Comprehensive Treatment of Hematological Patients with SARS-CoV-2 Infection Including Anti-SARS-CoV-2 Monoclonal Antibodies: A Single-Center Experience Case Series

Abstract

Patients with hematologic malignancies are at high risk of exacerbated condition and higher mortality from coronavirus disease 2019 (COVID-19). Bamlanivimab, casirivimab/imdevimab combination, and sotrovimab are monoclonal antibodies (mABs) that can reduce the risk of COVID-19-related hospitalization. Clinical effectiveness of bamlanivimab and casirivimab/imdevimab combination has been shown for the Delta variant (B.1.617.2), but the effectiveness of the latter treatment against the Omicron variant (B.1.1.529) has been suggested to be reduced. However, the tolerability and clinical usage of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific mABs in patients with hematologic malignancies are less specified. We present a retrospective case series analysis of all SARS-CoV-2-infected patients with hematologic malignancies who received SARS-CoV-2-specific mABs at our facility between February and mid-December 2021. A total of 13 COVID-19 patients (pts) with at least one malignant hematologic diagnosis received SARS-CoV-2-specific mABs at our facility, with 3 pts receiving bamlanivimab and 10 pts receiving casirivimab/imdevimab combination. We observed SARS-CoV-2 clearance in five cases. Furthermore, we observed a reduction in the necessity for oxygen supplementation in five cases where the application was administered off-label. To the best of our knowledge, we present the largest collection of anecdotal cases of SARS-CoV-2-specific monoclonal antibody use in patients with hematological malignancies. Potential benefit of mABs may be reduced duration and/or clearance of persistent SARS-CoV-2 infection.

Efficacy of COVID-19 Booster Vaccines in Patients with Hematologic Malignancies: Experiences in a Real-World Scenario

“…According to our experience with COVID-19 vaccines and SARS-CoV-2 infections [ 3 , 34 , 60 ], we also provide a risk-adapted and efficient guidance for the management of weak and failed responses to COVID-19 prime-boost vaccinations. We recommended an early application of a second booster shot (as early as 3 months after the first one) for patients with minor antibody titer levels or non-responders in our academic cancer center.…”

“…The worldwide spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) since 2019 resulted in the ongoing pandemic of coronavirus disease 2019 (COVID-19), which has affected all fields of healthcare systems dramatically. Patients with hematologic malignancies are at a particularly high risk of developing severe COVID-19 and its resultant mortality due to the immunosuppressive effects of anti-cancer therapies and the underlying malignant disease itself [ 1 , 2 , 3 , 4 , 5 , 6 ]. The introduction of vector- and mRNA-based COVID-19 vaccines has become of particular importance in fighting the COVID-19 pandemic, resulting in up to 90–100% efficacy in the general population [ 7 , 8 , 9 , 10 , 11 , 12 ].…”

Clinical Post-SARS-CoV-2 Infection Scenarios in Vaccinated and Non-Vaccinated Cancer Patients in Three German Cancer Centers: A Retrospective Analysis

“…In parallel to the development and introduction of vaccines, significant progress has been achieved in the field of specific COVID-19 therapy [ 14 , 15 , 16 ]. Recently, we have demonstrated SARS-CoV-2 clearance and reduction for oxygen supplementation in high-risk patients with hematologic malignancies following the application of mABs neutralizing SARS-CoV-2 [ 23 ]. Within our study, the proportion of patients that received neutralizing mABs binding to the SARS-CoV-2 spike protein was three-fold lower among non-vaccinated cases in comparison to vaccinated ones, which could also have had an impact on COVID-19 course within both groups.…”

Broadly Neutralizing Antibodies to SARS-CoV-2 Provide Novel Insights Into the Neutralization of Variants and Other Human Coronaviruses

“…The spike protein is therefore a primary target of neutralizing antibodies (nAbs) towards COVID-19 therapy ( Corti et al., 2021 ; Kumar et al., 2021 ; Kyriakidis et al., 2021 ). SARS-CoV-2 nAbs provide an attractive alternate strategy for immediate therapy or prophylaxis to COVID-19, especially in immunocompromised patients, unvaccinated, vaccine-hesitant patients, and also in situations where vaccines are less effective against a particular variant ( Siemieniuk et al., 2021 ; Boeckel et al., 2022 ; Gentile and Moriello, 2022 ; Gupta et al., 2022 ). Therapeutic nAbs primarily function by blocking the entry of the virus into the host cells, and perhaps also facilitate the elimination of infected host cells by Fc-mediated effector functions and reducing viral load in vivo ( Kumar et al., 2021 ).…”