University Hospital of Naples Federico II). Clinical severity of COVID-19 was evaluated according to the National Institute of Health (NIH) classification scale.
Results: A total of 47 TET patients were included in the analysis. Thirty-eight (81.0%) had thymoma, 8 thymic carcinoma (17.0%), and (2.0%) neuroendocrine tumor; 29 (61.7%) suffered from GS. All patients received a full cycle of mRNA vaccine. Overall, 31 (66.0%) patients experienced acute COVID-19 during the observation period. No statistically significant correlation was found between GS and occurrence of SARS-CoV-2 infection (P=0.5406). The median NIH score of COVID-19 severity was 2 in the overall population; no patient died. Among the 18 patients with GS, 10 (55.6%) had an NIH score of 2, 4 (22.2%) had an NIH score of 3, 1 (5.6%) had an NIH score of 4, and 3 (16.6%) had an NIH score 5, and thus required hospitalization. On the other hand, among the 13 patients without GS, 12 (92.3%) had an NIH score of 2 and 1 (7.7%) an NIH score of 3; no patient required either oxygen support or hospitalization.
Conclusions: We observed an overall higher severity of acute COVID-19 among TET patients with GS as compared to those without GS. Despite the small sample size, our findings suggest the need of dedicated multidisciplinary management of COVID-19, as well as other infectious diseases in particularly frail patients, such as those with TET and GS.
Keywords: Thymic epithelial tumors (TETs); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); Good’s syndrome (GS)
Acknowledgments
The authors would like to acknowledge the European Reference Network (ERN-EURACAN) as a powerful resource for transnational collaboration in rare cancers. Clinical research activities were performed by E.P. and P.D.P. within the PhD Program in Advanced Biomedical and Surgical Therapies at Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy. Laboratory research activities were performed by M Gelzo and G Cernera at CEINGE-advanced biotechnologies. P.D.P. is supported by an American-Italian Cancer Foundation Post-Doctoral Research Fellowship, year 2023–2024.
Funding: None.
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://med.amegroups.com/article/view/10.21037/med-23-ab013/coif). P.D.P. is supported by an American-Italian Cancer Foundation Post-Doctoral Research Fellowship, year 2023–2024. P.D.P. also reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Lilly, Gilead, MSD, Roche, Exact Sciences, Novartis, and support for attending meetings or travel from Gilead, Lilly, Istituto Gentili, MSD. M.O. reports speakers fee and travel accommodation from MSD, Novartis, BMS, Sanofi Regeneron, Amgen. SDP reports consulting fees from Astrazeneca, Novartis, Pfizer, Roche, Daiichi Sankyo, Lilly, Clovis, Seagen, GSK, MSD, and payment or honoraria for lectures, presentations, speaker’s bureaus, manuscript writing or educational events from Astrazeneca, Novartis, Pfizer, Roche, Daiichi Sankyo, Lilly, Clovis, Seagen, GSK, MSD. M Giuliano reports consulting fees from Lilly, Celgene, Novartis, Pfizer, and payment or honoraria for lectures, presentations, speaker’s bureaus, manuscript writing or educational events from Lilly, Celgene, Novartis, Pfizer, Istituto Gentili, Eisai Europe Ltd, Roche. M Giuliano also reports support for attending meetings and/or travel from Novartis, Pfizer, Roche. The other authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved by the Ethical Committee of University of Naples Federico II protocol # 201/20 and individual consent for this retrospective analysis was waived.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
doi: 10.21037/med-23-ab013
Cite this abstract as: Pietroluongo E, De Placido P, Tortora M, Saponaro M, Morra R, Neola G, Grieco A, Piscopo A, Peddio A, Marretta AL, Buonaiuto R, Caltavituro A, Mirello G, Di Rienzo R, Tafuro M, Gelzo M, Cernera G, Ottaviano M, Castaldo G, Formisano P, De Placido S, Palmieri G, Giuliano M. AB013. Occurrence and severity of COVID-19 in patients affected by thymic epithelial tumors with or without Good’s syndrome: a single centre experience. Mediastinum 2023;7:AB013.
