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Invited Commentary
September 10, 2020

Immune Stimulation With Recombinant Human Granulocyte Colony–Stimulating Factor for Coronavirus Disease 2019 (COVID-19)—Beware of Blind Spots

Author Affiliations
  • 1Division of Pulmonary, Allergy, and Critical Care Medicine and Center for Translational Lung Biology, University of Pennsylvania Perelman School of Medicine, Philadelphia
  • 2Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia
  • 3Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia
  • 4Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia
  • 5Parker Institute for Cancer Immunotherapy at the University of Pennsylvania Perelman School of Medicine, Philadelphia
JAMA Intern Med. Published online September 10, 2020. doi:10.1001/jamainternmed.2020.5536

The sobering mortality of coronavirus disease 2019 (COVID-19), the pandemic triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the few proven treatments have stimulated a global effort to rapidly discover and disseminate novel therapies. A noteworthy feature of the disease is the marked degree of lymphopenia in many hospitalized patients with COVID-19 and the association of lymphopenia with adverse outcomes.1

Lymphopenia during infection, and particularly during sepsis, is not unique to COVID-19, nor even to viral illness. In studies of hospitalized patients with positive blood cultures, most had lymphopenia, and persistent lymphopenia was associated with mortality.2 However, during many acute viral respiratory infections, lymphopenia is transient and coincident with peak symptoms but then rapidly resolves as the patient improves.3 The severity, and in some cases persistence, of lymphopenia in patients with COVID-19 is different.3 As patients with sepsis have concomitant inflammation and features of immune exhaustion, an attractive strategy might augment specific immune responses, particularly if it could be predicted which patients would be most likely to benefit.

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