Treatment of immunocompromised COVID-19 patients with convalescent plasma.
Identifieur interne : 000187 ( Main/Exploration ); précédent : 000186; suivant : 000188Treatment of immunocompromised COVID-19 patients with convalescent plasma.
Auteurs : Monica Fung [États-Unis] ; Ashok Nambiar [États-Unis] ; Suchi Pandey [États-Unis] ; J Matthew Aldrich [États-Unis] ; Justin Teraoka [États-Unis] ; Christopher Freise [États-Unis] ; John Roberts [États-Unis] ; Sindhu Chandran [États-Unis] ; Steven R. Hays [États-Unis] ; Emma Bainbridge [États-Unis] ; Catherine Devoe [États-Unis] ; Annelys Roque Gardner [États-Unis] ; Deborah Yokoe [États-Unis] ; Timothy J. Henrich [États-Unis] ; Jennifer M. Babik [États-Unis] ; Peter Chin-Hong [États-Unis]Source :
- Transplant infectious disease : an official journal of the Transplantation Society [ 1399-3062 ] ; 2020.
Abstract
Immunosuppressed patients such as solid organ transplant and hematologic malignancy patients appear to be at increased risk for morbidity and mortality due to coronavirus disease 2019 (COVID-19) caused by SARS coronavirus 2 (SARS-CoV-2). Convalescent plasma, a method of passive immunization that has been applied to prior viral pandemics, holds promise as a potential treatment for COVID-19. Immunocompromised patients may experience more benefit from convalescent plasma given underlying deficits in B and T cell immunity as well as contraindications to antiviral and immunomodulatory therapy. We describe our institutional experience with four immunosuppressed patients (two kidney transplant recipients, one lung transplant recipient, and one chronic myelogenous leukemia patient) treated with COVID-19 convalescent plasma through the Expanded Access Program (NCT04338360). All patients clinically improved after administration (two fully recovered and two discharged to skilled nursing facilities) and none experienced a transfusion reaction. We also report the characteristics of convalescent plasma product from a local blood center including positive SARS-CoV-2 IgG and negative SARS-CoV-2 PCR in all samples tested. This preliminary evidence suggest that convalescent plasma may be safe among immunosuppressed patients with COVID-19 and emphasizes the need for further data on the efficacy of convalescent plasma as either primary or adjunctive therapy for COVID-19.
DOI: 10.1111/tid.13477
PubMed: 32989856
PubMed Central: PMC7537112
Affiliations:
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wicri:level="2"><nlm:affiliation>Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Nambiar, Ashok" sort="Nambiar, Ashok" uniqKey="Nambiar A" first="Ashok" last="Nambiar">Ashok Nambiar</name><affiliation wicri:level="2"><nlm:affiliation>Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Pandey, Suchi" sort="Pandey, Suchi" uniqKey="Pandey S" first="Suchi" last="Pandey">Suchi Pandey</name><affiliation wicri:level="2"><nlm:affiliation>Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Pathology, Stanford University School of Medicine, Palo Alto, CA</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Aldrich, J Matthew" sort="Aldrich, J Matthew" uniqKey="Aldrich J" first="J Matthew" last="Aldrich">J Matthew Aldrich</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, C,, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, C,</wicri:regionArea><wicri:noRegion></wicri:noRegion></affiliation></author><author><name sortKey="Teraoka, Justin" sort="Teraoka, Justin" uniqKey="Teraoka J" first="Justin" last="Teraoka">Justin Teraoka</name><affiliation wicri:level="2"><nlm:affiliation>Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Freise, Christopher" sort="Freise, Christopher" uniqKey="Freise C" first="Christopher" last="Freise">Christopher Freise</name><affiliation wicri:level="2"><nlm:affiliation>Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Roberts, John" sort="Roberts, John" uniqKey="Roberts J" first="John" last="Roberts">John Roberts</name><affiliation wicri:level="2"><nlm:affiliation>Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Chandran, Sindhu" sort="Chandran, Sindhu" uniqKey="Chandran S" first="Sindhu" last="Chandran">Sindhu Chandran</name><affiliation wicri:level="2"><nlm:affiliation>Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, CA</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Hays, Steven R" sort="Hays, Steven R" uniqKey="Hays S" first="Steven R" last="Hays">Steven R. Hays</name><affiliation wicri:level="2"><nlm:affiliation>Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Bainbridge, Emma" sort="Bainbridge, Emma" uniqKey="Bainbridge E" first="Emma" last="Bainbridge">Emma Bainbridge</name><affiliation wicri:level="2"><nlm:affiliation>Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Devoe, Catherine" sort="Devoe, Catherine" uniqKey="Devoe C" first="Catherine" last="Devoe">Catherine Devoe</name><affiliation wicri:level="2"><nlm:affiliation>Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Roque Gardner, Annelys" sort="Roque Gardner, Annelys" uniqKey="Roque Gardner A" first="Annelys" last="Roque Gardner">Annelys Roque Gardner</name><affiliation wicri:level="2"><nlm:affiliation>Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Yokoe, Deborah" sort="Yokoe, Deborah" uniqKey="Yokoe D" first="Deborah" last="Yokoe">Deborah