A Fatal Breakthrough COVID-19 Case Following Bendamustine-Rituximab Therapy

Int J Infect Dis. 2022 Aug;121:85-88. doi: 10.1016/j.ijid.2022.04.058. Epub 2022 Apr 30.


Although messenger ribonucleic acid vaccines are substantially effective toward SARS-CoV-2 infection, patients with hematologic malignancies are still prone to the virus. Herein, we report a fatal case of breakthrough SARS-CoV-2 Delta variant infection in a patient with mucosa-associated lymphoid tissue lymphoma with remission by bendamustine-rituximab (BR) therapy completed a year ago. The serologic study revealed impaired responsiveness toward vaccines and prolonged high viral load after infection. BR therapy seemingly induced an immune escape. Prevention and treatment strategies for such vulnerable patients should be clarified immediately.

Keywords: Bendamustine-rituximab therapy; Breakthrough; COVID-19; Fatal; Immune escape.

Publication types

  • Case Reports

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Bendamustine Hydrochloride / adverse effects
  • COVID-19 Drug Treatment*
  • Humans
  • Rituximab / adverse effects
  • SARS-CoV-2*


  • Rituximab
  • Bendamustine Hydrochloride

Supplementary concepts

  • SARS-CoV-2 variants