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Decreased platelet count and chronic COVID-19 pneumonia: case report An approximately 59-year-old woman developed a decreased platelet count during treatment with obinutuzumab for follicular lymphoma (FL). Additionally, she also developed chronic COVID-19 pneumonia during treatment with obinutuzumab and rituximab for FL [not all dosages and outcomes stated; routes and durations of treatments to reactions onsets not stated]. The woman was admitted to the current hospital owing to COVID-19 pneumonia in April 2020. It was reported that, in September 2018, she had been diagnosed with concurrent uterine cancer and FL of the small intestine, multiple lymph nodes, and bone marrow. Therefore, she had undergone ovariohysterectomy and resection of the FL lesion of the small intestine, and received G-CHOP therapy comprised of obinutuzumab, cyclophosphamide, doxorubicin, vincristine, and prednisone. However, she developed decreased platelet counts, which was thought to be a side effect of obinutuzumab. Therefore, the course 2 of CHOP and 4th administration of obinutuzumab, the woman’s chemotherapy was discontinued. Eventually, a gradual increase in platelet counts was noted and approximately 6 months later her platelet count return to normal. In view of long-term interruption and complete metabolic response, she was initiated on maintenance therapy with rituximab bimonthly in September 2019. She had been received a total of 3 rituximab therapy doses before the development of COVID-19 pneumonia. At the current admission for COVID-19 pneumonia, she received Ig replacement therapy and IgG levels were maintained. From day 1 of hospitalisation, her COVID-19 pneumonia was treated according to the protocols. On day 16 of hospitalisation, chest radiographs confirmed the resolution of COVID-19 pneumonia and improvement in CRP level and fever were noted. Around day 22 of admission, a new lung lesion was observed in the right upper lung region, which was migrated to the right middle lung region on day 28. Around day 34, she again developed fever, cough, and CRP elevation. Further investigations along follow-up nasopharyngeal SARS-CoV-2 tests were found to be negative. However, on day 46, the SARS-CoV-2 test on bronchoalveolar lavage (BAL) tested positive. The subsequent immunoassay did not show anti-SARS-CoV-2 antibodies. Meanwhile, her fever and cough improved with a decrease in CRP level. On day 59, a subsequent CT scan showed new lesions in the right lower lung region. In view of her treatment therapy, the development of chronic COVID-19 pneumonia was thought to be obinutuzumab and rituximab therapy. She was observed under careful surveillance. Yasuda H, et al. Persistent COVID-19 Pneumonia and Failure to Develop Anti-SARS-CoV-2 Antibodies During Rituximab Maintenance Therapy for Follicular Lymphoma. 803520705 Clinical Lymphoma, Myeloma & Leukemia 20: 774-776, No. 11, Nov 2020. Available from: URL: http://doi.org/10.1016/j.clml.2020.08.017

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