Yokoe</name><affiliation wicri:level="2"><nlm:affiliation>Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Henrich, Timothy J" sort="Henrich, Timothy J" uniqKey="Henrich T" first="Timothy J" last="Henrich">Timothy J. Henrich</name><affiliation wicri:level="2"><nlm:affiliation>Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Babik, Jennifer M" sort="Babik, Jennifer M" uniqKey="Babik J" first="Jennifer M" last="Babik">Jennifer M. Babik</name><affiliation wicri:level="2"><nlm:affiliation>Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Chin Hong, Peter" sort="Chin Hong, Peter" uniqKey="Chin Hong P" first="Peter" last="Chin-Hong">Peter Chin-Hong</name><affiliation wicri:level="2"><nlm:affiliation>Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author></analytic><series><title level="j">Transplant infectious disease : an official journal of the Transplantation Society</title><idno type="eISSN">1399-3062</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Immunosuppressed patients such as solid organ transplant and hematologic malignancy patients appear to be at increased risk for morbidity and mortality due to coronavirus disease 2019 (COVID-19) caused by SARS coronavirus 2 (SARS-CoV-2). Convalescent plasma, a method of passive immunization that has been applied to prior viral pandemics, holds promise as a potential treatment for COVID-19. Immunocompromised patients may experience more benefit from convalescent plasma given underlying deficits in B and T cell immunity as well as contraindications to antiviral and immunomodulatory therapy. We describe our institutional experience with four immunosuppressed patients (two kidney transplant recipients, one lung transplant recipient, and one chronic myelogenous leukemia patient) treated with COVID-19 convalescent plasma through the Expanded Access Program (NCT04338360). All patients clinically improved after administration (two fully recovered and two discharged to skilled nursing facilities) and none experienced a transfusion reaction. We also report the characteristics of convalescent plasma product from a local blood center including positive SARS-CoV-2 IgG and negative SARS-CoV-2 PCR in all samples tested. This preliminary evidence suggest that convalescent plasma may be safe among immunosuppressed patients with COVID-19 and emphasizes the need for further data on the efficacy of convalescent plasma as either primary or adjunctive therapy for COVID-19.</div></front></TEI><pubmed><MedlineCitation Status="Publisher" Owner="NLM"><PMID Version="1">32989856</PMID><DateRevised><Year>2020</Year><Month>11</Month><Day>29</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1399-3062</ISSN><JournalIssue CitedMedium="Internet"><PubDate><Year>2020</Year><Month>Sep</Month><Day>29</Day></PubDate></JournalIssue><Title>Transplant infectious disease : an official journal of the Transplantation Society</Title><ISOAbbreviation>Transpl Infect Dis</ISOAbbreviation></Journal><ArticleTitle>Treatment of immunocompromised COVID-19 patients with convalescent plasma.</ArticleTitle><Pagination><MedlinePgn>e13477</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1111/tid.13477</ELocationID><Abstract><AbstractText>Immunosuppressed patients such as solid organ transplant and hematologic malignancy patients appear to be at increased risk for morbidity and mortality due to coronavirus disease 2019 (COVID-19) caused by SARS coronavirus 2 (SARS-CoV-2). Convalescent plasma, a method of passive immunization that has been applied to prior viral pandemics, holds promise as a potential treatment for COVID-19. Immunocompromised patients may experience more benefit from convalescent plasma given underlying deficits in B and T cell immunity as well as contraindications to antiviral and immunomodulatory therapy. We describe our institutional experience with four immunosuppressed patients (two kidney transplant recipients, one lung transplant recipient, and one chronic myelogenous leukemia patient) treated with COVID-19 convalescent plasma through the Expanded Access Program (NCT04338360). All patients clinically improved after administration (two fully recovered and two discharged to skilled nursing facilities) and none experienced a transfusion reaction. We also report the characteristics of convalescent plasma product from a local blood center including positive SARS-CoV-2 IgG and negative SARS-CoV-2 PCR in all samples tested. This preliminary evidence suggest that convalescent plasma may be safe among immunosuppressed patients with COVID-19 and emphasizes the need for further data on the efficacy of convalescent plasma as either primary or adjunctive therapy for COVID-19.