THE IMPORTANCE OF B CELLS IN OVERCOMING COVID-19 INFECTION IN COMMON VARIABLE IMMUNODEFICIENCY PATIENTS.

INTRODUCTION: COVID-19 patients exhibit a hyper-inflammatory state. CVID patients have impaired immunoglobulin production and a wide variability in COVID-19 disease course. METHODS: We compared hospitalized patients with CVID and COVID-19 disease (CVID+ COVID-19+) to patients with CVID and another pneumonia (CVID+ COVID-19–) and COVID-19 patients without CVID (CVID– COVID-19+) between March 2020 and September 2021. RESULTS: 4 female CVID+ COVID-19+ patients received regularly scheduled intravenous immunoglobulin (IVIG) therapy. 1 of 4 died with comorbidities: systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and vasculitis treated with hydroxychloroquine, leflunomide, and rituximab. 1 of 6 CVID+ COVID-19– patients died, and was administrated omalizumab and prednisone. 3 of 34 CVID– COVID-19+ patients died; one with significant lung pathology, on home oxygen, and another had uncontrolled type II diabetes, obesity, Behcet syndrome, SLE and RA treated with apremilast, hydroxychloroquine, and rituximab. Mean BMI was 32.1 ± 1.5 for CVID+ COVID-19+, 30.5 ± 5.3 for CVID+ COVID-19– and 37.8 ± 1.5 for CVID– COVID-19+ cases. The number of hospitalizations and comorbidities were greater for COVID-19– cases. Admission LDH was greater in expired cases. Serum IgG for CVID+ patients that died were 852 and 808 mg/dL. CONCLUSION: Despite regular IVIG therapy, adequate serum IgG, and convalescent plasma early during hospitalization, the CVID+ COVID-19+ patient that died received anti-CD20, B-cell depleting therapy with rituximab. In addition to immunoglobulin production, B-cells may have a different role in fighting acute COVID-19 infection. B-cell depletion therapy may predispose to worse outcomes and inflammatory markers may aid in prognostication.