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Immunoglobulin shots a good idea after COVID-19 pneumonia?

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Ask the Doctor Question:

My husband is 64 years old with CLL 11q ATM in complete remission. He received obinutuzumab plus venetoclax over a year ago at MD Anderson. He now is on Day 75 with COVID-19 pneumonia. We are on day 75, with 45 days in the ICU. He is COVID-19 negative on rapid test now. We have no idea of his antibody status. He received Pfizer x2 seven months before getting COVID. He still has infiltrates in his lungs. The oncologists want to give him immunoglobulin shots. Is that a good idea? He is also being treated for an arrhythmia which has induced his lungs filling with fluid, so he is on Lasix right now. The arrhythmia is now gone.

Answer: This is a tough call. If there is a persistent or secondary infection or an auto-immune process going on, then IVIG might be helpful. However, if the lung infiltrates are inflammatory or due to fluid overload, then IVIG would likely not help and could possibly even make things worse. Venetoclax + obinutuzumab deplete the B cells, which in his case can be good and bad, but most folks recover after a year off of treatment. If there is still the concern of persistent SARS-CoV-2 infection, then a monoclonal antibody or convalescent plasma might be an option. Please do not rely on rapid tests in ensuring he is cleared the virus from his system. The PCR test is more sensitive and accurate, especially with lower viral loads/disease burden.

If he is not recovering, hopefully his healthcare team has considered a bronchoscopy so they can perform a biopsy of his lung tissue to test and culture the cells. However, that too has its risks. And due to the possibility of aerosols being spread during the procedure, this might not be a viable option from his healthcare team’s perspective. Please pose all of this to the infectious disease doctors and pulmonologists who are following his case.