</AbstractText><CopyrightInformation>© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Fung</LastName><ForeName>Monica</ForeName><Initials>M</Initials><Identifier Source="ORCID">https://orcid.org/0000-0002-1725-5259</Identifier><AffiliationInfo><Affiliation>Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Nambiar</LastName><ForeName>Ashok</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Pandey</LastName><ForeName>Suchi</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Aldrich</LastName><ForeName>J Matthew</ForeName><Initials>JM</Initials><AffiliationInfo><Affiliation>Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, C,, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Teraoka</LastName><ForeName>Justin</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Freise</LastName><ForeName>Christopher</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Roberts</LastName><ForeName>John</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Chandran</LastName><ForeName>Sindhu</ForeName><Initials>S</Initials><Identifier Source="ORCID">https://orcid.org/0000-0003-4547-3381</Identifier><AffiliationInfo><Affiliation>Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hays</LastName><ForeName>Steven R</ForeName><Initials>SR</Initials><AffiliationInfo><Affiliation>Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Bainbridge</LastName><ForeName>Emma</ForeName><Initials>E</Initials><AffiliationInfo><Affiliation>Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>DeVoe</LastName><ForeName>Catherine</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Roque Gardner</LastName><ForeName>Annelys</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Yokoe</LastName><ForeName>Deborah</ForeName><Initials>D</Initials><AffiliationInfo><Affiliation>Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Henrich</LastName><ForeName>Timothy J</ForeName><Initials>TJ</Initials><Identifier Source="ORCID">https://orcid.org/0000-0002-6684-0622</Identifier><AffiliationInfo><Affiliation>Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Babik</LastName><ForeName>Jennifer M</ForeName><Initials>JM</Initials><Identifier Source="ORCID">https://orcid.org/0000-0001-6914-4959</Identifier><AffiliationInfo><Affiliation>Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Chin-Hong</LastName><ForeName>Peter</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Division of Infectious Disease, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><GrantList CompleteYN="Y"><Grant><GrantID>T32 AI060530</GrantID><Acronym>AI</Acronym><Agency>NIAID NIH HHS</Agency><Country>United States</Country></Grant><Grant><GrantID>75A50120C00096</GrantID><Agency>US Department of Health and Human Services</Agency><Country></Country></Grant></GrantList><PublicationTypeList><PublicationType UI="D002363">Case Reports</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>09</Month><Day>29</Day></ArticleDate></Article><MedlineJournalInfo><Country>Denmark</Country><MedlineTA>Transpl Infect Dis</MedlineTA><NlmUniqueID>100883688</NlmUniqueID><ISSNLinking>1398-2273</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="Y">COVID-19</Keyword><Keyword MajorTopicYN="Y">convalescent plasma</Keyword><Keyword MajorTopicYN="Y">immunocompromised</Keyword><Keyword MajorTopicYN="Y">transplant</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2020</Year><Month>09</Month><Day>01</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2020</Year><Month>09</Month><Day>06</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2020</Year><Month>9</Month><Day>30</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>9</Month><Day>30</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>9</Month><Day>29</Day><Hour>5</Hour><Minute>40</Minute></PubMedPubDate></History><PublicationStatus>aheadofprint</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">32989856</ArticleId><ArticleId IdType="doi">10.1111/tid.13477</ArticleId><ArticleId IdType="pmc">PMC7537112</ArticleId></ArticleIdList><ReferenceList><Title>REFERENCES</Title><Reference><Citation>World Health Organization. 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Babik</name><name sortKey="Bainbridge, Emma" sort="Bainbridge, Emma" uniqKey="Bainbridge E" first="Emma" last="Bainbridge">Emma Bainbridge</name><name sortKey="Chandran, Sindhu" sort="Chandran, Sindhu" uniqKey="Chandran S" first="Sindhu" last="Chandran">Sindhu Chandran</name><name sortKey="Chin Hong, Peter" sort="Chin Hong, Peter" uniqKey="Chin Hong P" first="Peter" last="Chin-Hong">Peter Chin-Hong</name><name sortKey="Devoe, Catherine" sort="Devoe, Catherine" uniqKey="Devoe C" first="Catherine" last="Devoe">Catherine Devoe</name><name sortKey="Freise, Christopher" sort="Freise, Christopher" uniqKey="Freise C" first="Christopher" last="Freise">Christopher Freise</name><name sortKey="Hays, Steven R" sort="Hays, Steven R" uniqKey="Hays S" first="Steven R" last="Hays">Steven R. Hays</name><name sortKey="Henrich, Timothy J" sort="Henrich, Timothy J" uniqKey="Henrich T" first="Timothy J" last="Henrich">Timothy J. Henrich</name><name sortKey="Nambiar, Ashok" sort="Nambiar, Ashok" uniqKey="Nambiar A" first="Ashok" last="Nambiar">Ashok Nambiar</name><name sortKey="Pandey, Suchi" sort="Pandey, Suchi" uniqKey="Pandey S" first="Suchi" last="Pandey">Suchi Pandey</name><name sortKey="Roberts, John" sort="Roberts, John" uniqKey="Roberts J" first="John" last="Roberts">John Roberts</name><name sortKey="Roque Gardner, Annelys" sort="Roque Gardner, Annelys" uniqKey="Roque Gardner A" first="Annelys" last="Roque Gardner">Annelys Roque Gardner</name><name sortKey="Teraoka, Justin" sort="Teraoka, Justin" uniqKey="Teraoka J" first="Justin" last="Teraoka">Justin Teraoka</name><name sortKey="Yokoe, Deborah" sort="Yokoe, Deborah" uniqKey="Yokoe D" first="Deborah" last="Yokoe">Deborah Yokoe</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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